What Gets Resident Physicians Stressed and How Would They Like to Be Supported? A Best-Worst Scaling Study

Andrew Wu, MD

Beth Israel Deaconess Medical Center
What Gets Resident Physicians Stressed and How Would They Like to Be Supported? A Best-Worst Scaling Study

Scientific Abstract

Background: Physician burnout has severe consequences on clinician well-being. Residents face numerous work-related stressors that can lead to burnout; however, given significant per-specialty variation in work, it is difficult to identify systemic stressors and implement effective burnout interventions on an institutional level. This study used best-worst scaling (BWS), a rank-ordering survey method, to assess how residents prioritized 16 work-related stressors and determine their willingness to utilize 4 wellness supports.

Methods: All 552 BIDMC resident physicians were invited to participate in an electronic survey in Fall 2020. Study collection ended after 6 weeks, resulting in 267 responses (48 % response rate). Utilities indicative of resident preference were determined using hierarchical Bayesian analysis, which allowed rank-ordering of work-related stressors and mental health supports.

One-way ANOVA with Kruskal-Wallis testing was used to determine statistical differences between utilities. Latent class analysis (LCA) was used to identify respondents that shared similar rank-ordering preferences.

Results: Top-ranked stressors were work-life integration (p<0.001) and electronic health record (EHR) documentation (p<0.001). LCA identified individuals that cited perceived inadequate support (n=88), financial worries (n=61), and social isolation (n=52) as high-ranking stressors. Individual therapy (p<0.001) and coaching (p<0.001) were the top two-ranking supports, respectively, compared to peer support and support groups. LCA identified those that were open to all four mental health supports (n=90), therapy and coaching (n=52), therapy only (n=33), coaching only (n=14), and uninterested in all mental health supports (n=78).

Conclusions: EHR documentation and work-life integration are top-ranking sources of stress regardless of specialty. Targeted interventions to address these stressors on an institutional level will likely result in highly impactful improvements to resident well-being. Residents appear most willing to utilize individualized therapy and coaching versus other mental health supports, though some residents are open to other forms of support.

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Andrew Wu, MD, Ritika Parris, MD, Timothy M. Scarella, MD, Carrie Tibbles, MD, John Torous, MD, Kevin P. Hill, MD, MHS