Association of Psychological Safety with Burnout and Intent to Leave Among Physician Faculty in New York City

Background: Data on the potential protective effect of psychological safety (PS) on well-being and satisfaction among physicians are lacking. Objective: We sought to examine (1) prevalence of PS; (2) relationship between PS, burnout, and intent to leave one’s job (ILJ); and (3) demographic and occupational factors associated with PS within our physician faculty. Design: Participants: An institution-wide survey was sent to all faculty within our eight-hospital health system, between July and September 2022. Main measures: PS was assessed using the seven-item Fearless Organization Questionnaire and burnout with the Maslach Burnout Inventory-2. Demographics and a measure of ILJ were assessed. Multivariable logistic regression analyses were conducted to determine associations between PS, burnout, ILJ, and demographic and occupational correlates of PS. Key Results: A total of 867 out of 3086 total estimated clinical faculty members (28.1%) participated in the survey. The majority were 40 and older (67.4%), female (51.9%), white (60.0%), and married/partnered (80.4%); worked in ambulatory care departments (53.7%); and ranked assistant or associate professors (75.8%). On average, 57.6% of physicians evaluated their workplace as psychologically safe (range across items = 40.9–69.9%), with 35.2% screening positive for burnout and 13.4% reporting ILJ. After adjusting for demographic and occupational characteristics, each standard deviation unit increase in PS scores was associated with 27% lower odds of screening positive for burnout (odds ratio (OR) = 0.73, 95% confidence interval (CI) = 0.63–0.84) and 38% lower odds of ILJ (OR = 0.62, 95% CI = 0.52–0.74). Female gender was associated with lower scores of PS. Conclusions: A majority of faculty physicians reported working in a psychologically safe environment. Greater PS was associated with lower odds of burnout and ILJ. Investment in gender and diversity equity training may be one concrete step in advancing PS in the workplace.