Role of a pediatric department chair: factors leading to satisfaction and burnout.

OBJECTIVE: To determine factors associated with satisfaction and burnout in pediatric department chairs. STUDY DESIGN: A 1-time online survey of 250 current and former pediatric chairs who were members of Association of Medical School Pediatric Department Chairs anytime between 1993 and 2005. The questionnaire included demographics, satisfaction levels, stress experienced, and time spent on various work activities. We also included the Maslach Burnout Inventory-Human Services Survey and the abbreviated Workplace Climate Questionnaire. Burnout was defined as high scores on the depersonalization or emotional exhaustion subscales of the Maslach Burnout Inventory-Human Services Survey. RESULTS: Our response rate was 62%; most chairs (65%) reported being very satisfied with their job. Approximately 30% of chairs for <5 years experienced burnout, compared with 15% of chairs who held their positions for >5 years (P < .05). Factors associated with burnout included years as chair (odds ratio [OR], 0.9; 95% CI, 0.80-0.99), >1 night worked per week (OR, 5.9; 95% CI, 1.5-22.9), high workload (OR, 3.0; 95% CI, 1.3-6.7), and lack of supportive work environment (OR, 2.2; 95% CI, 1.1-4.2). CONCLUSION: Steps should be taken to decrease burnout in chairs, including policies that promote physician well being as integral to successful departments.

Potential medication dosing errors in outpatient pediatrics.

OBJECTIVE: To determine the prevalence of potential dosing errors of medication dispensed to children for 22 common medications. STUDY DESIGN: Using automated pharmacy data from 3 health maintenance organizations (HMOs), we randomly selected up to 120 children with a new dispensing prescription for each drug of interest, giving 1933 study subjects. Errors were defined as potential overdoses or potential underdoses. Error rate in 2 HMOs that use paper prescriptions was compared with 1 HMO that uses an electronic prescription writer. RESULTS: Approximately 15% of children were dispensed a medication with a potential dosing error: 8% were potential overdoses and 7% were potential underdoses. Among children weighing <35 kg, only 67% of doses were dispensed within recommended dosing ranges, and more than 1% were dispensed at more than twice the recommended maximum dose. Analgesics were most likely to be potentially overdosed (15%), whereas antiepileptics were most likely potentially underdosed (20%). Potential error rates were not lower at the site with an electronic prescription writer. CONCLUSIONS: Potential medication dosing errors occur frequently in outpatient pediatrics. Studies on the clinical impact of these potential errors and effective error prevention strategies are needed.