Objective: To measure the degree of burnout among emergency physicians (EPs) and to identify and rank predictive factors. Methods: Using the Maslach Burnout Inventory as well as a 79-item questionnaire, a cross-sectional survey was conducted for physician registrants at the Annual Scientific Assemblies of the American College of Emergency Physicians from 1992 to 1995. Degrees of burnout were stratified into low, moderate, and high ranges. Univariate and stepwise multiple regression analyses were conducted to identify and rank correlates to burnout scores. Results: Of 1,272 registrants taking the inventory, 60% registered in the moderate to high burnout ranges. Twenty-one correlates were identified. These were classified broadly in terms of negative perceptions of self, negative practice habits and attitudes, and unhealthy lifestyles. The most highly ranked correlates were: selfrecognition of burnout, lack of job involvement, negative self-assessment of productivity, dissatisfaction with career, sleep disturbances, increased number of shifts per month, dissatisfaction with specialty services, intent to leave the practice within 10 years, higher levels of alcohol consumption, and lower levels of exercise. Age and years of practice were not significant predictors of burnout. Projected attrition rates were 7.5% over 5 years and 25% over 10 years. Conclusions: Elevated levels of burnout exist among a substantial percentage of surveyed EPs. However, there is evidence for a "survivor" category of practitioners for whom burnout either does not develop or is a reversible process. The projected attrition rate over 5 and 10 years appears to be no greater than that of the average medical specialty.

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Team-building interventions seek to build competent, collaborative, and creative work teams by removing the barriers to effective group functioning and by helping participants better understand and utilize the group processes associated with effective group behavior. This article examines a confron tation-team-building intervention that was highly successful in building the supervisors into a cohesive, trusting, and unified group. However, the team became the most important variable, with little consideration given to the rest of the organization. As a result, the whole organization was severely crippled and had to be completely rebuilt. Lessons are drawn from this excellent example of a lopsided intervention.

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