Association of Weekly Protected Nonclinical Time With Resident Physician Burnout and Well-being

Importance Burnout among physicians is high, with resulting concern about quality of care. With burnout beginning early in physician training, much-needed data are lacking on interventions to decrease burnout and improve well-being among resident physicians. Objectives To design a departmental-level burnout intervention, evaluate its association with otolaryngology residents' burnout and well-being, and describe how residents used and perceived the study intervention. Design, Setting, and Participants A prospective, nonrandomized crossover study was conducted from September 25, 2017, to June 24, 2018, among all 19 current residents in the Department of Otolaryngology at the University of Minnesota. Statistical analysis was performed from June 28 to August 7, 2018. Interventions All participants were assigned 2 hours per week of protected nonclinical time alternating with a control period of no intervention at 6-week intervals. Main Outcomes and Measures Burnout was measured by the Maslach Burnout Inventory and Mini-Z Survey. Well-being was measured by the Resident and Fellow Well-Being Index and a quality-of-life single-item self-assessment. In addition to a baseline demographic survey, participants completed the aforementioned surveys at approximately 6-week intervals during the study period. Results Among the 19 residents in the study (10 men [53%]), the overall protected time intervention (week 0 to week 32) was associated with a mean decrease of 0.63 points (95% CI, -1.03 to -0.22 points) in the Maslach Burnout Inventory emotional exhaustion score, indicating a clinically meaningful decrease in burnout, and a mean decrease of 1.26 points (95% CI, -2.18 to -0.34 points) in the Resident and Fellow Well-Being Index score, indicating a clinically meaningful improvement in well-being. The baseline to week 32 mean changes in the Maslach Burnout Inventory depersonalization score, Maslach Burnout Inventory personal accomplishment score, and quality-of-life single-item self-assessment were not clinically meaningful. There were clinically meaningful improvements in 4 of 6 tested Mini-Z Questionnaire items from baseline to week 32: job stress (weighted kappa statistic, 0.21; 95% CI, -0.11 to 0.53), burnout (weighted kappa statistic, 0.25; 95% CI, -0.02 to 0.53), control over workload (weighted kappa statistic, 0.26; 95% CI, -0.01 to 0.53), and sufficient time for documentation (weighted kappa statistic, 0.31; 95% CI, 0.08 to 0.54). Conclusions and Relevance This study found that 2 hours per week of protected nonclinical time was associated with decreased burnout and increased well-being in a small sample of otolaryngology residents. Future randomized clinical studies in larger cohorts are warranted to infer causality of decreased burnout and increased well-being as a result of protected nonclinical time. Question Is 2 hours per week of protected nonclinical time associated with decreased burnout and increased well-being in otolaryngology residents? Findings In this prospective, nonrandomized crossover study, 2 hours per week of protected nonclinical time was associated with decreased burnout and increased well-being in otolaryngology residents. Meaning The preliminary results of this intervention in a small sample size are encouraging and warrant further investigation in larger cohorts of residents in randomized clinical trials to confirm the effectiveness of the protected time intervention to decrease burnout and increase well-being. This nonrandomized crossover study describes the design of a departmental-level burnout intervention, evaluates the intervention's association with otolaryngology residents' burnout and well-being, and describes how residents used and perceived the intervention.