Female Clinicians Suffer from Clinician Burnout More Than Males

Female clinicians experience clinician burnout at a higher rate than their male clinician counterparts, according to a study published in JAMA Network Open.

Research also revealed local work culture factors might result in increased clinician burnout on top of EHR usage.

Healthcare professionals commonly tie EHR usability, emergence, and prevalence to clinician burnout. Poor EHR usability can lead to high levels of physician attrition, depression, dissatisfaction, and burnout.

However, enhanced EHR usability can lead to increased EHR adoption rates, fewer clinical errors, mitigated clinician burnout, financial benefits, and better patient safety.

Duke University researchers assessed EHR use among 1,310 attending physicians, advanced practice providers (APPs), and organization staff using its EHR system usage report and a burnout, wellness, and work satisfaction survey.

Researchers leveraged the Maslach Burnout Inventory (MBI) EHR sub-survey to gauge clinician burnout. Researchers base MBIon a five-point Likert scale of response, ranging from “strongly disagree” to “strongly agree.” Those scores were then transformed to a 100-point scale to ease interpretation.

Female clinicians across all three clinician types reported more burnout than their male colleagues. Although female clinicians spent more time in the EHR and had more appointment days, female clinicians did not have more patient encounters and did not have more inbox messages than male clinicians.

“Differences by sex in how clinicians deliver clinical care may also be driving these differences in EHR usage metrics,” explained the study authors. 

“For example, female clinicians spend more time in direct patient care, even to the disadvantage of their overall volume of encounters. They may also be responding to different gendered expectations for care encounters reflected in the time spent in front of the patient.”

Research also revealed no statistical difference in after-hours EHR time by clinician gender. Both male and female clinicians spent roughly one-third of their time after hours using the EHR. Female clinicians with moderate to severe burnout spent less time after hours in the EHR than equally burnt-out male clinicians.

“The consistency of EHR use after hours and across all burnout categories appears to be more reflective of the flexibility to utilize the EHR at times that are more effective for them to complete their work,” the study authors explained.

“The relative decrease in after-hours time for female clinicians with moderate-to-severe burnout may be indicative of other competing priorities outside of work for these clinicians that necessitate improved efficiency with the EHR. Our results suggest that the time of day when a clinician works is not as important as the volume of time that they work,” the researchers continued.

Furthermore, female clinicians independently contributed to increased chances of clinician burnout and significantly interacted with work culture domains of commitment and work-life balance, the study authors wrote. In other words, burnout among female clinicians might not be tied to the EHR, but to the amount of time they spend at work in general.

“Our multivariate analysis, taking into consideration clinician demographic characteristics, sex, EHR metrics, and wellness survey, found wellness domains suppressed the significance of EHR metrics for average patient age, total time in system, and in-basket messages,” the study authors explained. “This suggests that wellness domains have greater explanatory power, which is consistent with the results of likelihoods test of R2 difference and relative fit statistics.”

The EHR use data revealed the number of days in the system as the most significant clinician burnout factor. Increased days in EHR usage were closely associated with a decreased chance of burnout, reflecting increased EHR efficiency by clinicians with higher volume EHR users.

The study showed organization staff had the most similar work volume metrics for days in the EHR system and appointment days. Although time constraints and training requirements could be a factor, researchers found female house staff had increased total time and after-hours time. 

“This study provides insight into variations of EHR usage by sex and across 3 types of clinicians,” the study authors concluded. “We found that clinician burnout was associated with commitment and local work culture factors. Burnout was greater for female clinicians irrespective of differences with male counterparts in EHR usage.”