A Brief Instrument to Assess Both Burnout and Professional Fulfillment in Physicians: Reliability and Validity, Including Correlation with Self-Reported Medical Errors, in a Sample of Resident and Practicing Physicians

Mickey Trockel, Bryan Bohman, Emi Lesure, Maryam S Hamidi, Dana Welle, Laura Roberts, Tait Shanafelt, Mickey Trockel, Bryan Bohman, Emi Lesure, Maryam S Hamidi, Dana Welle, Laura Roberts, Tait Shanafelt

Abstract

Objective: The objective of this study was to evaluate the performance of the Professional Fulfillment Index (PFI), a 16-item instrument to assess physicians' professional fulfillment and burnout, designed for sensitivity to change attributable to interventions or other factors affecting physician well-being.

Methods: A sample of 250 physicians completed the PFI, a measure of self-reported medical errors, and previously validated measures including the Maslach Burnout Inventory (MBI), a one-item burnout measure, the World Health Organization's abbreviated quality of life assessment (WHOQOL-BREF), and PROMIS short-form depression, anxiety, and sleep-related impairment scales. Between 2 and 3 weeks later, 227 (91%) repeated the PFI and the sleep-related impairment scale.

Results: Principal components analysis justified PFI subscales for professional fulfillment, work exhaustion, and interpersonal disengagement. Test-retest reliability estimates were 0.82 for professional fulfillment (α = 0.91), 0.80 for work exhaustion (α = 0.86), 0.71 for interpersonal disengagement (α = 0.92), and 0.80 for overall burnout (α = 0.92). PFI burnout measures correlated highly (r ≥ 0.50) with their closest related MBI equivalents. Cohen's d effect size differences in self-reported medical errors for high versus low burnout classified using the PFI and the MBI were 0.55 and 0.44, respectively. PFI scales correlated in expected directions with sleep-related impairment, depression, anxiety, and WHOQOL-BREF scores. PFI scales demonstrated sufficient sensitivity to detect expected effects of a two-point (range 8-40) change in sleep-related impairment.

Conclusions: PFI scales have good performance characteristics including sensitivity to change and offer a novel contribution by assessing professional fulfillment in addition to burnout.

Figures

Fig. 1
Fig. 1
Standardized scores (z-scores) for self-reported medical errors, sleep-related impairment, depression, and anxiety by Professional Fulfillment Scale burnout score quartile
Fig. 2
Fig. 2
Cohen’s d effect-size differences in mean World Health Organization Brief Quality of Life (QoL) domain scores, comparing physicians with and without burnout by professional fulfillment category

