Sliwa, James A.

Abstract Background Physiatry is a specialty with high rates of burnout. Although organizational strategies to combat burnout are key, it is also important to understand strategies that individual physiatrists can use to address burnout. Objective To identify changes that resulted in improvement of occupational well‐being of physiatrists over a 6‐ to 9‐month period. Design We employed two quantitative surveys spaced 6 to 9 months apart to identify physiatrists who experienced meaningful improvement in occupational burnout and/or professional fulfillment between the two survey timepoints. These physiatrists were subsequently recruited to participate in a qualitative study using semi‐structured interviews to identify changes that respondents felt contributed to improvements in burnout and professional fulfillment. Setting Online surveys and interviews. Participants Physiatrists in the American Academy of Physical Medicine and Rehabilitation (AAPM&R) Membership Masterfile. Main Outcome Measure Burnout and professional fulfillment were assessed using the Stanford Professional Fulfillment Index. Results One hundred twelve physiatrists responded to the baseline and follow‐up surveys. Of these, 35 were eligible for interviews based on improvements in the Stanford Professional Fulfillment Index, and 23 (64%) agreed to participate. Themes from the qualitative interviews highlighted the importance of personal lifestyle choices, approaches to improve professional satisfaction, and strategies to foster work‐life harmony. Personal lifestyle strategies included investing in wellness and mental health. Efforts to improve professional satisfaction included decreasing work intensity, prioritizing meaningful aspects of work, and building relationships with colleagues. Fostering work‐life harmony also included making trade‐offs in both domains, setting boundaries at work, setting expectations at home, and overcoming personal challenges. Conclusion Our findings illustrate that, in addition to organizational strategies demonstrated to be effective, there are actions that individual physiatrists can take to recover from burnout and foster professional fulfillment.

AbstractIntroductionMultiple national studies suggest that, among physicians, physiatrists are at increased risk for occupational burnout.ObjectiveTo identify characteristics of the work environment associated with professional fulfillment and burnout among U.S. physiatrists.DesignBetween May and December 2021, a mixed qualitative and quantitative approach was used to identify factors contributing to professional fulfillment and burnout in physiatrists.SettingOnline interviews, focus groups, and survey.ParticipantsPhysiatrists in the AAPM&R Membership Masterfile.Main Outcome MeasuresBurnout and professional fulfillment assessed using the Stanford Professional Fulfillment Index.ResultsIndividual interviews with 21 physiatrists were conducted to identify domains that contributed to professional fulfillment followed by focus groups for further definition. Based on themes identified, scales were identified or developed to evaluate: control over schedule (6 items; Cronbach's alpha = 0.86); integration of physiatry into patient care (3 items; Cronbach's alpha = 0.71); personal‐organizational values alignment (3 items; Cronbach's alpha = 0.90); meaningfulness of physiatrist clinical work (6 items; Cronbach's alpha = 0.90); teamwork and collaboration (3 items; Cronbach's alpha = 0.89). Of 5760 physiatrists contacted in the subsequent national survey, 882 (15.4%) returned surveys (median age 52 years; 46.1% women). Overall, 42.6% (336 of 788) experienced burnout and 30.6% (244 of 798) had high levels of professional fulfillment. In multivariable analysis, each one‐point improvement in control over schedule (odds ratio [OR] = 1.96; 95% confidence interval [CI] = 1.45–2.69), integration of physiatry into patient care (OR = 1.77; 95% CI = 1.32–2.38), personal‐organizational values alignment (OR = 1.92; 95% CI = 1.48–2.52), meaningfulness of physiatrist clinical work (OR = 2.79; 95% CI = 1.71–4.71) and teamwork and collaboration score (OR = 2.11; 95% CI = 1.48–3.03) was independently associated with higher likelihood of professional fulfillment.ConclusionsControl over schedule, optimal integration of physiatry into clinical care, personal‐organizational values alignment, teamwork, and meaningfulness of physiatrist clinical work are strong and independent drivers of occupational well‐being in U.S. physiatrists. Variation in these domains by practice setting and subspecialty suggests tailored approaches are needed to promote professional fulfillment and reduce burnout among U.S. physiatrists.

