Mistreatment linked to burnout in emergency medicine residents

By Christopher Cheney

Emergency medicine residents who experience workplace mistreatment are more likely to be burned out than residents who do not experience workplace mistreatment, according to a new research article.

Earlier research has shown that emergency departments are a hotbed for workplace mistreatment. A New York City study found that 97% of emergency medicine residents had experienced verbal harassment in an ED.

study published in 2016 found that 78% of ED healthcare workers had reported a violent assault in the prior year.

The new research article, which was published by Annals of Emergency Medicine, is based on survey data collected from 7,680 emergency medicine residents. The study examined three types of mistreatment: discrimination; physical, verbal, or emotional abuse; and sexual harassment. Burnout was measured with two factors from the Maslach Burnout Inventory: emotional exhaustion and depersonalization.

The research article features several key findings:

  • 31.7% of survey respondents reported burnout
  • 3.2% of survey respondents reported career choice regret
  • 29.9% of survey respondents reported experiencing mistreatment a few times per year, and 18.3% of survey respondents reported experiencing mistreatment a few times per month or more
  • Compared to residents who did not experience mistreatment, residents who experienced mistreatment were more likely to report burnout—for mistreatment a few times per year, the odds ratio was 1.6; for mistreatment a few times per month or more, the odds ratio was 3.3
  • Compared to residents who did not report burnout, residents who reported burnout were more likely to have career choice regret (odds ratio 11.3)
  • After adjusting the data for burnout, there was not a significant association between the frequency of mistreatment and career choice regret
  • Overall, the incidence of burnout was similar among men (30.5%) and women (32.5%), but after adjusting the data for mistreatment, women were less likely to report burnout than men (odds ratio 0.77)
  • Senior residents were more likely to report burnout than first-year residents
  • Senior residents were more likely to report career choice regret than first-year or second-year residents

“Workplace mistreatment is associated with burnout, but not career choice regret, among emergency medicine residents. Efforts to address workplace mistreatment may improve emergency medicine residents’ professional well-being,” the study’s co-authors wrote.

The residents’ perspective

Limiting mistreatment of staff in the ED setting is a challenge, Jessica Adkins Murphy, MD, president of the Emergency Medicine Residents’ Association and an emergency medicine resident practicing at University of Kentucky Hospital, told HealthLeaders.

“The reason this has been so challenging is because in the emergency room we are dealing with a lot of people who are having the worst days of their lives. Many people have addiction issues and psychiatric emergencies. They are unable to inhibit their reactions to providers. That is why we see a high level of workplace violence in the emergency room. That has led to challenges in implementing zero tolerance policies for mistreatment,” she said.

The ED setting is unlike most other workplaces, Murphy said. “We can’t treat people the way airports treat people. At an airport, if you have shown violence toward staff, you do not get to fly. Flying is seen as a privilege. On the other hand, healthcare is something we need to provide to people regardless of their psychiatric condition or behavior. We must provide emergency care to people. Some people want hospitals to function more like airports, but it doesn’t work in practice. However, we can set the tone for what is acceptable in the emergency department. We can post notices that we have a no-tolerance policy for abuse and mistreatment.”

To reduce mistreatment in the ED setting, developing the staff’s de-escalation skills is crucial, she said. “We could do a lot more to educate staff on de-escalation. As important a skill as it is to suture and to be able to intubate patients, you need to be able to effectively de-escalate patients and their family members. When it seems like tensions are running high, we should be able to defuse the situation instead of letting it get to the point where there is risk of violence. It does not work 100% of the time, but it can be effective.”

The study’s finding that there is no association between mistreatment and residents feeling career choice regret is not surprising, Murphy said. “The rate of career choice regret was only about 3% in residents. They were not at the point of regretting going into this career path. This is compared to other studies that have found rates of career choice regret as high as 30% in practicing physicians who are out of residency. In this study, it appears that residents were not at a severe level of burnout where they regretted going into this profession.”

It is also unsurprising that senior residents were more likely to report burnout than first-year residents, she said. “You would expect that someone who has been through mistreatment several times might have developed enough resilience to let moral injuries roll off them, but that is not the case. Depending on how supported you feel, how many hours you have worked, or how things are going at home, mistreatment can make you feel so fatigued that you do not have the resilience or emotional energy to deal with these things, which can result in burnout.”

Christopher Cheney is the senior clinical care​ editor at HealthLeaders. This story first ran on HealthLeaders Media. 

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