References

    1. Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med. 2014;12(6):573–576. doi: 10.1370/afm.1713.
    1. Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009;374(9702):1714–1721. doi: 10.1016/S0140-6736(09)61424-0.
    1. Shanafelt TD, Sloan JA, Habermann TM. The well-being of physicians. Am J Med. 2003;114(6):513–519. doi: 10.1016/S0002-9343(03)00117-7.
    1. Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377–1385. doi: 10.1001/archinternmed.2012.3199.
    1. Shanafelt TD, Hasan O, Dyrbye LN, Sinsky C, Satele D, Sloan J, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90(12):1600–1613. doi: 10.1016/j.mayocp.2015.08.023.
    1. Dyrbye LN, Varkey P, Boone SL, Satele DV, Sloan JA, Shanafelt TD. Physician satisfaction and burnout at different career stages. Mayo Clin Proc. 2013;88(12):1358–1367. doi: 10.1016/j.mayocp.2013.07.016.
    1. Buchbinder SB, Wilson M, Melick CF, Powe NR. Primary care physician job satisfaction and turnover. Am J Manag Care. 2001;7(7):701–713.
    1. Williams ES, Skinner AC. Outcomes of physician job satisfaction: a narrative review, implications, and directions for future research. Health Care Manag Rev. 2003;28(2):119–139. doi: 10.1097/00004010-200304000-00004.
    1. Scheepers RA, Boerebach BC, Arah OA, Heineman MJ, Lombarts KM. A systematic review of the impact of physicians’ occupational well-being on the quality of patient care. Int J Behav Med. 2015;22(6):683–698. doi: 10.1007/s12529-015-9473-3.
    1. Linzer M, Poplau S, Brown R, Grossman E, Varkey A, Yale S, et al. Do work condition interventions affect quality and errors in primary care? Results from the healthy work place study. J Gen Intern Med. 2017;32(1):56–61. doi: 10.1007/s11606-016-3856-2.
    1. Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med. 2002;136(5):358–367. doi: 10.7326/0003-4819-136-5-200203050-00008.
    1. Linzer M, Manwell LB, Williams ES, Bobula JA, Brown RL, Varkey AB, et al. Working conditions in primary care: physician reactions and care quality. Ann Intern Med. 2009;151(1):28–36. doi: 10.7326/0003-4819-151-1-200907070-00006.
    1. An PG, Manwell LB, Williams ES, Laiteerapong N, Brown RL, Rabatin JS, et al. Does a higher frequency of difficult patient encounters lead to lower quality care? J Fam Pract. 2013;62(1):24–29.
    1. Melville A. Job satisfaction in general practice implications for prescribing. Soc Sci Med Med Psychol Med Sociol. 1980;14(6):495–499. doi: 10.1016/0160-7979(80)90050-8.
    1. Grol R, Mokkink H, Smits A, van Eijk J, Beek M, Mesker P, et al. Work satisfaction of general practitioners and the quality of patient care. Fam Pract. 1985;2(3):128–135. doi: 10.1093/fampra/2.3.128.
    1. DiMatteo MR, Sherbourne CD, Hays RD, Ordway L, Kravitz RL, McGlynn EA, et al. Physicians' characteristics influence patients’ adherence to medical treatment: results from the medical outcomes study. Health Psychol. 1993;12(2):93. doi: 10.1037/0278-6133.12.2.93.
    1. Linn LS, Brook RH, Clark VA, Davies AR, Fink A, Kosecoff J. Physician and patient satisfaction as factors related to the organization of internal medicine group practices. Med Care. 1985;23(10):1171–1178. doi: 10.1097/00005650-198510000-00006.
    1. Haas JS, Cook EF, Puopolo AL, Burstin HR, Cleary PD, Brennan TA. Is the professional satisfaction of general internists associated with patient satisfaction? J Gen Intern Med. 2000;15(2):122–128. doi: 10.1046/j.1525-1497.2000.02219.x.
    1. Maslach C, Jackson SE. The measurement of experienced burnout. J Occup Behav. 1981;2:99–113. doi: 10.1002/job.4030020205.
    1. Halbesleben JRB, Rathert C. Linking physician burnout and patient outcomes: exploring the dyadic relationship between physicians and patients. Health Care Manag Rev. 2008;33(1):29–39. doi: 10.1097/01.HMR.0000304493.87898.72.
    1. West CP, Huschka MM, Novotny PJ, Sloan JA, Kolars JC, Habermann TM, et al. Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study. JAMA. 2006;296(9):1071–1078. doi: 10.1001/jama.296.9.1071.
    1. Shanafelt TD, Balch CM, Bechamps G, Russell T, Dyrbye L, Satele D, et al. Burnout and medical errors among American surgeons. Ann Surg. 2010;251(6):995–1000. doi: 10.1097/SLA.0b013e3181bfdab3.
    1. West CP, Dyrbye LN, Satele DV, Sloan JA, Shanafelt TD. Concurrent validity of single-item measures of emotional exhaustion and depersonalization in burnout assessment. J Gen Intern Med. 2012;27(11):1445–1452. doi: 10.1007/s11606-012-2015-7.
    1. West CP, Dyrbye LN, Sloan JA, Shanafelt TD. Single item measures of emotional exhaustion and depersonalization are useful for assessing burnout in medical professionals. J Gen Intern Med. 2009;24(12):1318. doi: 10.1007/s11606-009-1129-z.
    1. Williams ES, Konrad TR, Linzer M, McMurray J, Pathman DE, Gerrity M, et al. Refining the measurement of physician job satisfaction: results from the Physician Worklife Survey. SGIM Career Satisfaction Study Group. Society of General Internal Medicine. Med Care. 1999;37(11):1140–1154. doi: 10.1097/00005650-199911000-00006.
