Prevalence of burnout and impact of workload on physician wellness: A cross-sectional survey of hospitalists in British Columbia, Canada

Background

Hospitalists in British Columbia care for a large percentage of hospitalized patients across 21 acute care facilities.

Objective

We aimed to characterize the demographic and work attributes of the workforce and to understand levels of burnout and the relationship between workload and job satisfaction.

Methods

We conducted a cross-sectional survey of individuals participating in hospitalist programs in BC.

Results

Almost all individuals (96%) were involved in the care of patients with COVID-19 in 2021, the height of the pandemic. High rates of burnout were demonstrated among hospitalists, with a large number of providers planning to significantly reduce or stop their involvement in acute care. Regression analysis identified workload as an important factor associated with burnout. Older physicians, those who had been practising for longer, and those with moderate to high number of shifts were more likely to consider reducing their involvement with their programs.

Conclusions

High levels of burnout are associated with a desire to reduce work involvement among BC hospitalists. Health system leaders need to consider factors contributing to burnout as a key aspect of broader health human resource planning efforts.

INTRODUCTION

Physician burnout has been increasingly identified as a major challenge for health systems in recent years.¹ High burnout levels among physicians has been well described across multiple clinical settings, specialties, and geographies.^2-9 Before the onset of the COVID-19 pandemic, burnout rates varied among different physician specialties, with rates as high as 80% described in some studies.³

As governments, healthcare institutions, and the larger medical community began to prepare for the emergence of the COVID-19 pandemic, concerns about the well-being of frontline healthcare workers became an even bigger priority.¹⁰ A number of studies demonstrated an increase in burnout levels among some physicians,^10-12 while others showed more inconsistent results.^13, 14

Hospitalists were one of the physician groups that were directly affected by the additional work demands and intensity associated with COVID-19.^15, 16 Before the pandemic, burnout rates among hospitalists ranged between 30% and 52%,^17-19 though more recent studies suggested rates as high as 62%–76%.^20, 21 As the pandemic evolved, many hospitalists were called upon to not only provide direct clinical care to hospitalized patients with COVID-19 but to also lead the implementation of workflow changes, treatment protocols, and other adaptations in the acute care system. A number of studies have demonstrated that hospitalists experienced increased levels of burnout and moral distress during this period.^13, 22, 23

Hospital medicine programs in the Canadian province of British Columbia (BC) were first implemented in the early 2000s in response to the mass withdrawal of primary care providers from inpatient care.²⁴ Since then, the number of hospitalist programs across the province has steadily grown,²⁵ with an increasing number of hospitalized patients cared for by dedicated hospital-based providers.²⁶ Hospitalist programs now exist at 21 acute care hospitals across BC, ranging from smaller facilities in semirural communities, to medium-sized community hospitals, and larger tertiary academic referral centers in urban and cosmopolitan areas.

Like other jurisdictions in Canada, BC utilizes a publicly funded healthcare system where the Ministry of Health oversees the delivery of a range of clinical programs and services in both acute and community settings.²⁷ While the Ministry of Health sets the overall strategic directions for the healthcare system and provides funding for program operations and physician services, the actual delivery of health services is done through seven Health Authorities (HA).

Doctors of BC is the professional physician association that represents the interests of physician providers in the province.²⁸ In addition to advocacy and various forms of support services for its members, it engages with the BC Ministry of Health in negotiations for the Physician Master Agreement that governs compensation for physician services. Physicians who practise in various medical specialties are represented within the organization through “Sections.”²⁹ The Section of Hospital Medicine is the main venue where hospitalists from across the province can organize themselves, provide support to each other, and advocate for their interests within the broader physician community and the healthcare system.

In early 2022, the Section of Hospital Medicine conducted an online survey of hospitalists in the province to better understand the demographic breakdown, workloads, and job satisfaction of the hospitalist workforce. We also aimed to understand the impact of COVID-19 on BC hospitalists, the prevalence of burnout among them, and career intentions.

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CONCLUSIONS

Our survey of individuals who participated in hospitalist programs across British Columbia in 2021 revealed high levels of burnout were associated with a desire to reduce participation in clinical work in hospital medicine. While the degree and rapid development of hospitalist staffing shortages that occurred subsequently was unforeseeable and likely related to multiple factors, findings from our survey a year before had suggested that a major crisis was probable. This highlights the importance of regular surveys of providers to understand job satisfaction levels and burnout rates as part of routine health human resources planning and in-depth analysis of predictors of burnout and anticipated career changes. It also highlights the urgent need for adoption of a combination of systematic and targeted interventions to reduce burnout levels and mitigate its impact on individuals,^46, 47 particularly for specialists in high stress jobs such as hospitalists. These include addressing workload concerns, adoption of robust recruitment strategies to replace an aging hospitalist workforce, and better engagement with frontline providers.³⁵