Reading the Smoke Signals: What Is the Meaning of Burnout Among Pediatric Critical Care Physicians?*
In this issue of Critical Care Medicine, Shenoi et al (12) report on burnout and psychological distress in a cohort of PICU physicians surveyed using the MBI and the General Health Questionnaire. They describe a sample of 253 physicians (37% of the 686 invited), 60.5% male, and the majority between the ages of 41 and 60 years. One of the first studies reporting Burnout Syndrome (BOS) in a large cohort of PICU physicians in the United States found a prevalence of 49% burnout in at least one of the three subscales of the MBI (12). The survey also measured psychological distress and found a very strong association with severe burnout. Interestingly, they did not find any association between burnout and PICU type, size, or on-call burden (12). These findings are similar to a prior study of U.S. PICU physicians that found no difference between burnout scores providers taking in-house call compared to from-home coverage models (13).
Disturbingly, female respondents in the present study by Shenoi et al (12) were twice as likely to report burnout, with 60% of women respondents scoring high for any burnout subscale, at an odds ratio of 2.1 compared with their male counterparts. Furthermore, 30% of female PICU attendings in this cohort reported self-perceived low personal accomplishment, almost twice as high as the male respondents. Factors that may influence work-life balance and its impact on BOS, such as marital status and children, were not found to be significant in this cohort. These findings point to a clear gender discrepancy in burnout in pediatric critical care medicine (12).
Why would such a significant proportion of women practicing in largely academic centers have a low opinion of their own accomplishment? A recent report on U.S. medical school faculty demonstrated that more than twice as many men as women hold full-professor appointments, and women counterparts had lower publication numbers and National Institutes of Health grants (14). Could these disparities in academic accomplishments underlie this sense of low self-efficacy, or is it vice versa? A recent survey demonstrated that almost 50% of female early medical students had imposter syndrome—a persistent fear of being exposed as a “fraud” (over twice the rate in their male counterparts), which was highly associated with burnout (15).