Could Shorter Hospital ICU Rotations Help Alleviate Physician Burnout?

Shortening the length of rotations in a medical intensive care unit (MICU) from the traditional 14-consecutive day schedule to only seven days helps mitigate burnout among critical care physicians, according to a new Penn Medicine pilot study.

The study, published June 25 in the American Journal of Respiratory and Critical Care Medicine, took place at Penn Medicine last year across four critical care rotations, spanning the Hospital of the University of Pennsylvania (HUP) and Penn Presbyterian Medical Center, with the aim to identify effective strategies to mitigate burnout and maximize fulfillment.

The team, who had found high rates of burnout among intensivists at the end of 14-day rotations, tested a strategy proposed by the Critical Care Societies Collaborative that called for limiting the maximum number of days worked consecutively. The data also revealed that shorter rotations not only led to lower burnout rates—by as much as 41 percent—but the change also resulted in increased job fulfillment.

The Penn Medicine researchers noted that nearly half of the 10,000 critical care physicians practicing in the United States reported symptoms of severe burnout, which can lead to compassion fatigue, decreased quality of care and job turnover. However, there is some evidence that the issue could be getting better. A study recently published in Mayo Clinic Proceedings, conducted by researchers from the AMA, the Mayo Clinic and Stanford University School of Medicine found 44 percent of U.S. physicians exhibited at least one symptom of burnout in 2017, compared with 54 percent in 2014 and 46 percent in 2011.

As part of this pilot, intensivists in one unit, the Founders 9 MICU at HUP, had the option to attend for the traditional 14-day rotation or change their schedule to a seven-day rotation. Rotations in two other units were capped at seven consecutive days, while intensivists in the fourth unit worked a two-week rotation, with one weekend off.

From May 2018 to February 2019, the research team administered more than 180 surveys to 29 physicians at different points throughout the rotations, including on day seven of a 14-day rotation and between clinical rotations. They found burnout and fulfillment varied by the clinical rotation and length of rotation.

For example, intensivists in in the Founders 9 MICU, a 24-bed unit staffed by two critical care physicians, fellows and internal medicine residents, responded with 61 percent burnout and 47 percent fulfillment rates. Meanwhile, the intensivists working a seven-day rotation in the Donner 3 MICU at HUP—an 8-bed unit, staffed by one critical care physician and two advanced practice providers—responded with a 24 percent burnout and 76 percent fulfillment rates.

"In critical care medicine, periods of extreme stress can contribute to high burnout. Our study shows that organizations can implement new strategies, such as shorter staffing rotations, that have a real impact on burnout rates and job fulfillment," said the study's lead author, Mark E. Mikkelsen, M.D., chief of medical critical care and an associate professor of Medicine. "Based on our findings, we changed our scheduling approach to limit the number of consecutive days per rotation, and ensure adequate non-clinical time between rotations."