One of the most exciting things about this was that I got to take a five-hour plane ride by myself without children. I was very excited. So we all know that critical care is a very, very challenging and stressful field. And many studies show that over half of critical care physicians are burned out every year. And many studies also find that these critical care doctors have high levels of job satisfaction. And so a few years ago, my colleague, Dr. Claire Barshide, who's a medical sociologist, we wanted to discover and explore the seeming contradiction of high work satisfaction and also high burnout. And so we wanted to assess alternate ways of thinking about dissatisfaction or discontent with your job and try to understand the potential modifiable risk factors that are associated with them. We didn't want to measure burnout directly, because frankly, I think burnout is a little bit overstudied right now. We know that people are burned out, but we don't know why or what the deeper things are that underpin burnout. So based on some other surveys, we had four outcome variables. And we asked people to rate their overall work satisfaction on a Likert scale. We asked people to rate their work-life balance satisfaction. We asked them how frequently they experienced stress in any given week. And we asked, lastly, their turnover intention, the likelihood that they were going to look for a new job within one year. And the reason why this is so important is that, as we know, turnover is very, very expensive for the health care workforce. And we first sent the survey in 2016 to the SCCM physician database. And then we wanted to repeat the survey in order to understand how the pandemic had changed these factors five years later. And with the second survey, we expanded the scope to include all SCCM members. But for the purposes of comparison, since we only looked at physicians in 2016, I'm only going to talk about what we found for comparing physician to physician in these two waves. So it was re-sent to the SCCM member database in 2021 and early 2022. So we asked many demographic questions. And we used generation because I think generation, more than age group, is able to, generations experience major world life events that color their worldview. Like, the oldest attending that I've ever trained with was a silent generation attending who grew up in the Depression. And the youngest trainee that I have now are medical students. They don't remember 9-11, and they don't remember what it was like to grow up without a smartphone. And so we decided to use generation instead of age as a lens for interpreting some of the data. We asked about different demographic things like gender and race, the type of hospital that you worked at, your relationship status, your salary, and the number of children you have, if any. We also looked at the different types of work structures that people had, how many hours they worked a week, the type of ICU they were in, the amount of time they spent practicing critical care medicine, and if they wanted to work the same number of hours or more hours, and also their practice environment. So in addition, a lot of emphasis has been placed on the health of the health care workforce. And we sought to understand a more complete picture of people's well-being and whether that affected anything. And we used these validated single-item questions asking people to characterize their own health. And these correlate strongly with outcomes. So these questions were on a four-point Likert scale as poor, fair, good, or excellent. And it's your own subjective view of your mental or physical health. So our results. In 2016, we got almost 700 completed responses. By the middle of the pandemic, people were tired of filling out surveys, so we got 450 completed responses, which is still the largest survey of critical care physicians to our knowledge. OK, so at least in terms of demographics, what we found was that between wave one and wave two, we got a lot more women who responded to the survey. The generation spread was about the same. We had almost 50% of Gen Xers and a lot more millennials in the second wave. The vast majority of people were married. Half of them in both groups, in both waves, had children who were in school age. And career stage was also pretty equally distributed. 40% of people were in their early career stage. And we define this early as 0 to 10 years, mid as 10 to 20, and late career is over 20 years. In terms of earnings, over 50% of respondents reported between $200,000 and $400,000 a year. And in wave two, we had a lot fewer low earners respond, and more people responded who are in the high income bracket. What was notable in wave one was almost 50% of respondents worked more than 60 hours a week, which is a lot. And those respondents who worked more than 60 hours fell to about 40% in wave two. Most people still are in academics. And I know that critical care is mainly practiced in non-academic environments in the United States, but the majority of our respondents were in academics. And the type of ICU was pretty distributed equally between the two waves. The majority of our respondents were PICU-MICU, neonatal ICU. And almost 50% of our respondents in both waves practiced critical care medicine for more than 3 quarters of their time. OK, so our key findings. So we found that in 2016, work satisfaction with practicing critical care medicine was very high. It was 82% of all respondents reported high satisfaction. And this, in the middle of the pandemic, has dropped sharply to about 64%. What we found was that in wave one, pre-pandemic, generation was significant. So most baby boomers reported high levels of work satisfaction. And also parents, respondents who had children, reported a high work satisfaction. But by 2022, these demographic differences disappeared. And there were no other work or demographic characteristics, including gender or income, that had a significant relationship with work satisfaction. So it fell significantly in five years. We found that work-life balance satisfaction really didn't change during the pandemic. It was consistently low. It was about 35%, 36% in both waves. And what was notable in 2016, in our first wave, was that we had a U-shaped distribution in generation. So we had millennials who reported high levels of work-life balance satisfaction. It dropped for Gen X, and then went back up. And baby boomers also had high levels of work-life balance satisfaction. Surprisingly, parents reported high levels of work-life balance satisfaction. But by 2022, these demographic differences were no longer significant. And it turns out that work-life balance satisfaction, at both points in our study, ranked lower than every other US specialty by other surveys, both in 2011 and 2020. On other survey data that rank different physician specialties, critical care, this is the lowest among all of those other physician specialties. And I think what is notable is that half of our respondents reported being somewhat or very dissatisfied with their work life balance. And so this is an unusual pattern where you have high levels of work satisfaction, but have low levels of work-life balance satisfaction. And this you will see sometimes in oncologists, where people who find a lot of meaning in their work, so their satisfaction is high, but they do too much of it, which affects work-life balance. We did find that while the overall rate of work-life balance satisfaction remained the same, there was a gender