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Variable Question Response Options (5 Point Likert Scale) Burnout To what degree have you experienced: Not at all to extremely During the past two weeks I have felt emotionally exhausted at work. Burnout To what degree have you experienced: Not at all to extremely During the past two weeks my job has contributed to me feeling less sensitive to others’ feelings/emotions Traumatic stress To what degree have you experienced: Not at all to extremely During the COVID-19 crisis, how much exposure to death or threat of death did you perceive for yourself or your loved ones, or through witnessing it in others, or through repeatedly hearing the extreme adverse details? Changing priorities Because of the COVID-19 Pandemic, I changed my priorities about what is important in life* Strongly disagree to strongly agree R-factor Based on your work-life experience over the past year, to what extent are you contemplating the following over the next two years? Reduce Reduce your clinical work effort (e.g., fewer hours of patient care). Strongly disagree to strongly agree Restrict Restrict scope of practice (e.g., do less of some specific aspect of your work). Strongly disagree to strongly agree Reroute Reroute your career away from patient care (e.g., research, administration, etc.). Strongly disagree to strongly agree Relocate Relocate, seek a new place to work. Strongly disagree to strongly agree Retire Retire from or quit clinical medicine. Strongly disagree to strongly agree Re-engage** Re-engage with colleagues to improve work-life well-being in your field. Strongly disagree to strongly agree Redesign** Redesign your practice or your workflow to improve work-life well-being. Strongly disagree to strongly agree R5: “Composite R” of first 5 R-factors that correlate Total score of Reduce, Restrict, Re-route, Relocate, Retire Valid N % Age < 45 317 49.0 >=45 330 51.0 Gender Female 408 60.1 Male 260 38.3 Other/Non-binary/Choose not to Disclose 11 1.6 Race White 537 79.0 Black or African-American 33 4.8 Asian 68 10.0 Other/Choose not to Disclose 42 6.2 Ethnicity Hispanic/Latino 48 7.2 Non-Hispanic/Latino 618 92.8 Region Northeast 119 17.4 South 180 26.4 Midwest 211 30.9 West 173 25.3 Institution type Medical school 397 58.3 Not at a medical school 284 41.7 Population density Urban 339 49.6 Suburban 226 33.1 Rural 118 17.3 Underserved area Yes 393 57.8 No 222 32.6 Unsure or N/A 65 9.6 Highest degree earned DO/MD 642 94.0 MD/PhD or DO/PhD 41 6.0 Traumatic Stress Not at all/Very little/Moderately 428 64.8 A lot/Extremely 232 35.2 Changing Priorities Strongly disagree/disagree/neither agree nor disagree 528 77.3 Agree/Strongly agree 155 22.7 Burnout No (<1.75 cutoff) 385 58.6 Yes (>=1.75 cutoff) 272 41.4 Reduce Strongly disagree/Disagree/Neither agree nor disagree 373 57.0 Agree/Strongly agree 281 43.0 Restrict Strongly disagree/Disagree/Neither agree nor disagree 434 66.9 Agree/Strongly agree 215 33.1 Reroute Strongly disagree/Disagree/Neither agree nor disagree 475 73.0 Agree/Strongly agree 176 27.0 Relocate Strongly disagree/Disagree/Neither agree nor disagree 521 79.1 Agree/Strongly agree 138 20.9 Retire Strongly disagree/Disagree/Neither agree nor disagree 571 88.0 Agree/Strongly agree 78 12.0 Re-engage (reverse) Neither agree nor disagree/Agree/Strongly agree 595 90.8 Strongly disagree/Disagree 60 9.2 Redesign (reverse) Neither agree nor disagree/Agree/Strongly agree 570 86.5 Strongly disagree/Disagree 89 13.5 Composite R5 above cutoff score (12.5) No 343 51.5 Yes 317 48.5 - Table 3.
Bivariate Analyses of Traumatic Stress, Change in Priorities, Burnout, and Overall Withdrawal from Clinical Practice (Composite R5) by Participant Demographic Information
Traumatic Stress P value Change in Priorities P value Burnout P value Composite R5 Above Cutoff score (12.5) P value % A lot/Extremely % Agree/Strongly agree % >= 1.75 Cutoff score Age 0.156 0.009 <0.001 0.871 <45 38.6 27.4 50.5 48.6 >=45 32.9 18.5 33.8 47.9 Gender 0.001 0.017 <0.001 0.009 Female 40.2 26.5 50.0 52.4 Male 26.4 17.7 28.1 42.0 Other/Non-binary/Choose not to Disclose 44.4 9.1 44.4 77.8 Race 0.170 0.105 0.425 0.082 White 34.9 21.2 40.5 46.0 Black or African-American 46.7 39.4 53.3 51.7 Asian 26.2 25.0 38.5 56.3 Other/Choose not to Disclose 42.5 23.8 47.5 64.1 Ethnicity 0.061 0.481 0.649 0.755 Hispanic/Latino 47.9 27.1 37.5 45.5 Non-Hispanic/Latino 34.2 22.8 41.6 48.5 Practice/program location 0.084 0.164 0.574 0.840 Northeast 35.9 16.8 43.2 47.0 South 40.0 27.2 39.9 46.6 Midwest 28.3 20.9 38.5 51.0 West 38.1 24.3 45.2 48.4 Institution type <0.001 0.853 0.936 0.936 Medical school 28.6 22.4 41.8 48.7 Not at a medical school 44.3 23.2 41.2 48.3 Area of working 0.232 0.032 0.592 0.235 Urban 32.1 18.9 39.4 47.3 Suburban 37.1 28.3 42.9 52.7 Rural 40.2 22.9 44.1 43.3 Underserved area 0.082 0.845 0.932 0.378 Yes 38.4 22.6 42.0 46.2 No 29.3 23.4 40.4 52.2 Unsure or N/A 34.9 20.0 41.3 50.0 - Table 4.
