The Inpatient Database as a Technique to PreventJunior Faculty Burnout George R. Brown, M.D. Junior faculty members beginning their careers in academic psychiatry are frequently assigned major clinical duties as directors of busy inpatient psychiatry units, leaving them little time or energy for research. The turnover in these positions is high and job dissatisfaction higher. This paper describes an inpatient database developed and used by the author as a clinical research tool to explore interesting questions about inpatient psychiatry and better integrate the academic and clinical service aspects of his junior faculty role.

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Unior faculty members of academic departments of psychiatry are generally the east experienced but most energetic members of the teaching staff. Often they are recent graduates from residency training who have limited choices about their position on the faculty. There is little disagreement that acute inpatient ward responsibilities are among the most demanding and intensive duties available, resulting in frequent openings as inpatient unit directors depart and few or no senior faculty volunteer to fill these positions (1). Therefore, new junior faculty members are often assigned to these positions. The time-intensive nature of inpatient work and the additional teaching time required by inexperienced residents and thirdyear medical students who work on these units leaves little time for junior faculty members to pursue their own research interests. Burke et al. (2) hypothesize that the relative lack of active psychiatric researchers, even in established academic departDr. Brown is the Director of Psychiatric Research, Department of Psychiatry, Wilford Hall Medical Center, Lacldand Air Force Base, San Antonio, Texas. Address correspondence to George R. Brown, M.D., 11163 Mesquite Flat, Helotes, Texas 78023.

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ments of psychiatry, is largely traceable to this phenomenon. Boredom with inpatient work is common after several hundred admissions, and job dissatisfaction often ensues. The many other ingredients of job dissatisfaction on the inpatient service include limited contact with senior faculty, few opportunities for teaching senior residents, little time for academic development, limited opportunity to work with "high functioning" patients in psychotherapy, greater medicolegal exposure, and the unending, 24-hour-a-day responsibility of caring for inpatients. A ''burnout syndrome" has been described distinct from simple job dissatisfaction in staff who are highly committed to their positions (3-11). Symptomatic expressions of such professional burnout can include somatic symptoms (fatigue, headaches, insomnia), psychological manifestations (depressed mood, apathy, cynicism, anxiety), and interpersonal difficulties (distancing maneuvers, avoidance, foreshortening interviews) (5). It comes as no surprise, therefore, that the attrition rate of disenchanted junior faculty is high, leaving inpatient unit director positions unfilled and resulting in the loss of valuable, creative psychiatrists from the dwindling ranks of academic psychiatry. , \ )I I

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Unfortunately, this cycle often repeats itself. Of the job openings recently advertised in a leading source for psychiatry positions (12), 89% involved inpatient positions (49% were exclusive assignments to an inpatient unit). Seventy-five percent of the univerSity-based academic positions advertised were for inpatient positions at the assistant or associate professor level. The lack of experienced clinician-researchers interested in topics of import to the inpatient setting has also been described, with the resulting dearth in research literature on these topics (1,2). This is no more apparent than in the submission materials for the 1991 Annual Meeting of the American Psychiatric Association, in which, of forty-eight topic areas covering the range of submissions, neither inpatient psychiatry nor hospital psychiatry are mentioned as possible choices (13). Three factors impede a newly appointed inpatient unit director in his or her attempt to cultivate a rewarding academic career: the structure of academic departments, the transition issues inherent in assuming a faculty role, and the overwhelming job requirements of an inpatient director, all of which frequently culminate in professional burnout and early attrition (1). In the report that follows, I will describe the inpatient database I created to overcome the above impediments and the ways it has contributed to my professional development and the department's research efforts by residents, students, and staff. CREATION OF THE INPATIENT DATABASE

Wilford Hall Medical Center is the United States Air Force's largest teaching facility, with 850 beds (86 psychiatric) and 45 accredited residency training programs and fellowships in all major specialties and most subspecialties. The Department of Psychiatry has eleven full-time psychiatrists and an average of twenty-four residents in all four years of postgraduate training. On complet\( \1)1 \II( I'

The inpatient database as a technique to prevent junior faculty burnout.

Junior faculty members beginning their careers in academic psychiatry are frequently assigned major clinical duties as directors of busy inpatient psy...
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