gap with work-life balance satisfaction in the pandemic. So almost 42% of men reported work-life balance satisfaction, and this was much lower in women. And this could be due to the unequal stresses of the pandemic on women. We found that in 2016, in wave one, more than a quarter of intensivists reported feeling stressed almost or most of the time. And in the middle of the pandemic, this rose to about 40%. Also in our earlier study, we found that the younger respondents, Gen X, early career, and those who made lower incomes reported higher levels of stress. But again, after the pandemic, all these generational and demographic differences disappeared. Other studies have found high rates of stress in women. We did not find gender and frequency of work stress in our study. And our last primary outcome was turnover and tension. So before the pandemic, about a quarter of respondents reported they were likely to look for a new job within a year. And again, this was mainly millennials, early career, and lower income earners. But during the pandemic, this rose to about a third of respondents. And generational career stage and income differences dissipated. Everybody was more likely to look for a new job in a year. And this represents, actually, a pretty significant disruption to health care in the United States, if up to a third of critical care physicians are likely to look for a new job. The estimates for the cost of turnover for physicians between $250,000 to $350,000 a year with lost income, recruiting, et cetera. So this represents a significant disruption. So post-pandemic, the work structure that most consistently related to our outcome variables was work hours. And the work hours had some nuance to it. It was the number of work hours. So we asked people to report how many hours a week do you work. And we had several categories, 40, 40 to 50, 50 to 60, 60 to 70. We divided them up in 10-hour increments. And we found that the inflection point was 60 hours. If you worked more than 60 hours a week, you're much more likely to have distress. And if you worked less than that, so we don't present this as a mean of the number of hours people work, but this was the inflection point where distress went up significantly. About half our respondents in 2016 reported working more than 60 hours. That is a lot of hours a week. And even in our phase 2 study, about 40% of people reported working more than 60 hours a week. And of note, only 25% of salaried US workers and only 20% of the general physician population works more than 60 hours a week. So this is a lot. But more importantly than the number of hours physician satisfaction with their work hours is more relevant than the numbers themselves. Most respondents wanted to work fewer hours. In both waves of our study, 62% wanted to work less but could not. And this desire to work less, but being unable to work less, affected every single one of our outcome variables. So if you wanted to work less, you were significantly less likely to be satisfied with your work. So the first number is those who wanted to maintain their work hours, maintain or work more. 78% of those people were satisfied with their jobs overall versus 55% of those respondents who wanted to work fewer hours. Sorry, my mouse is not working. This was also true with work-life balance satisfaction, but even more dramatic. If you wanted to work the same number of hours, 66% were satisfied with their work-life balance. But if you wanted to work fewer, this fell to 18%. This is a significant fall. This was also notable for stress. You were more than twice as likely to report frequent work stress if you wanted to work fewer hours. Same thing with turnover intention. You're more than twice as likely to seek a new job within a year if you wanted to work fewer hours. And the COVID-19 pandemic has had very, very widespread effects on physical and mental health. And so we found a very high rate of poor mental and physical health. So 28% of our respondents reported poor or fair mental health, and 21% reported poor or fair physical health. These are physicians that are self-reporting this kind of data. This is distressingly high. And what we found interesting was that the average college grad, full-time working US worker, only 15% of those college grads in the United States have poor mental or physical health, compared to significantly higher in the physician population, which is distressing. And a lot of previous research has pointed out many mechanisms of why physicians themselves are so unhealthy. And it's the lack of routine checkups, untreated mental health conditions, there's presenteeism while sick. I don't personally remember the last time that I took a sick day. I've been in medicine for almost 20 years. In 15 years, I have not called. I had COVID, and I had to take five days. And that is it. I have not called in sick to work. I check my blood pressure on the anesthesia machine in the morning. I don't remember the last time I got blood drawn. And so this is part of the reason why the health care workforce is so unhealthy. We just don't take care of ourselves. And those who rated their mental health favorably were much more likely to be satisfied with their work satisfaction. So the poor mental and physical health affected every single one of our outcome variables. And so mental health, if you have poor mental or physical health, you're much, much, much less satisfied with work. If you have poor mental or physical health, you're significantly less satisfied with your work-life balance. If you see that on the left, the mental health one, only 9% of people with poor or fair mental health were satisfied with their work-life balance. We don't know the direction of the causality, but they are very, very strongly correlated. And the same is true, again, for all our outcome variables. If you have poor physical or mental health, you're much more likely to be stressed. And lastly, if you have poor mental or physical health, you are twice as likely to seek a new job within a year. And so the SARS-CoV pandemic has further strained a health care workforce that was already under pressure. And so work satisfaction used to be a strength of physician intensivists. And this has sharply dropped while work stress and turnover and tension has increased. And the high numbers of intensivists report poor physical and mental health. And only a small minority of physician intensivists are satisfied with their work-life balance before or during the pandemic. And notably, the only work structure that was related to these outcomes is weekly work hours and their alignment with personal preferences. If you want to work less and can't, it's going to affect everything. And so I think in order to support the work satisfaction of critical care providers and to reduce their turnover, we need to really create durable structures that allow the overtaxed physician workforce to work less. And also, the poor self-reported mental and physical health of intensivists indicate that we are very vulnerable as individuals. And these indicators have outsized effects that are correlated with satisfaction, stress, and turnover and tension. And so we also need to prioritize the health of the workforce. So these are our two main take-homes from our study that we should allow people to work less if they want to work less and prioritize their own physical and mental health. Thank you.

critical care physicians

job satisfaction

burnout rates

COVID-19 pandemic

work-life balance