Associations Between Traumatic Stress, Changing Priorities, and Burnout, Adjusted for Age, Race, Gender, Ethnicity, and Institution Type
Traumatic Stress Not at all/Very little/Moderately (n = 428) A lot/Extremely (n = 232) P value OR CI Changing Priorities <0.001 2.6 1.8 to 3.9 Strongly disagree/ Disagree/Neither agree nor disagree 83.6% 64.7% Agree/Strongly agree 16.4% 35.3% Traumatic Stress Not at all/Very little/Moderately (n = 425) A lot/Extremely (n = 231) P value OR CI Burnout 0.007 1.6 1.1 to 2.4 <1.75 cutoff score 63.5% 49.4% >=1.75 cutoff score 36.5% 50.6% Burnout <1.75 cutoff score (n = 385) >=1.75 cutoff score (n = 272) P value OR CI Changing Priorities <0.001 3.0 2.0 to 4.5 Strongly disagree/ Disagree/Neither agree nor disagree 85.7% 64.7% Agree/Strongly agree 14.3% 35.3% Traumatic stress, adjusted for burnout Not at all/Very little/Moderately (n = 428) A lot/Extremely (n = 232) P value OR CI Changing Priorities <0.001 2.5 1.6 to 3.7 Strongly disagree/ Disagree/Neither agree nor disagree 83.6% 64.7% Agree/Strongly agree 16.4% 35.3% Abbreviations: OR, odds ratio; CI, confidence interval.
- Table 5.
R-Factors by COVID-19 Related Traumatic Stress, Changing Priorities, and Burnout, Adjusted for Age, Race, Gender, Ethnicity, and Institution Type
R-Factors Traumatic Stress Changing Priorities Burnout Traumatic Stress, Adjusted for Burnout Agree/Strongly Agree on the following items Not at all/Very little/Moderately A lot/Extremely P value OR CI Strongly Disagree/Disagree/Neither Agree nor Disagree Agree/Strongly Agree P value OR CI <1.75 Cutoff Score >=1.75 Cutoff Score P value OR CI Not at all/Very little/Moderately A Lot/Extremely P value OR CI Reduce 38.9% 50.4% 0.069 1.4 1.0 to 2.0 35.8% 66.9% <0.001 3.4 2.3 to 5.1 29.9% 62.1% <0.001 4.2 2.9 to 6.1 38.9% 50.4% 0.302 1.2 0.8 to 1.8 Restrict 29.9% 39.2% 0.044 1.5 1.0 to 2.1 26.0% 57.5% <0.001 3.9 2.6 to 5.9 23.2% 47.5% <0.001 3.3 2.3 to 4.9 29.9% 39.2% 0.152 1.3 0.9 to 1.9 Reroute 23.5% 33.5% 0.030 1.5 1.0 to 2.3 23.6% 38.7% <0.001 2.1 1.4 to 3.1 17.4% 41.0% <0.001 3.9 2.6 to 5.8 23.5% 33.5% 0.110 1.4 0.9 to 2.1 Relocate 17.6% 27.2% 0.048 1.5 1.0 to 2.3 15.9% 37.7% <0.001 3.1 2.0 to 4.8 10.9% 35.4% <0.001 3.8 2.4 to 5.9 17.6% 27.2% 0.236 1.3 0.8 to 2.0 Retire 10.9% 14.1% 0.202 1.4 0.8 to 2.5 10.2% 18.2% 0.002 2.7 1.4 to 4.9 9.0% 16.4% <0.001 5.5 2.8 to 10.5 10.9% 14.1% 0.330 1.3 0.7 to 2.4 Re-engage (reverse) 9.0% 9.5% 0.967 1 0.5 to 1.8 8.9% 9.9% 0.735 1.1 0.6 to 2.2 7.3% 11.4% 0.067 1.8 1.0 to 3.3 9.0% 9.5% 0.933 1.0 0.5 to 1.8 Redesign (reverse) 13.8% 13.0% 0.947 1 0.6 to 1.6 15.9% 5.3% 0.006 0.3 0.2 to 0.7 15.7% 9.9% 0.211 0.7 0.4 to 1.2 13.8% 13.0% 0.840 1.1 0.6 to 1.8 CompositeR above cutoff (12.5) 44.0% 57.0% 0.011 1.6 1.1 to 2.3 41.6% 72.2% <0.001 3.7 2.4 to 5.8 36.1% 66.4% <0.001 4.0 2.7 to 5.8 44.0% 57.0% 0.060 1.4 1.0 to 2.1 Abbreviations: OR, odds ratio; CI, confidence interval.
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