OB.GYN. chairs surveyed; Academic department chairs: Fed up, burnt out?

OB/GYN News, April 15, 2002 by Bruce Jancin

DALLAS -- The nation's chairs of academic ob.gyn. departments are at high risk for job burnout, a new survey shows.

While this is the first such study done in any medical specialty, the findings probably are generalizable to medical school department chairs in disciplines other than ob.gyn., according to Dr. Steven G. Gabbe, dean and professor of ob.gyn. at Vanderbilt University School of Medicine, Nashville, Tenn.

The survey results are disturbing because department chairs are among a specialty's leaders. They occupy key decision-making positions. They should serve as models of health and effectiveness for physicians in training as well as for patients. Yet many feel sucked dry and fed up, Dr. Gabbe observed at the annual meeting of the Council on Resident Education in Obstetrics and Gynecology and the Association of Professors of Gynecology and Obstetrics.

"Department chairs today have to behave more like chief executive officers of corporations than physicians. Department chairs in ob.gyn. are managing businesses that take in and spend tens of millions of dollars annually--and there's a great deal of stress associated with this role," he said.

Burnout has been extensively studied by industrial psychologists. Symptoms include insomnia, fatigue, headaches, and deteriorating personal relationships. The medical consequences of burnout include increased rates of hypertension, depression, acute MI, alcoholism, drug abuse, and colitis. Increased divorce rates and job turnover are among the social consequences.

Dr. Gabbe sent a questionnaire that included elements from the Maslach Burnout Inventory--Human Services Survey, considered the preferred method for assessment of burnout, to 131 chairs of academic ob.gyn. departments in the United States and Puerto Rico. The response rate was 91%. Anyone who's conducted a research survey will recognize this as extraordinarily high.

"We really touched a nerve," he said at the meeting, also sponsored by the American College of Obstetricians and Gynecologists.

Most department chairs reported high levels of emotional exhaustion and moderate to high levels of depersonalization. These are two of the three necessary elements in Maslach's definition of burnout, which is the standard one used in industrial psychology.

The third required element is a low sense of personal achievement. The fact that most ob.gyn. chairs reported a high sense of personal accomplishment was the only thing preventing the majority of them from falling into the abyss of burnout.

The nation's ob.gyn. chairs average 55 years in age and have served as chair a mean of 7.2 years. They work 67.4 hours per week. Half spend at least half of their work week on administrative duties. Of concern, nearly half of these career-long educators now spend 10% or less of their week in teaching.

Chairs spend a mean of 8% of their week doing research.

Fifteen percent of ob.gyn. chairs reported feeling burnout from work weekly or more often. Thirty-four percent indicated they are moderately to extremely likely to step down in the next 1-2 years, half as a result of reasons of age or health, the remainder because they're fed up with what they describe as an excessive work load and lack of support.

Psychologists cite a feeling of lack of control as a key factor in job burnout. So it's revealing to consider what the chairs identified as some of their chief job stressors: budget deficits, Medicare billing audits, union disputes, loss of key faculty. Not much control is possible over those, Dr. Gabbe observed.