Burnout Among Nephrologists in the United States: A Survey Study

Abstract

Rationale & objective: Burnout decreases job satisfaction and leads to poor patient outcomes but remains underinvestigated in nephrology. We explored the prevalence and determinants of burnout among a sample of nephrologists.

Study design: Cross-sectional.

Setting & participants: The nephrologists were approached via the American Medical Association Physicians Masterfile, National Kidney Foundation listserv, email, and social media between April and August 2019. The predictors were demographics and practice characteristics. The outcome was burnout, defined as responding "once a week" or more on either 1 of the 2 validated measures of emotional exhaustion and depersonalization or both.

Analytical approach: Participant characteristics were tabulated. Responses were compared using χ² tests. Multivariable logistic regression was used to estimate the odds ratios (ORs) of burnout for risk factors. Free text responses were thematically analyzed.

Results: About half of 457 respondents were 40-59 years old (n=225; 49.2%), and the respondents were more predominantly men (n=296; 64.8%), US medical graduates (n=285; 62.4%), and in academic practice (n=286; 62.6%). Overall, 106 (23.2%) reported burnout. The most commonly reported primary drivers of burnout were the number of hours worked (n=27; 25.5%) and electronic health record requirements (n=26; 24.5%). Caring for ≤25 versus 26-75 patients per week (OR, 0.34; 95% confidence interval [95% CI], 0.15-0.77), practicing in academic versus nonacademic settings (OR, 0.33; 95% CI, 0.21-0.54), and spending time on other responsibilities versus patient care (OR, 0.32; 95% CI, 0.17-0.61) were each independently associated with nearly 70% lower odds of burnout after adjusting for age, sex, race, and international medical graduate status. The free text responses emphasized disinterested health care systems and dissatisfaction with remuneration as the drivers of burnout.

Limitations: Inability to precisely capture response rate.

Conclusions: Nearly one-quarter of the nephrologists in our sample reported burnout. Future studies should qualitatively investigate how the care setting, time spent on electronic medical records, and hours of clinical care drive burnout and explore other system-level drivers of burnout in nephrology.

Keywords: Burnout; depersonalization; emotional exhaustion; nephrology; survey.

Graphical abstract

Figure 1

Frequencies of the most commonly reported drivers of burnout (among 106 participants who reported burnout, as defined by responding “once a week” or more frequently to either the question regarding emotional exhaustion or that regarding depersonalization). (A) Percentage of individuals reporting a reason as the primary driver of burnout. (B) Percentage of individuals reporting a reason being among the top 3 drivers of burnout. Abbreviation: EMR, electronic medical record.

Figure 2

Conceptual framework of qualitative themes from free text responses.