Clinical pathology selected abstracts

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Editor: Deborah Sesok-Pizzini, MD, MBA, chief medical officer, Labcorp Diagnostics, Burlington, NC, and adjunct professor, Department of Clinical Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.

A Canadian study of pathologist burnout: prevalence, drivers, and mitigation strategies

August 2023—Burnout has been reported to affect as many as 44 percent of physicians. It is listed in the International Classification of Diseases 11th Revision (ICD-11) and has been attributed to chronic workplace stress, emotional exhaustion, depersonalization, and a low sense of personal accomplishment. A social psychologist created the Maslach Burnout Inventory (MBI) tool to measure degrees of burnout. The 2018 Canadian Medical Association Physician Health Survey of 3,000 members found an overall burnout rate of 30 percent, and 28 percent of pathologists who responded to that survey indicated they were burned out. Physician burnout can have a significant negative impact on patient care, including on the amount of medical errors. It has been estimated that physician burnout costs the Canadian health care system CAD $185 million due to early retirement and CAD $27.9 million due to reduced professional work effort. The estimated annual cost related to physician burnout-driven turnover in the American health care system is $4.6 billion. Drivers of physician burnout include workload and job demands, work efficiency and resources, control and flexibility in one’s work, meaning in one’s work, work-life integration, social support and community at work, and organizational culture and values. The author conducted a national burnout study specifically related to pathology that used the MBI–Human Service Survey for Medical Personnel (MBI-HSS [MP]) tool for assessment. The goals of the study were to identify the prevalence of burnout within pathology practice in Canada, drivers of physician burnout, and pathologist burnout mitigation strategies at the individual and departmental level. The author designed an electronic survey that was disseminated by participating departmental chiefs and the Canadian Association of Pathologists. The survey included the MBI-HSS (MP) and three open-ended qualitative questions: “What do you find to be the most stressful aspect of your practice?”, “Have you introduced anything into your own practice that you think is helping to mitigate against burnout?”, and “Has your department introduced anything that you think is helping to mitigate against burnout?” All questions, except those that were open ended, required an answer for the participant to advance through the survey process and submit the completed survey. All participants provided informed consent, but the survey was anonymous—it did not involve collecting information that could identify the respondents. The survey was rolled out in three phases, and 427 pathologists across all 10 Canadian provinces completed it. This represented a survey response rate of approximately 50 percent of all Canadian Association of Pathologists members and 27 percent of all pathologists practicing in Canada. Burnout was defined as a high score on the emotional exhaustion (27 or more) or depersonalization (10 or more) domain. The results showed that the prevalence of burnout in Canadian pathology was 58 percent. Female pathologists showed significantly higher levels of emotional exhaustion than male pathologists, and those in practice for fewer than five years had the highest level of depersonalization. Of interest, those who had been in practice for six to 10 years had a significantly lower sense of personal accomplishment. Drivers of burnout included workload and chronic work-related pain. The most frequent effective departmental strategy to address burnout involved organizational culture, and the most effective approach by individual pathologists involved work-life integration. Workload was the leading job-related stressor, as reflected in 35 percent (210 of 599) of responses to the question, “What do you find to be the most stressful aspect of your work?” Furthermore, 47 percent (200 of 427) of pathologists responded yes to the question, “Do you experience chronic or persistent pain at work?” Female pathologists were more likely than male pathologists to experience chronic work-related pain, (61 and 32 percent, respectively). Based on the study findings, the author concluded that pathology departments should develop strategies for mitigating pathologist burnout. They include targeting workload and fostering a culture of wellness, social support, and community.

Keith J. The Burnout in Canadian Pathology Initiative—pathologist burnout prevalence, drivers, and existing mitigation strategies. Arch Pathol Lab Med. 2023;147:568–576.

Correspondence: Dr. Julia Keith at julia.keith@sunnybrook.ca