UC Irvine

Background: Exposure to traumatic events is part of medical practice and frequently experienced by physicians on a daily basis. Physicians are considered to experience traumatic exposures at work more often than other professions. Traumatic exposure has been described in the literature as starting very early on within a physician’s career. However, little is known about the relationship of Cumulative Traumatic Exposure (CTE) with the outcomes of Physician Burnout (PBO) and Post Traumatic Stress Disorder (PTSD) symptoms on trauma-exposed physicians. The purpose of this study was to better identify the prevalence of self-reported symptoms of CTE, PBO and PTSD among trauma exposed physician specialists and explore the moderating role of Professional Fulfillment (PF) and Social Support (SS) on these variables. The need to accurately quantify CTE, PBO and PTSD symptoms will be essential to developing intervention studies and wellness programs focused on providing support to trauma exposed physicians at greatest need.The aims of the study were to: 1) Describe the prevalence of and relationships among CTE, PBO and PTSD symptoms among trauma exposed physician specialists; 2) Examine whether the relationship between CTE and the outcomes of PBO and PTSD is moderated by Social Support (SS), and 3) Examine whether the relationship between CTE and the outcomes of PBO and PTSD is moderated by Professional Fulfillment (PF). Methods: The study was an observational cross-sectional design, which was aligned with the research aims of evaluating correlates of PTSD symptoms, PBO, and high-risk specialty physicians experiencing CTE. Data was collected from 50 board-certified or board-eligible physicians practicing at a Level II trauma center. CTE was measured with the Life Stressor Checklist–Revised (LSC-R); PBO was assessed by the Stanford Professional Fulfillment Index (SPFI), using its subscales of Work Exhaustion and Interpersonal Disengagement. Professional Fulfillment was also assessed with the SPFI Fulfillment subscale (SPFI). Finally, PTSD symptoms were assessed by the PTSD Checklist for DSM-5 (PCL-5), while Social Support was assessed with the Social Support Rating Scale (SSRS). Descriptive statistics were conducted and statistics for five focal study variables for Aim 1. Descriptive statistics were conducted to analyze Aim 2, while four multiple linear regression analyses were conducted, and model assumption of normality, homoscedasticity and absence of multicollinearity were evaluated.  CTE and social support were mean centered and an interaction term was entered to test moderation. In Aim 3, three multiple linear regression analyses were conducted with CTE and PF mean centered and an interaction term entered in to test moderation. All variance inflation factors were below conventional threshold, and multicollinearity was not a concern. Findings: Participant age averaged 49.86 years (SD = 10.13). Most participants were male (n = 32, 64.0%). The most frequently observed racial category was White (n = 28, 56.0%) followed by Asian (n=7, 14.0%) and Hispanic (n=6, 12.0%). Regarding years in practice, the most common category was more than 20 years (n = 17, 34.0%). Emergency medicine was the most frequently reported specialty (n = 32, 64.0%) followed by Trauma (n=6, 12.0%) and Obstetrics and Gynecology (n=6, 12.0%).In terms of descriptive statistics on key variables, CTE was found to have a have a mean of 9.60, SD (4.01), while overall PBO had a mean score of .86 (SD of .61), and the PBO subscale scores, Work Exhaustion and Interpersonal Disengagement had mean scores of 1.24 (SD 0.99) and.60 (SD 0.56), respectively. Further, Professional Fulfillment had a mean score of 2.84 (SD 1.13), while Social Support had a mean score of 25.50 (SD 6.41). Hypothesis 1 was partially supported as CTE and PTSD symptoms were present, while PBO and PTSD scores were not elevated. Further, Hypotheses 1b and 1c did not yield significant relationships between CTE and the outcome of PBO and PTSD or of PBO with PTSD, respectively.Moderation analyses revealed that none of the seven moderation models yielded a statistically significant interaction effect, and none of the overall models accounted for a significant proportion of variance in the outcomes. Hypotheses 2 was not supported; Social Support did not moderate the relationship between CTE and the PBO subscales of Work Exhaustion or Interpersonal Disengagement. Hypotheses 3a and 3 b were also not supported; Professional Fulfillment did not moderate the relationship between CTE and the PBO subscales or PTSD. However, Professional Fulfillment had a significant negative main effect on work exhaustion, B = −.21, SE = 0.08, β = −.36, t = −2.52, p = .015, indicating that higher Professional Fulfillment was associated with lower Work Exhaustion. Moreover, the main effect of Professional Fulfillment was found to be marginally significant, B = −.14, SE = 0.07, β = −.28, t = −1.96, p = .056, indicating higher Professional Fulfillment was also associated with lower Interpersonal Disengagement. However, caution is warranted, as these values did not cross the p < .05 threshold.Conclusion. The study described Cumulative Traumatic Exposure, Physician Burnout, and PTSD symptoms among 50 trauma-exposed physician specialists and tested Social Support and Professional Fulfillment as moderators of the exposure-outcome relationships. Physicians reported moderate traumatic exposure, generally low Physician Burnout and Interpersonal Disengagement, and highly variable PTSD symptom severity, with a subset reporting clinically meaningful symptoms. Although the mean PTSD score fell below the provisional screening threshold, the wide range of scores indicate that some physicians reported clinically meaningful symptom burden even as the group average remained subclinical.While none of the moderation models were significant, Professional Fulfillment did however show a significant inverse association with Work Exhaustion, as a measure of PBO, pointing to its potential as a direct protective resource. Although constrained by a small, singlesite sample and a cross-sectional design, the findings highlight the heterogeneity of traumarelated distress in the acute-care workforce and identify Professional Fulfillment as a promising, actionable target for future intervention. As work-related stressors have been implicated impacting the health of practicing physicians, the study added to the body of knowledge as well as addressed gaps specific to evaluate CTE, PBO and PTSD in physicians through use of the structured instruments. For nursing, the results affirm a leadership role in advancing interprofessional well-being and in building the larger, longitudinal evidence base needed to protect the mental health of clinicians who care for the acutely injured and critically ill.