- In a randomized trial, a parental support package targeting perinatal stressors significantly mitigated burnout among pregnant and postpartum physician trainees.
- The support package included a wearable breast pump, a smart bassinet, 24/7 virtual perinatal support, and faculty mentorship.
- Investing in physician well-being may positively affect patient safety, physician recruitment, and physician retention, researchers said.
A parental support package targeting perinatal stressors significantly mitigated burnout among pregnant and postpartum physician trainees, a randomized controlled trial showed.
From enrollment during pregnancy to 24 weeks postpartum, mean burnout scores on the Stanford Professional Fulfillment Index (score range 0-10) increased from 2.96 to 3.03 in the group receiving parental support and from 3.13 to 3.79 in the group that received usual support (adjusted between-group difference in change -0.58, 95% CI -1.10 to -0.07, P =0.03), reported Erika Rangel, MD, of Massachusetts General Hospital in Boston, and co-authors in JAMA.
The difference in change on a subscale of interpersonal disengagement was significant between the two groups (adjusted between-group difference in change -0.70, 95% CI -1.24 to -0.15, P=0.01), while the difference in emotional exhaustion scores was not.
Due to discrimination and stigma, pregnant physicians often “push themselves harder than they should,” which has consequences for them and their babies, Rangel told MedPage Today.
Prior research has linked longer paid leave to better infant bonding and maternal health and longer breastfeeding, she noted.
“This is the first level 1 evidence that shows that a tangible support package can meaningfully change burnout and well-being for child-bearing physicians,” Rangel said.
The support package included four components: a wearable breast pump, a smart bassinet, 24/7 virtual perinatal support, and faculty mentorship.
The intervention is both pragmatic and relatively low cost, at $2,300 per participant, the authors noted, adding that physician burnout costs the healthcare system close to triple that amount, at $7,600 per employed physician annually.
Determining the impact of individual components was difficult, Rangel said. Trainees were initially most excited by the “tangible” items — breast pumps and bassinets — but later appreciated being able to access off-hours perinatal appointments and saw mentors as “hugely impactful.”
The study’s findings represent “the tip of the iceberg,” she noted. Investing in physician well-being may positively affect patient safety, physician recruitment, and physician retention.
For this study, the authors included 143 pregnant (≥12 weeks’ gestation) residents or fellows at seven training institutions in the Northeast U.S. in their primary analysis. Median age was 32, and the majority were white.
Participants were randomized 1:1 to receive a parental support package or usual support from early pregnancy through 24 weeks postpartum. For the intervention group, mentors were expected to meet with trainees at least three times. Participants were surveyed at enrollment and at 4, 16, and 24 weeks postpartum.
Looking at secondary outcomes, the intervention group experienced lower relationship strain versus the usual support group (adjusted between-group difference in score change -0.90, 95% CI -1.77 to -0.03, P=0.04).
In the usual support group, within-group analyses showed a drop in values alignment (adjusted score change -0.68, 95% CI -1.27 to -0.09) and professional fulfillment (adjusted score change -0.62, 95% CI -1.06 to -0.18) and greater odds of career regret (OR 10.1, 95% CI 3.14-32.46). These metrics appeared stable among the intervention group.
In exploratory analyses, the share of participants citing “high burnout” grew in the usual support group and fell in the parental support group (47.1% vs -16.8%, P = 0.004). In adjusted analyses, the parental support group also experienced lower odds of high burnout versus the usual support group (OR 0.19, 95% CI 0.06-0.65, P=0.008).
Exploratory analyses also suggested that extended leave was tied to a 1.06-point lower burnout score compared with a standard-length leave (95% CI -1.93 to -0.20, P=0.02), while short leave was associated with a 0.74-point greater professional fulfillment score (95% CI 0.01-1.48, P=0.047).
A limitation of the study was that participants knew which group they were assigned to, which may have “influenced perceptions,” the authors noted. Conducting the trial only in the Northeast may have impacted generalizability.
Future research could test the effectiveness of a lower-cost combination of supports or a single-component intervention, and leverage mentors from other institutions to allow for greater privacy. The team also plans to use sleep impairment data to assess impacts on patient care.
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