title: Worklife and Wellness in Academic General Internal Medicine: Results from a National Survey.
abstract: General internal medicine (GIM) careers are increasingly viewed as challenging and unsustainable.
  
  
  
  We aimed to assess academic GIM worklife and determine remediable predictors of stress and burnout.
  
  
  
  We conducted an email survey.
  
  
  
  Physicians, nurse practitioners, and physician assistants in 15 GIM divisions participated.
  
  
  
  A ten-item survey queried stress, burnout, and work conditions such as electronic medical record (EMR) challenges. An open-ended question assessed stressors and solutions. Results were categorized into burnout, high stress, high control, chaos, good teamwork, high values alignment, documentation time pressure, and excessive home EMR use. Frequencies were determined for national data, Veterans Affairs (VA) versus civilian populations, and hospitalist versus ambulatory roles. A General Linear Mixed Model (GLMM) evaluated associations with burnout. A formal content analysis was performed for open-ended question responses.
  
  
  
  Of 1235 clinicians sampled, 579 responded (47 %). High stress was present in 67 %, with 38 % burned out (burnout range 10-56 % by division). Half of respondents had low work control, 60 % reported high documentation time pressure, half described too much home EMR time, and most reported very busy or chaotic workplaces. Two-thirds felt aligned with departmental leaders' values, and three-quarters were satisfied with teamwork. Burnout was associated with high stress, low work control, and low values alignment with leaders (all p < 0.001). The 45 VA faculty had less burnout than civilian counterparts (17 % vs. 40 %, p < 0.05). Hospitalists described better teamwork than ambulatory clinicians and fewer hospitalists noted documentation time pressure (both p < 0.001). Key themes from the qualitative analysis were short visits, insufficient support staff, a Relative Value Unit mentality, documentation time pressure, and undervaluing education.
  
  
  
  While GIM divisions overall demonstrate high stress and burnout, division rates vary widely. Sustainability efforts within GIM could focus on visit length, staff support, schedule control, clinic chaos, and EMR stress.
authors.affiliation: Division of General Internal Medicine, Hennepin County Medical Center, 701 Park Avenue (P7), Minneapolis, MN, 55415, USA. Mark.Linzer@hcmed.org.|Department of Medicine, University of Minnesota, Minneapolis, MN, USA. Mark.Linzer@hcmed.org.
authors.forename: Mark
authors.initials: M
authors.lastname: Linzer
authors.affiliation: Division of General Internal Medicine, Hennepin County Medical Center, 701 Park Avenue (P7), Minneapolis, MN, 55415, USA.|Minneapolis Medical Research Foundation, Minneapolis, MN, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Poplau
authors.affiliation: Department of Medicine, University of Kansas, Kansas City, KS, USA.
authors.forename: Stewart
authors.initials: S
authors.lastname: Babbott
authors.affiliation: Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Wichita, KS, USA.
authors.forename: Tracie
authors.initials: T
authors.lastname: Collins
authors.affiliation: Minneapolis Medical Research Foundation, Minneapolis, MN, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Guzman-Corrales
authors.affiliation: Biostatistical Design and Analysis Center, Clinical and Translational Sciences Institute, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Jeremiah
authors.initials: J
authors.lastname: Menk
authors.affiliation: Center for Physician Wellness and Professional Fulfillment, Stanford Medicine, Palo Alto, CA, USA.
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Murphy
authors.affiliation: Society of General Internal Medicine and Association of Chiefs and Leaders in General Internal Medicine, Alexandria, VA, USA.
authors.forename: Kay
authors.initials: K
authors.lastname: Ovington
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D002055:Burnout, Professional / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006282:Health Personnel / Q000523:psychology* / Q000706:statistics & numerical data*; D006801:Humans; D007388:Internal Medicine / Q000706:statistics & numerical data*; D007588:Job Satisfaction; D008297:Male; D009722:Nurse Practitioners / Q000523:psychology / Q000706:statistics & numerical data; D010823:Physician Assistants / Q000523:psychology / Q000706:statistics & numerical data; D010820:Physicians / Q000523:psychology / Q000706:statistics & numerical data; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D017132:Workplace / Q000523:psychology / Q000706:statistics & numerical data*
keywords: burnout; clinician burnout; general internal medicine; physician satisfaction; stress