Wang, Hanhan

Abstract Purpose This study evaluates associations with suicidal ideation (SI) of impact of work on personal relationships (IWPR), self-valuation (SV), and imposter phenomenon and compares the SI point prevalence in physicians vs other workers. Method This study used American Medical Association Physician Professional Data to sample US physicians across different specialties between November 2020-March 2021. Of 7360 survey respondents, 6497 (88.3%) completed the SI question. A probability-based sample included 2508 nonphysician individuals from the US population employed at the time of survey administration, with 2501 workers (99.7%) completing the SI item. Logistic regression was used to evaluate the associations of occupational distress factors, including IWPR, SV, imposter phenomenon, and other factors, with SI before and after adjusting for depression and compare the risk of SI among physicians with other US workers. Results The study included 6497 physicians and 2501 workers in other fields. Adjusting for sex, age, relationship status, parenting status, and depression, each 1-point higher IWPR score (range, 0-10) was associated with 10% increased SI odds (odds ratio [OR], 1.10; 95% confidence interval [CI], 1.05-1.15). Adjusting for the same variables, each 1-point higher SV score (range, 0-10) was associated with 10% lower SI odds (OR, 0.90; 95% CI, 0.85-0.95). The association between imposter phenomenon scores (range, 4-20) and SI was not statistically significant (OR, 1.03; 95% CI, 0.99-1.08). The unadjusted 1-year SI point prevalence was 6.6% (95% CI, 6.0%-7.4%) in physicians vs 5.6% (95% CI, 4.7%-6.6%) among workers in other fields (P = .09). In a multivariable model, workers in other fields with a bachelor’s or master’s degree had lower SI odds compared with physicians (OR, 0.64; 95% CI, 0.46-0.87). Conclusions IWPR and low SV are associated with SI among physicians, independent of depression. Development and evaluation of interventions designed to mitigate these factors in physicians may be warranted.

Abstract Purpose To evaluate the correlation between occupational burnout and depression, frequency with which they coexist, how often 1 condition may be present in the absence of the other, and their association with suicidal ideation. Method The authors conducted a secondary analysis of cross-sectional national surveys of practicing U.S. physicians (conducted October 19, 2023, to March 3, 2024) and residents/fellows (“trainees”; conducted November 30, 2023, to January 2, 2024). They measured correlation between emotional exhaustion (EE) and depersonalization (DP) scores using the Maslach Burnout Inventory and depression T-scores using the National Institutes of Health Patient Reported Outcomes Measurement Information System Depression scale. Results A total of 5993 practicing physicians and 2676 trainees were included in the analysis. The pooled R2 value between EE and depression scores for physicians and trainees was 0.42 (P < .001) and between DP and depression scores was 0.28 (P < .001). Among the 4087 practicing physicians with normal depression scores, 1201 (29.4%) had high EE and/or high DP. Among the 1601 trainees with normal depression scores, 485 (30.3%) had high EE and/or high DP. On multivariable logistic regression adjusting for age, gender, relationship status, and work hours, each 1-point increase in depression T-score was associated with 15% higher odds of suicidal ideation among practicing physicians (OR 1.15; 95% CI, 1.13–1.17; P < .001) and trainees (OR 1.15, 95% CI, 1.13–1.17; P < .001). No statistically significant association between EE or DP scores and suicidal ideation was observed. Conclusions Occupational burnout and depression are correlated but distinct constructs with distinct outcomes. Less than half the variation in burnout is explained by depression (and vice versa). Population health approaches to improve physician well-being should address both conditions. Organizational efforts should go beyond providing support for individuals experiencing distress and also address the work environment factors that contribute to it.

