Burnout and distress among internal medicine program directors: results of a national survey

Abstract

Background: Physician burnout and distress has been described in national studies of practicing physicians, internal medicine (IM) residents, IM clerkship directors, and medical school deans. However, no comparable national data exist for IM residency program directors.

Objective: To assess burnout and distress among IM residency program directors, and to evaluate relationships of distress with personal and program characteristics and perceptions regarding implementation and consequences of Accreditation Council for Graduate Medical Education (ACGME) regulations.

Design and participants: The 2010 Association of Program Directors in Internal Medicine (APDIM) Annual Survey, developed by the APDIM Survey Committee, was sent in August 2010 to the 377 program directors with APDIM membership, representing 99.0 % of the 381 United States categorical IM residency programs.

Main measures: The 2010 APDIM Annual Survey included validated items on well-being and distress, including questions addressing quality of life, satisfaction with work-life balance, and burnout. Questions addressing personal and program characteristics and perceptions regarding implementation and consequences of ACGME regulations were also included.

Key results: Of 377 eligible program directors, 282 (74.8 %) completed surveys. Among respondents, 12.4 % and 28.8 % rated their quality of life and satisfaction with work-life balance negatively, respectively. Also, 27.0 % reported emotional exhaustion, 10.4 % reported depersonalization, and 28.7 % reported overall burnout. These rates were lower than those reported previously in national studies of medical students, IM residents, practicing physicians, IM clerkship directors, and medical school deans. Aspects of distress were more common among younger program directors, women, and those reporting greater weekly work hours. Work-home conflicts were common and associated with all domains of distress, especially if not resolved in a manner effectively balancing work and home responsibilities. Associations with program characteristics such as program size and American Board of Internal Medicine (ABIM) pass rates were not found apart from higher rates of depersonalization among directors of community-based programs (23.5 % vs. 8.6 %, p = 0.01). We did not observe any consistent associations between distress and perceptions of implementation and consequences of program regulations.

Conclusions: The well-being of IM program directors across domains, including quality of life, satisfaction with work-life balance, and burnout, appears generally superior to that of medical trainees, practicing physicians, and other medical educators nationally. Additionally, it is reassuring that program directors' perceptions of their ability to respond to current regulatory requirements are not adversely associated with distress. However, the increased distress levels among younger program directors, women, and those at community-based training programs reported in this study are important concerns worthy of further study.

Figure 1.

Overall quality of life (QOL) and satisfaction with work-life balance among internal medicine program directors.

Figure 2.

Emotional exhaustion, depersonalization, and overall burnout among internal medicine program directors (IM PDs), medical students, internal medicine (IM) residents, practicing physicians, IM clerkship directors (IM CDs), and medical school deans nationally. (% reporting high levels of each burnout domain).

Figure 3.

Mean weekly work hours across levels of overall quality of life (QOL) and satisfaction with work-life balance among internal medicine program directors.

Figure 4.

Relationship of work–home conflicts with distress rates among internal medicine program directors. (Survey question: Have you experienced a conflict between work and personal responsibilities in the last 3 weeks?).

Figure 5.

Relationship of work–home conflict resolution with distress rates among internal medicine program directors. (Survey question: Please think of the most recent conflict between work and personal responsibilities you have experienced. Was this resolved in favor of work responsibilities, in favor of personal responsibilities, or in a manner that met both responsibilities?).