Clark, Gary S.

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.