ORIGINAL RESEARCH A National Comparison of Burnout and Work-Life Balance Among Internal Medicine Hospitalists and Outpatient General Internists Daniel L. Roberts, MD 1 *, Tait D. Shanafelt, MD 2 , Liselotte N. Dyrbye, MD, MHPE 3 , Colin P. West, MD, PhD 4,5 1 Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Phoenix, Arizona; 2 Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota; 3 Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota; 4 Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota; 5 Division of Biomedical Statistics and Infor- matics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota. BACKGROUND: General internists suffer higher rates of burnout and lower satisfaction with work-life balance than most specialties, but the impact of inpatient vs outpatient practice location is unclear. METHODS: Physicians in the American Medical Association Physician Masterfile were previously surveyed about burn- out, depression, suicidal ideation, quality of life, fatigue, work-life balance, career plans, and health behaviors. We extracted and compared data for these variables for the 130 internal medicine hospitalists and 448 outpatient gen- eral internists who participated. Analyses were adjusted for age, sex, hours worked, and practice setting. RESULTS: There were 52.3% of the hospitalists and 54.5% of the outpatient internists affected by burnout (P 5 0.86). High scores on the emotional exhaustion subscale (43.8% vs 48.1%, P 5 0.71) and on the depersonalization subscale (42.3% vs 32.7%, P 5 0.17) were common but similar in fre- quency in the 2 groups. Hospitalists were more likely to score low on the personal accomplishment subscale (20.3% vs 9.6%, P 5 0.04). There were no differences in symptoms of depression (40.3% for hospitalists vs 40.0% for outpatient internists, P 5 0.73) or recent suicidality (9.2% vs 5.8%, P 5 0.15). Rates of reported recent work-home conflict were similar (48.4% vs 41.3%, P 5 0.64), but hospi- talists were more likely to agree that their work schedule leaves enough time for their personal life and family (50.0% vs 42.0%, P 5 0.007). CONCLUSIONS: Burnout was common among both hospi- talists and outpatient general internists, although hospital- ists were more satisfied with work-life balance. A better understanding of the causes of distress and identification of solutions for all internists is needed. Journal of Hospital Medicine 2014;9:176–181. V C 2014 Society of Hospital Medicine An increasingly robust body of literature has identified burnout as a substantial problem for physicians across specialties and practice settings. 1–4 Burnout, a work- related condition characterized by emotional exhaus- tion, depersonalization, and lack of a sense of personal accomplishment, 5 has been tied to negative consequen- ces for patients, physicians, and the medical profession including medical errors, 6 poor physician health, 7,8 and decreased professionalism. 9 Studies of burnout among general internists have pointed to time pres- sures, lack of work control, and difficult patient encounters as possible contributors. 10,11 Burnout has been demonstrated to affect a sizable proportion of hospitalists, with prevalence estimates from prior studies varying from 12.9% to 27.2%, although nearly all studies of US hospitalists have relied on single-item instruments. 12–15 Hospital-based physicians have represented a rapidly expanding seg- ment of the internist workforce for more than a dec- ade, 14 but studies of the impact of inpatient vs outpatient practice location on burnout and career satisfaction are limited. A meta-analysis of the impact of practice location on burnout relied almost exclu- sively on noncomparative studies from outside the United States. 15 A recent study of US physician burn- out and satisfaction with work-life balance showed that general internists expressed below average satis- faction with work-life balance and had the second highest rate of burnout among 24 specialties. 4 How- ever, this report did not differentiate between general internists working in inpatient vs outpatient settings. We therefore examined burnout, satisfaction with work-life balance, and other aspects of well-being among internal medicine hospitalists relative to outpa- tient general internists, using a national sample devel- oped in partnership with the American Medical Association. METHODS Physician Sample As described previously, 4 the American Medical Asso- ciation Physician Masterfile, a nearly complete record of US physicians, was used to generate a sample of physicians inclusive of all specialty disciplines. The 27,276 physicians who opened at least 1 invitation e- mail were considered to have received the invitation to participate in the study. Participation was volun- tary, and all responses were anonymous. For this *Address for correspondence and reprint requests: Daniel Roberts, MD, 5777 East Mayo Boulevard, Phoenix, AZ 85054; Telephone: 480- 342-1387; Fax: 480-342-1388; E-mail: roberts.daniel@mayo.edu Received: September 1, 2013; Revised: November 15, 2013; Accepted: December 13, 2013 2014 Society of Hospital Medicine DOI 10.1002/jhm.2146 Published online in Wiley Online Library (Wileyonlinelibrary.com). 176 An Official Publication of the Society of Hospital Medicine Journal of Hospital Medicine Vol 9 | No 3 | March 2014