Background Physician burnout is of growing concern. Burnout among physical medicine and rehabilitation (PM&R) physicians has shown a significant increase, positioning PM&R as one of the most “burned out” of specialties. Little has been written about potential factors contributing to physiatrist burnout or potential interventions. Objective To determine the prevalence of burnout among physiatrists and identify risk factors for burnout and potential strategies to decrease burnout among physiatrists. Design Prospective cross‐sectional survey. Setting National survey of board certified physiatrists. Participants: One thousand five hundred thirty‐six physiatrists certified by the American Board of PM&R. Outcome The Mini‐Z Burnout Survey, 1 question from the Maslach Burnout Scale on callousness toward patients, and several potential drivers of burnout. The probability of burnout, identified by question 3 on the Mini‐Z, was the dependent variable. Other questions on the Mini‐Z were explored as independent variables using logistic regression. Results Seven hundred seventy physiatrists (50.7%) fulfilled the definition of burnout. Only 38% of physiatrists reported not becoming more callous toward patients. The top 3 causes of burnout identified by physiatrists were increasing regulatory demands, workload and job demands, and practice inefficiency and lack of resources. Higher burnout rate was associated with high levels of job stress and working more hours per week. Lower burnout rates were associated with higher job satisfaction, control over workload, professional values aligned with those of department leaders, and sufficient time for documentation. There was no significant association between burnout and sex, years in practice, practice focus, or practice area. Conclusion Burnout is a significant problem among PM&R physicians and is pervasive throughout the specialty. Opportunities exist to address major contributing drivers of burnout relating to practice patterns and efficiency of care within PM&R. These opportunities are, to varying degrees, under the control of hospital leaders, practice administrators, and practitioners.

BackgroundOsteopathic physicians (DOs) represent over 30% of residents in allopathic (MD) Accreditation Council for Graduate Medical Education (ACGME) accredited physical medicine and rehabilitation (PM&R) training programs. However, some have questioned the quality of osteopathic medical school training and the graduates of osteopathic medical schools. The performance of osteopathic physicians in allopathic PM&R training programs has not been assessed.ObjectiveTo compare allopathic (MD) and osteopathic (DO) physician performance on American Board of Physical Medicine and Rehabilitation (ABPMR) initial certifying examinations.DesignRetrospective cross‐sectional study.SettingBoard‐eligible PM&R physicians.ParticipantsMDs and DOs who completed an allopathic ACGME‐accredited PM&R residency training program.MethodsMD and DO pass rates and mean scaled scores on the ABPMR initial certifying examinations were compared. MD versus DO degrees and training program 6 years aggregate board pass rates were independent variables.InterventionsNot applicable.Main Outcome MeasureMD and DO pass rates and mean scaled scores on the ABPMR initial certifying examinations.ResultsOf the 2187 physicians who were first‐time ABPMR initial certifying examination takers, there were 1596 MDs (73%) and 591 DOs (27%). No statistically significant difference was found in pass rates between MDs and DOs on Part I (94.9% vs. 93.9%, P = .35) or Part II (87.8% vs. 88%, P = .83) of the ABPMR certifying examination. Analysis of mean scaled scores demonstrated higher MD scores on both Part I ( 526, SD = 31, vs. 516, SD = 67, P = .002) and Part II ( 6.73, SD = .83 vs. 6.62, SD = .77, P = .005), significant only in programs with a 90%‐100% pass rate. These differences, however, were of very small magnitude and likely not meaningful from a clinical or educational perspective.ConclusionThis study did not find meaningful differences in performance on the ABPMR certifying examinations between MDs and DOs.

BackgroundCertification by the American Board of Physical Medicine and Rehabilitation (ABPMR) requires passing both a written multiple choice examination (Part I) and an oral examination (Part II), but it has been unclear whether the two examinations measure the same or different dimensions of knowledge.ObjectiveTo evaluate the concordance between the Part I and Part II examinations for ABPMR initial certification with regard to candidate performance on the examinations and their subsets. Our question is whether the Part II examination provides additional assessment of a candidate beyond what Part I provides.DesignRetrospective psychometric evaluation of deidentified board examination scores.SettingABPMR database of Part I and Part II examination scores.ParticipantsCandidates for the ABPMR Part I and Part II examinations after 2005, with a more detailed analysis of candidates for the Part I examination from 2014 to 2016. Examination scores of candidates who took the Part II examination both before and after the examination was standardized in 2005 were also used for an additional analysis.MethodsCorrelations, simple linear regressions, and principal components analysis.Main Outcome MeasurementsCorrelation coefficients, variance analysis, and unexplained variance in the principal components analysis.ResultsThere is a weak to moderate correlation between performance on the Part I and Part II examinations: r = 0.33, P < .001. There is an additional dimension of assessment that is demonstrated on the Part II examination, with this being primarily in the domains of systems‐based practice and interpersonal communication skills.ConclusionThe Part I and Part II examinations, although with some overlap, contribute different and meaningful components to the overall evaluation of candidates for board certification in PM&R.Level of EvidenceIII.