Longitudinal Analyses of Pediatrician Burnout

Cull WL, Frintner MP, Starmer AJ, Leslie LK.

Presented at the 2017 Pediatric Academic Societies Annual Meeting.

Background: Prior studies have raised concern regarding physician burnout and the potential that it is on the rise. Cross-sectional studies can only provide limited, retrospective information on physician experiences with burnout over time.

Objective: Utilize the unique capabilities of a longitudinal design to 1.) examine whether burnout is increasing over time among two cohorts of pediatricians, and 2.) identify transitions experienced by pediatricians that are associated with reduced burnout.

Methods: Data from a national, longitudinal study, AAP Pediatrician Life and Career Experience Study (PLACES), were used to examine self-reported burnout over a five-year period, 2012 to 2016, among 2002-2004 and 2009-2011 residency graduates (N = 1804). Participation rates ranged from 94% in 2012 to 85% in 2016. A simple self-report measure of current experience of burnout was collected each year. Mixed-effects logistic regression for longitudinal analysis was used to examine burnout over time. Models examined first individual changes in burnout for all participants and for subgroups (gender, age cohort, medical school location, and receiving subspecialty fellowship training), and second what work or individually-focused transitions were associated with lower burnout.

Results: At any given year, between 20% and 35% of the study pediatricians reported that they were currently experiencing burnout; cumulatively, 58% reported experiencing burnout at least once in five years. Mixed effects models showed significant increases in burnout over time for all participants combined and for each subgroup examined (Table 1). An additional mixed effects model identified several transitions that were associated with lower burnout (Table 2). The greatest attenuation of rising burnout was found for pediatricians experiencing increased flexibility in work schedule, decreased work busyness, or a job change. Lifestyle changes of increasing exercise and increasing sleep were also associated with less burnout, but not as strongly.

Discussion: After five years of participation in a longitudinal study, more than 1 in 3 early to mid-career pediatricians report currently experiencing burnout. This represents a 75% relative increase in burnout since the start of the study and was found consistently across pediatrician subgroups. Specific structures of the pediatricians' jobs, such as flexible work schedules and busyness of work settings, were most strongly associated with reduced burnout.