New insights into physician burnout and turnover intent: a validated measure of physician fortitude.
Physician burnout
Physician fortitude
Turnover
Turnover intent
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
18 Jun 2024
18 Jun 2024
Historique:
received:
01
03
2024
accepted:
07
06
2024
medline:
19
6
2024
pubmed:
19
6
2024
entrez:
18
6
2024
Statut:
epublish
Résumé
Given the increasing prevalence of the physician burnout, this study provides new insights into the antecedents driving burnout and turnover intent. By introducing the concept of physician fortitude, we develop a valid and statistically-reliable measure that increases our understanding of these issues. A two-sample design was employed. Using a sample of 909 physicians, Advanced Practice Providers (APPs) and healthcare leaders, exploratory factor analysis was employed to create a 12-item fortitude scale. In the second study, using a sample of 212 of practicing physicians, APPs and healthcare leaders, bivariate and tetrachoric correlations, and ordinary least square regression modeling were able to establish reliability and validity. The fortitude scale shows sufficient reliability. Moreover, we found significant support for convergent and criterion-related validity. Fortitude was significantly related to all three subdimensions of burnout, including emotional exhaustion (r = -.62, p < .01), depersonalization (r = -.70, p < .01) and personal accomplishment (r = .65, p < .01), and turnover intent (r = -.55, p < .01). Moreover, the fortitude measure explained more variance in all three subdimensions of burnout and turnover intent compared to common measures, including grit, hardiness, mental toughness and resilience (p < .01). Results from this study empirically demonstrate that fortitude is significantly related to burnout, and turnover intent. This new fortitude measure adds a new perspective to assist in the development of more effective interventions. Opportunities for future research are discussed.
Sections du résumé
BACKGROUND
BACKGROUND
Given the increasing prevalence of the physician burnout, this study provides new insights into the antecedents driving burnout and turnover intent. By introducing the concept of physician fortitude, we develop a valid and statistically-reliable measure that increases our understanding of these issues.
METHODS
METHODS
A two-sample design was employed. Using a sample of 909 physicians, Advanced Practice Providers (APPs) and healthcare leaders, exploratory factor analysis was employed to create a 12-item fortitude scale. In the second study, using a sample of 212 of practicing physicians, APPs and healthcare leaders, bivariate and tetrachoric correlations, and ordinary least square regression modeling were able to establish reliability and validity.
RESULTS
RESULTS
The fortitude scale shows sufficient reliability. Moreover, we found significant support for convergent and criterion-related validity. Fortitude was significantly related to all three subdimensions of burnout, including emotional exhaustion (r = -.62, p < .01), depersonalization (r = -.70, p < .01) and personal accomplishment (r = .65, p < .01), and turnover intent (r = -.55, p < .01). Moreover, the fortitude measure explained more variance in all three subdimensions of burnout and turnover intent compared to common measures, including grit, hardiness, mental toughness and resilience (p < .01).
CONCLUSIONS
CONCLUSIONS
Results from this study empirically demonstrate that fortitude is significantly related to burnout, and turnover intent. This new fortitude measure adds a new perspective to assist in the development of more effective interventions. Opportunities for future research are discussed.
Identifiants
pubmed: 38890733
doi: 10.1186/s12913-024-11186-7
pii: 10.1186/s12913-024-11186-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
748Informations de copyright
© 2024. The Author(s).
Références
Shanafelt TD, West CP, Dyrbye LN, Trockel M, Tutty M, Wang H, Carlasare LE, Sinsky C. Changes in burnout and satisfaction with work-life integration in physicians during the first 2 years of the COVID-19 pandemic. Mayo Clin Proc. 2022;97(12):2248–58 Elsevier.
doi: 10.1016/j.mayocp.2022.09.002
pubmed: 36229269
Ortega MV, Hidrue MK, Lehrhoff SR, Ellis DB, Sisodia RC, Curry WT, Del Carmen MG, Wasfy JH. Patterns in physician burnout in a stable-linked cohort. JAMA Netw Open. 2023;6(10):e2336745-.
doi: 10.1001/jamanetworkopen.2023.36745
pubmed: 37801314
pmcid: 10559175
Li CJ, Shah YB, Harness ED, Goldberg ZN, Nash DB. Physician burnout and medical errors: exploring the relationship, cost, and solutions. Am J Med Qual. 2023;38(4):196–202.
doi: 10.1097/JMQ.0000000000000131
pubmed: 37382306
Williams ES, Rathert C, Buttigieg SC. The personal and professional consequences of physician burnout: a systematic review of the literature. Med Care Res Rev. 2020;77(5):371–86.
doi: 10.1177/1077558719856787
pubmed: 31216940
Han S, Shanafelt TD, Sinsky CA, Awad KM, Dyrbye LN, Fiscus LC, Trockel M, Goh J. Estimating the attributable cost of physician burnout in the United States. Ann Intern Med. 2019;170(11):784–90.
doi: 10.7326/M18-1422
pubmed: 31132791
Brown PA, Slater M, Lofters A. Personality and burnout among primary care physicians: an international study. Psychol Res Behav Manag. 2019;18:169–77.
doi: 10.2147/PRBM.S195633
Meredith LS, Bouskill K, Chang J, Larkin J, Motala A, Hempel S. Predictors of burnout among US healthcare providers: a systematic review. BMJ Open. 2022;12(8):e054243.
doi: 10.1136/bmjopen-2021-054243
pubmed: 36008065
pmcid: 9422884
Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Proc. 2017;92(1):129–46 Elsevier.
doi: 10.1016/j.mayocp.2016.10.004
pubmed: 27871627
Greep NC, Woolhandler S, Himmelstein D. Physician Burnout: Fix the Doctor or Fix the System? Am J Med. 2022;135(4):416–7.
doi: 10.1016/j.amjmed.2021.10.011
pubmed: 34736881
Kruse CS, Mileski M, Dray G, Johnson Z, Shaw C, Shirodkar H. Physician burnout and the electronic health record leading up to and during the first year of COVID-19: systematic review. J Med Internet Res. 2022;24(3):e36200.
doi: 10.2196/36200
pubmed: 35120019
pmcid: 9015762
Speicher LL, Francis D. Improving employee experience: reducing burnout, decreasing turnover and building well-being. Clin Gastroenterol Hepatol. 2023;21(1):11–4.
doi: 10.1016/j.cgh.2022.09.020
pubmed: 36155248
West CP, Dyrbye LN, Shanafelt TD. Physician burnout: contributors, consequences and solutions. J Intern Med. 2018;283(6):516–29.
doi: 10.1111/joim.12752
pubmed: 29505159
Haslam A, Tuia J, Miller SL, Prasad V. Systematic review and meta-analysis of randomized trials testing interventions to reduce physician burnout. Am J Med. 2023;137:249–257.e1. https://doi.org/10.1016/j.amjmed.2023.10.003 .
Catapano P, Cipolla S, Sampogna G, Perris F, Luciano M, Catapano F, Fiorillo A. Organizational and individual interventions for managing work-related stress in healthcare professionals: a systematic review. Medicina. 2023;59(10):1866.
doi: 10.3390/medicina59101866
pubmed: 37893584
pmcid: 10608642
McManus IC, Winder B, Paice E. How consultants, hospitals, trusts and deaneries affect pre-registration house officer posts: a multilevel model. Med Educ. 2002;36(1):35–44.
doi: 10.1046/j.1365-2923.2002.01123.x
pubmed: 11849522
McManus IC, Keeling A, Paice E. Stress, burnout and doctors’ attitudes to work are determined by personality and learning style: a twelve year longitudinal study of UK medical graduates. BMC Med. 2004;2(1):1–2.
doi: 10.1186/1741-7015-2-29
Duckworth AL, Peterson C, Matthews MD, Kelly DR. Grit: perseverance and passion for long-term goals. J Pers Soc Psychol. 2007;92(6):1087.
doi: 10.1037/0022-3514.92.6.1087
pubmed: 17547490
Lee DH, Reasoner K, Lee D. Grit: what is it and why does it matter in medicine? Postgrad Med J. 2023;99(1172):535–41.
doi: 10.1136/postgradmedj-2021-140806
pubmed: 37319151
Shakir HJ, Cappuzzo JM, Shallwani H, Kwasnicki A, Bullis C, Wang J, Hess RM, Levy EI. Relationship of grit and resilience to burnout among US neurosurgery residents. World Neurosurg. 2020;1(134):e224–36.
doi: 10.1016/j.wneu.2019.10.043
Miyawaki Y, Sada KE, Shidahara K, Nawachi S, Asano Y, Katayama Y, Hayashi K, Katsuyama E, Katsuyama T, Takano-Narazaki M, Matsumoto Y. The Association of Grit With Burnout Components (Professional Efficacy, Exhaustion, and Cynicism) Among Academic Rheumatologists: The TRUMP: 2: SLE Study. J Clin Rheumatol. 2023;29(6):268–74.
doi: 10.1097/RHU.0000000000001989
pubmed: 37226300
Kobasa SC. Stressful life events, personality, and health: an inquiry into hardiness. J Pers Soc Psychol. 1979;37(1):1.
doi: 10.1037/0022-3514.37.1.1
pubmed: 458548
Ladstätter F, Cooper-Thomas HD, Moreno-Jiménez B, Ponsoda V, Song S, Garrosa E. Deciphering hardiness: differential relationships of novelty seeker, rigid control, and hardy profiles on nurses’ burnout and their effects. Nurs Adv Health Care. 2018;2(1):1–8.
Vagni M, Maiorano T, Giostra V, Pajardi D, Bartone P. Emergency stress, hardiness, coping strategies and burnout in health care and emergency response workers during the COVID-19 pandemic. Front Psychol. 2022;21(13):918788.
doi: 10.3389/fpsyg.2022.918788
Britt TW, Shen W, Sinclair RR, Grossman MR, Klieger DM. How much do we really know about employee resilience? Ind Organ Psychol. 2016;9(2):378–404.
doi: 10.1017/iop.2015.107
Siu OL, Hui CH, Phillips DR, Lin L, Wong TW, Shi K. A study of resiliency among Chinese health care workers: Capacity to cope with workplace stress. J Res Pers. 2009;43(5):770–6.
doi: 10.1016/j.jrp.2009.06.008
Jones G, Hanton S, Connaughton D. A framework of mental toughness in the world’s best performers. Sport Psychol. 2007;21(2):243–64.
Lin Y, Clough PJ, Welch J, Papageorgiou KA. Individual differences in mental toughness associate with academic performance and income. Pers Individ Differ. 2017;15(113):178–83.
doi: 10.1016/j.paid.2017.03.039
Passmore S, Hemming E, McIntosh HC, Hellman CM. The relationship between hope, meaning in work, secondary traumatic stress, and burnout among child abuse pediatric clinicians. Perm J. 2020;24:19.087.
doi: 10.7812/TPP/19.087
pubmed: 31852051
Vetter MH, Vetter MK, Fowler J. Resilience, hope and flourishing are inversely associated with burnout among members of the Society for Gynecologic Oncology. Gynecol Oncol Rep. 2018;1(25):52–5.
doi: 10.1016/j.gore.2018.06.002
Henttonen P, Määttänen I, Makkonen E, Honka A, Seppälä V, Närväinen J, García-Velázquez R, Airaksinen J, Jokela M, Lahti EE. A measure for assessment of beneficial and harmful fortitude: development and initial validation of the Sisu Scale. Heliyon. 2022;8(11):e11483.
doi: 10.1016/j.heliyon.2022.e11483
pubmed: 36406727
pmcid: 9667267
Pretorius TB, Padmanabhanunni A. The dynamics of appraisal: a review of 20 years of research using the Fortitude Questionnaire. South Afr J Psychol. 2021;51(1):158–74.
doi: 10.1177/0081246320957489
Van Tongeren DR, Aten JD, McElroy S, Davis DE, Shannonhouse L, Davis EB, Hook JN. Development and validation of a measure of spiritual fortitude. Psychol Trauma Theory Res Pract Policy. 2019;11(6):588.
doi: 10.1037/tra0000449
Hinkin TR. A review of scale development practices in the study of organizations. J Manag. 1995;21(5):967–88.
Carmines EG, Zeller RA. Reliability and Validity Assessment. Quantitative applications in the social sciences. Beverly Hills, London: Sage Publications; 1979. no. 07–017.
Crocker L, Algina J. Introduction to classical and modern test theory. Holt, Rinehart and Winston, 6277 Sea Harbor Drive, Orlando, FL 32887; 1986.
Fabrigar LR, Wegener DT, MacCallum RC, Strahan EJ. Evaluating the use of exploratory factor analysis in psychological research. Psychol Methods. 1999;4(3):272.
doi: 10.1037/1082-989X.4.3.272
Kaiser HF. An index of factorial simplicity. Psychometrika. 1974;39(1):31–6.
doi: 10.1007/BF02291575
Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory Manual. 3rd ed. Palo Alto: Consulting Psychologists Press; 1996.
Lim VK, Chen D, Aw SS, Tan M. Unemployed and exhausted? Job-search fatigue and reemployment quality. J Vocat Behav. 2016;1(92):68–78.
doi: 10.1016/j.jvb.2015.11.003
Hamidi MS, Bohman B, Sandborg C, Smith-Coggins R, De Vries P, Albert MS, Murphy ML, Welle D, Trockel MT. Estimating institutional physician turnover attributable to self-reported burnout and associated financial burden: a case study. BMC Health Serv Res. 2018;18:1–8.
doi: 10.1186/s12913-018-3663-z
Willard-Grace R, Knox M, Huang B, Hammer H, Kivlahan C, Grumbach K. Burnout and health care workforce turnover. Ann Fam Med. 2019;17(1):36–41.
doi: 10.1370/afm.2338
pubmed: 30670393
pmcid: 6342603
Rabatin J, Williams E, Baier Manwell L, Schwartz MD, Brown RL, Linzer M. Predictors and outcomes of burnout in primary care physicians. J Prim Care Community Health. 2016;7(1):41–3.
doi: 10.1177/2150131915607799
pubmed: 26416697
Roslan NS, Yusoff MS, Morgan K, Razak AA, Shauki NI. Evolution of Resilience Construct, Its Distinction with Hardiness, Mental Toughness, Work Engagement and Grit, and Implications to Future Healthcare Research. Educ Med J. 2022;14(1).
Stoffel JM, Cain J. Review of grit and resilience literature within health professions education. Am J Pharm Educ. 2018;82(2):6150.
doi: 10.5688/ajpe6150
pubmed: 29606705
pmcid: 5869747
Podsakoff PM, MacKenzie SB, Lee JY, Podsakoff NP. Common method biases in behavioral research: a critical review of the literature and recommended remedies. J Appl Psycho. 2003;88(5):879.