Importance Exploring the relationship between moral distress and occupational burnout is necessary to understand the association between these constructs. Objective To evaluate moral distress among physicians and US workers, and to explore the association of moral distress with burnout, intent to leave (ITL) current position, and intent to reduce clinical work hours (ITR). Design, Setting, and Participants This cross-sectional national survey study included physicians from all specialties and a probability-based sample of employed nonphysicians. Participants were aged 29 to 65 years. Data were collected between October 19, 2023, and March 5, 2024. Data were analyzed from June 30 to October 20, 2025. Main Outcomes and Measures Moral distress was measured using the Moral Distress Thermometer (MDT, range 0-10), with a high level of moral distress defined by a score of 4 or higher. Burnout was measured using the complete Maslach Burnout Inventory (MBI). Professional fulfillment was measured using the Stanford Professional Fulfillment Index. ITL and ITR were measured using a standardized item with response options of none, slight, moderate, likely, and definitely. Results This survey study included 5741 physicians and 3501 nonphysician US workers. The median (IQR) age of physicians was 53 (44-62), and included 3262 men (58.0%), 2255 women (40.1%), and 107 individuals who responded other (1.9%). The mean (SD) moral distress score for physicians was 3.29 (2.81), with 2243 (39.1%) reporting a high level of moral distress (4 or more considered high). On multivariable analysis, women physicians had higher odds of moral distress (OR, 1.29; 95% CI, 1.12-1.48). Compared with internal medicine subspecialists, emergency medicine physicians (OR, 3.16; 95% CI, 2.27-4.4) and general internal medicine physicians (OR, 1.92; 95% CI, 1.42-2.59) were more likely to report high levels of moral distress. Mean emotional exhaustion and depersonalization scores, as well as the proportion of physicians with burnout, were higher with each 1-point increase in moral distress score. The overall correlation between the emotional exhaustion score and moral distress score was R = 0.55 ( P < .001) while the correlation between the depersonalization score and moral distress score was R = 0.50 ( P < .001). Additionally, 1068 of 3477 physicians (30.7%) with a moral distress score less than 4 had burnout symptoms compared with 1675 of 2231 physicians (75.1%) with scores of 4 or more ( P < .001). The prevalence of ITL and ITR was higher for each 1-point increase in moral distress score. For example, 619 of 3404 physicians (18.2%) with low moral distress reported ITL within 24 months compared with 748 of 2171 (34.5%) among those with high moral distress ( P < .001). Compared with other US workers, physicians had markedly higher odds of experiencing moral distress (OR, 4.40; 95% CI, 3.84-5.06). Conclusion and Relevance In this survey study, moral distress was common among physicians and experienced at higher rates than the general US working population. Understanding the differences between moral distress and burnout may allow organizations to more effectively implement interventions to address both concerns among clinicians.

This survey study examines whether disparities in risk of burnout and low satisfaction with work-life integration by sex are similar among physicians compared with US workers in other fields.

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.

ImportanceVacation has been shown to be an important restorative activity in the general population; less is known about physicians’ vacation behaviors and their association with burnout and professional fulfillment.ObjectiveTo examine the number of vacation days taken per year and the magnitude of physician work while on vacation and their association with physician burnout and professional fulfillment, by individual and organizational characteristics.Design, Setting, and ParticipantsThis cross-sectional survey of US physicians was conducted between November 20, 2020, and March 23, 2021. Data analysis was performed from March to July 2023.Main Outcomes and MeasuresBurnout was measured using the Maslach Burnout Index, and professional fulfillment was measured using the Stanford Professional Fulfillment Index. Number of vacation days taken in the last year, time spent working on patient care and other professional tasks per typical vacation day (ie, work on vacation), electronic health record (EHR) inbox coverage while on vacation, barriers to taking vacation, and standard demographics were collected.ResultsAmong 3024 respondents, 1790 of 3004 (59.6%), took 15 or fewer days of vacation in the last year, with 597 of 3004 (19.9%) taking 5 or fewer days. The majority, 2104 respondents (70.4%), performed patient care–related tasks on vacation, with 988 of 2988 (33.1%) working 30 minutes or more on a typical vacation day. Less than one-half of physicians (1468 of 2991 physicians [49.1%]) reported having full EHR inbox coverage while on vacation. On multivariable analysis adjusting for personal and professional factors, concern about finding someone to cover clinical responsibilities (odds ratio [OR], 0.48 [95% CI, 0.35-0.65] for quite a bit; OR, 0.30 [95% CI, 0.21-0.43] for very much) and financial concerns (OR, 0.49 [95% CI, 0.36-0.66] for quite a bit; OR, 0.38 [95% CI, 0.27-0.54] for very much) were associated with decreased likelihood of taking more than 3 weeks of vacation per year. Taking more than 3 weeks of vacation per year (OR, 0.66 [95% CI, 0.45-0.98] for 16-20 days; OR, 0.59 [95% CI, 0.40-0.86] for >20 days vs none) and having full EHR inbox coverage while on vacation (OR, 0.74; 95% CI, 0.63-0.88) were associated with lower rates of burnout on multivariable analysis, whereas spending 30 minutes or longer per vacation day on patient-related work (OR, 1.58; 95% CI, 1.22-2.04 for 30-60 minutes; OR, 1.97; 95% CI, 1.41-2.77 for 60-90 minutes; OR, 1.92; 95% CI, 1.36-2.73 for >90 minutes) was associated with higher rates of burnout.Conclusions and RelevanceIn this cross-sectional study of 3024 physicians, the number of vacation days taken and performing patient-related work while on vacation were associated with physician burnout. System-level efforts to ensure physicians take adequate vacation and have coverage for clinical responsibilities, including EHR inbox, may reduce physician burnout.

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.