"A National Survey of Burnout and Depression Among Fellows Training in Pulmonary and Critical Care Medicine: A Special Report by the APCCMPD

Chest. 2020 Sep 18;S0012-3692(20)34511-6. doi: 10.1016/j.chest.2020.08.2117. Online ahead of print.

Abstract

Background: The prevalence of burnout and depressive symptoms is high among physician trainees.

Research question: What is the burden of burnout and depressive symptoms among fellows training in pulmonary and critical care medicine (PCCM) and what are associated individual fellow, program, and institutional characteristics?

Study design/methods: We conducted a cross-sectional electronic survey of fellows enrolled in pulmonary, PCCM, and critical care medicine training programs in the United States to assess burnout and depressive symptoms. Burnout symptoms were measured using the Maslach Burnout Index two-item measure. The two-item Primary Care Evaluation of Mental Disorders Procedure was used to screen for depressive symptoms. For each of the two outcomes (burnout and depressive symptoms), we constructed three multivariate logistic regression models to assess individual fellow characteristics, program structure, and institutional polices associated with either burnout or depressive symptoms.

Results: 502 of the 976 fellows who received the survey completed it - including both outcome measures - giving a response rate of 51%. 50% of fellows screened positive for either burnout or depressive symptoms, with 41% positive for depressive symptoms, 32% positive for burnout, and 23% for both. Reporting a coverage system in the case of personal illness or emergency (adjusted odds ratio (aOR) 0.44, 95% CI 0.26-0.73)) and access to mental health services (aOR 0.14, 95% CI 0.04-0.47) were associated with lower odds of burnout. Financial concern was associated with higher odds of depressive symptoms (aOR 1.13, 95% CI 1.05-1.22). Working more than 70 hours in an average clinical week and the burden of electronic health record (EHR) documentation were associated with a higher odds of both burnout and depressive symptoms.

Interpretation: Given the high prevalence of burnout and depressive symptoms among fellows training in PCCM, there is an urgent need to identify solutions that address this public health crisis. Strategies such as providing an easily accessible coverage system; access to mental health resources; reducing EHR burden; addressing work hours; and addressing financial concerns among trainees may help reduce burnout or depressive symptoms and should be further studied by the graduate medical education community.