    1. Rohland BM, Kruse GR, Rohrer JE. Validation of a single-item measure of burnout against the Maslach Burnout Inventory among physicians. Stress Health. 2004;20(2):75–79. doi: 10.1002/smi.1002.
    1. Halbesleben JRB, Demerouti E. The construct validity of an alternative measure of burnout: investigating the English translation of the Oldenburg burnout inventory. Work Stress. 2005;19(3):208–220. doi: 10.1080/02678370500340728.
    1. Goldhagen BE, Kingsolver K, Stinnett SS, Rosdahl JA. Stress and burnout in residents: impact of mindfulness-based resilience training. Adv Med Educ Pract. 2015;6:525–532.
    1. Demerouti E, Mostert K, Bakker AB. Burnout and work engagement: a thorough investigation of the independency of both constructs. J Occup Health Psychol. 2010;15(3):209. doi: 10.1037/a0019408.
    1. Glasheen JJ, Misky GJ, Reid MB, Harrison RA, Sharpe B, Auerbach A. Career satisfaction and burnout in academic hospital medicine. Arch Intern Med. 2011;171(8):782–790. doi: 10.1001/archinternmed.2011.153.
    1. Shanafelt TD, Dyrbye LN, Sinsky C, Hasan O, Satele D, Sloan J, et al. Relationship between clerical burden and characteristics of the electronic environment with physician burnout and professional satisfaction. Mayo Clin Proc. 2016;91(7):836–848. doi: 10.1016/j.mayocp.2016.05.007.
    1. Bassett-Jones N, Lloyd GC. Does Herzberg’s motivation theory have staying power? J Manag Dev. 2005;24(10):929–943. doi: 10.1108/02621710510627064.
    1. Brown S, Gunderman RB. Viewpoint: enhancing the professional fulfillment of physicians. Acad Med. 2006;81(6):577–582. doi: 10.1097/01.ACM.0000225224.27776.0d.
    1. Herzberg F. One more time: how do you motivate employees: Harvard business review Boston, MA; 1968.
    1. DeVon HA, Block ME, Moyle-Wright P, Ernst DM, Hayden SJ, Lazzara DJ, et al. A psychometric toolbox for testing validity and reliability. J Nurs Scholarsh. 2007;39(2):155–164. doi: 10.1111/j.1547-5069.2007.00161.x.
    1. Husted JA, Cook RJ, Farewell VT, Gladman DD. Methods for assessing responsiveness: a critical review and recommendations. J Clin Epidemiol. 2000;53(5):459–468. doi: 10.1016/S0895-4356(99)00206-1.
    1. Piedmont RL. Factorial validity. In: Michalos AC, editor. Encyclopedia of quality of life and well-being research. Dordrecht: Springer Netherlands; 2014. pp. 2148–2149.
    1. Buysse DJ, Yu L, Moul DE, Germain A, Stover A, Dodds NE, et al. Development and validation of patient-reported outcome measures for sleep disturbance and sleep-related impairments. Sleep. 2010;33(6):781–792. doi: 10.1093/sleep/33.6.781.
    1. Pilkonis PA, Choi SW, Reise SP, Stover AM, Riley WT, Cella D, et al. Item banks for measuring emotional distress from the Patient-Reported Outcomes Measurement Information System (PROMIS®): depression, anxiety, and anger. Assessment. 2011;18(3):263–283. doi: 10.1177/1073191111411667.
    1. Skevington SM, Lotfy M, O'Connell KA. The World Health Organization’s WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL Group. Qual Life Res. 2004;13:299–310. doi: 10.1023/B:QURE.0000018486.91360.00.
    1. Williams ES, Konrad TR, Linzer M, McMurray J, Pathman DE, Gerrity M, et al. Physician, practice, and patient characteristics related to primary care physician physical and mental health: results from the Physician Worklife Study. Health Serv Res. 2002;37(1):121–143.
    1. Linzer M, Konrad TR, Douglas J, McMurray JE, Pathman DE, Williams ES, et al. Managed care, time pressure, and physician job satisfaction: results from the Physician Worklife Study. J Gen Intern Med. 2000;15(7):441–450. doi: 10.1046/j.1525-1497.2000.05239.x.
    1. Dolan ED, Mohr D, Lempa M, Joos S, Fihn SD, Nelson KM, et al. Using a single item to measure burnout in primary care staff: a psychometric evaluation. J Gen Intern Med. 2015;30(5):582–587. doi: 10.1007/s11606-014-3112-6.
    1. Group TW Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychol Med. 1998;28(3):551–558. doi: 10.1017/S0033291798006667.
    1. Clark LA, Watson D. Constructing validity: basic issues in objective scale development. Psychol Assess. 1995;7(3):309. doi: 10.1037/1040-3590.7.3.309.
    1. Rosen IM, Gimotty PA, Shea JA, Bellini LM. Evolution of sleep quantity, sleep deprivation, mood disturbances, empathy, and burnout among interns. Acad Med. 2006;81(1):82–85. doi: 10.1097/00001888-200601000-00020.
    1. Bekke-Hansen S, Trockel M, Burg MM, Taylor CB. Depressive symptom dimensions and cardiac prognosis following myocardial infarction: results from the ENRICHD clinical trial. Psychol Med. 2012;42(01):51–60. doi: 10.1017/S0033291711001000.
    1. Erickson SM; Rockwern B; Koltov M; McLean R. Putting patients first by reducing administrative tasks in health care: a position paper of the American College of Physicians. Ann Intern Med 2017;166(9):659–661.
    1. Shipman SA, Sinsky CA. Expanding primary care capacity by reducing waste and improving the efficiency of care. Health Aff. 2013;32(11):1990–1997. doi: 10.1377/hlthaff.2013.0539.
    1. Roberts LW. Is a doctor like a toaster? Earning trust in the profession of medicine. Springer; 2017.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa