Open Forum Infectious Disease study highlights workplace issues within the specialty.
Kwan Kew Lai, MD, DMD, remembers the stress of trying to balance, teaching, research, and clinical work as a full-time professor in the Department of Infectious Diseases at a major academic hospital.
Over the course of her career, she recalls, her responsibilities in administration, patient care, and teaching “increased relentlessly.” And, given that research and scholarly work received additional emphasis when it came time for advancement within the department hierarchy, she routinely felt pressure to produce. Worried that these outside forces would affect her patient care—the reason she went into medicine in the first place—the infectious disease specialist left academia more than 10 years ago.
“Women faculty, being in the minority, had to constantly prove themselves to their male department chairs that they were equally capable of handling increasing workload, myriad of new teaching, patient care, and administrative responsibilities heaped upon them, as well as continue to be as productive in research and publications as their male counterparts, while juggling family and child care,” Lai told Contagion®. “There was no such thing as protected time for research or scholarly activities despite being in an academic center. How many physicians would dare publicly declare or admit to their superiors in private that they were overwhelmed and needed help and relief? To do so would be tantamount to committing academic suicide.”
It turns out Lai is hardly alone, particularly within the field of infectious diseases. A recent survey, conducted by infectious disease specialists based at Montefiore Medical Center/Albert Einstein College of Medicine in New York and published in Open Forum Infectious Diseases, found that, at least among their colleagues, burnout was high—although, notably, so was job satisfaction. Indeed, more than half of the survey respondents met the criteria for burnout, based on the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), while more than 90% felt positive about their work.
“There has been so much literature in scientific journals and the lay press about physician burnout and how this impacts the future of the workforce as well as patients, [but] there is less on specialty-specific burnout,” study co-author Priya Nori, MD, assistant professor of infectious diseases and orthopedic surgery, and medical director of the Antibiotic Stewardship Program at Albert Einstein College of Medicine, told Contagion®. “Optimistically, we wanted to believe that the immense intellectual and personal satisfaction derived from our field somehow protected people from burnout. Like their colleagues in other fields, ID physicians are also prone to burnout due to the systems issues pervasive throughout medicine—focus on documentation, billing, relative value units, administrative tasks, lack of support staff—basically all the things that take the joy out of being a doctor, teacher, and mentor.”
Nori and her co-authors surveyed 32 of their colleagues, using the MBI-HSS and a self-styled job description survey, during the 2018 Montefiore ID divisional retreat on burnout, wellness, and stress management and found that professionals who described themselves as physician scientists/funded investigators, clinicians, clinician-educators, and/or hospital administrators, all within the ID arena, scored highly on “emotional exhaustion” (34%) and “depersonalization” (38%). Seventeen (53%) participants met criteria for burnout. Most felt they lacked adequate support staff or financial compensation. Notably, given Lai’s experience described above, significantly more males felt they had adequate coverage to tend to personal matters (77% male vs 13% female), while more females reported that child care was a source of stress (70% female vs 27% male). In addition, more female respondents said they were asked to stop working by family members (64% vs 8% male).
At the same time, 15 of the respondents scored highly on the MBI-HSS personal accomplishment subscale (not surprisingly, they were less likely to meet the criteria for burnout). And, more than 70% of all surveyed faculty in all roles felt they had accomplished worthwhile things and found their work rewarding.
So, are ID specialists more likely to experience burnout than other physicians? Or, conversely, is the field perhaps more rewarding than others?
Nori isn’t so sure. “Infectious diseases involve every organ system and sometimes spare no host; they can be devastating and incredibly fascinating all the same time,” she noted. “Infectious disease is also the only field where illnesses are emerging [that] did not exist before, such as extensively drug-resistant organisms or new influenza viruses due to genetic re-assortment. Infectious diseases are also re-emerging due to political factors, civil wars, lack of access to vaccines, anti-vax movements, climate change, globalization, etc. And, as new treatments advance for rheumatologic diseases, multiple sclerosis, inflammatory bowel disease, cancers, etc. there is collateral damage on the host immune system, predisposing patients to a variety of infectious diseases. Also, as more patients receive and live longer with either bone marrow or solid organ transplants, we have to ensure that we can prevent and treat their infectious complications.”
Lai’s experience, it seems, echoes that of many of the Montefiore survey partipants. She said in an interview that she did feel satisfied with her work—citing in particular her “close relationship with...HIV/AIDS patients, and [her] passion for teaching”—but also mentioned she was “under-compensated as a woman, received minimal support staffing, lacked mentors to guide me in my professional development and promotion, and above all, work-life balance was difficult to achieve.”
So what is she doing now? Among other things, she has provided medical care on a volunteer basis, working most recently in West Africa during the Ebola crisis. She wrote a book about her experiences there entitled Lest We Forget: A Doctor’s Experience with Life and Death During the Ebola Outbreak.
“I left academia… to pursue my delayed passion for medical volunteering and now divide my time working part-time as a clinician and volunteering the rest of my time in HIV/AIDs mentoring, disaster medical relief work, and providing medical care in refugee camps all over the world with various NGOs, including Médecins Sans Frontières,” she said.
Noble work, for sure. But perhaps industry as a whole should move toward helping professionals who encounter burnout to keep them in academic hospitals where they can serve as a resource and mentor to others.