Career Satisfaction in Emergency Medicine: The ABEM Longitudinal Study of Emergency Physicians

Compassion Fatigue in Emergency Medicine: Current Perspectives

Compassion fatigue (CF), or loss of ability to empathize or feel compassion for others for whom one cares, is a growing concern for emergency physicians (EP). EPs, by the nature of their jobs, work under unpredictable conditions at odd hours with high levels of exposure to traumatic events. They are placed under substantial psychological, physical, and cognitive pressure, with little opportunity to recover or reflect. CF occurs when this workplace stress leads to feelings of being overwhelmed, helpless, unsupported, and unable to cope. Additionally, primary traumatic stress from threats of workplace violence and secondary traumatic stress (STS) from witnessing the suffering of others increase the likelihood of developing CF. Unchecked, this progression to CF causes reduction in quality of care to patients, reduction in patient satisfaction, increased levels of EP depression and anxiety, increased levels of EP substance use, and increased attrition from the specialty. To truly improve CF, individuals and organizations should be aware of the contributors to CF: namely, emotional exhaustion, depersonalization, primary and STS, and personal achievement. EPs should maximize their resilience to CF by using cognitive behavioral techniques and mindfulness, taking care of their physical health, seeking meaning and development within their work, developing hobbies outside of work, and creating boundaries between work and home. Organizations should actively address the known drivers of physician burnout: workload and job demands, efficiency and resources, meaning in work, culture and values, control and flexibility, work community, and work-life integration. Organizations should also provide adequate safety within facilities to reduce the threat of primary trauma and should supply adequate support and destigmatization for post-traumatic symptoms for EPs suffering from STS.

Workplace Mistreatment, Career Choice Regret, and Burnout in Emergency Medicine Residency Training in the United States

STUDY OBJECTIVE

The influence of workplace mistreatment on the well-being and career satisfaction of emergency medicine residents is unknown. This study examined the relationships between burnout, career choice regret, and workplace mistreatment in a national sample of emergency medicine residents.

METHODS

This was a secondary analysis of a survey study on the prevalence of workplace mistreatment among emergency residents. Residents who reported emotional exhaustion or depersonalization at least once per week were considered to have burnout. Residents who reported dissatisfaction with their decision to become an emergency physician were considered to have career choice regret. Respondents also reported the type (discrimination, abuse, sexual harassment) and frequency of mistreatment over the academic year. Multivariable logistic regression, adjusting for program characteristics, was used to examine resident characteristics associated with burnout and career choice regret, with the frequency of mistreatment as a covariate.

RESULTS

Of the 8,162 eligible residents, 7,680 (94.1 %) participated. About a third of respondents reported burnout (2,188 of 6,902, 31.7%), whereas a minority (224 of 6,923, 3.2%) reported career choice regret. Of the 7,087 responses on mistreatment frequency, 2,117 (29.9%) reported "a few times per year," and 1,296 (18.3%) reported "a few times per month or more." Compared with residents who never experienced mistreatment, residents who reported increasing frequencies of mistreatment were associated with having burnout-from mistreatment a few times per year (OR [odds ratio],1.6; 99% CI [confidence interval], 1.3 to 1.9) to a few times per month or more (OR, 3.3; 99% CI, 2.7 to 4.1). Compared with residents without burnout, residents who reported burnout were associated with having career choice regret (OR, 11.3; 99% CI, 7.0 to 18.1). After adjusting for burnout, there were no significant relationships between the frequency of mistreatment and career choice regret.

CONCLUSIONS

Workplace mistreatment is associated with burnout, but not career choice regret, among emergency medicine residents. Efforts to address workplace mistreatment may improve emergency medicine residents' professional well-being.

The 2013 to 2019 Emergency Medicine Workforce: Clinician Entry and Attrition Across the US Geography

STUDY OBJECTIVE

We sought to identify longitudinal trends in workforce entry and attrition among rural and urban emergency physicians, nonemergency physicians, and advanced practice providers.

METHODS

We performed a repeated cross-sectional analysis, from 2013 to 2019, of emergency clinicians who received reimbursement for at least 50 Evaluation and Management services [99281-99285] from Medicare part B within any study year. We calculated the emergency workforce's entry and attrition rates annually. Entry was defined as clinicians newly entering or re-entering the workforce, and attrition was defined as clinicians leaving permanently or temporarily. We stratified the analyses by rural designation and assessed the proportions and state-level changes in clinician density.

RESULTS

In total, 82,499 unique clinicians performed at least 50 Evaluation and Management services within any of the 7 study years examined, including 47,000 emergency physicians, 9,029 nonemergency physicians, and 26,470 advanced practice providers. Emergency physicians made up a decreasing proportion of the workforce (68.1% in 2013; 65.5% in 2019), and advanced practice providers made up an increasing proportion of the workforce (20.9% in 2013; 26.1% in 2019). Annually, 5.9% to 6.8% (2,186 to 2,407) of emergency physicians newly entered and 0.8% to 1.4% (264 to 515) re-entered the workforce, whereas 3.8% to 4.9% (1,241 to 1,793) permanently left and 0.8% to 1.6% (276 to 521) temporarily left. Additionally, the total proportion of clinicians practicing in rural designations decreased, and advanced practice providers separately made up a substantially increasing proportion of the rural workforce (23.0% in 2013; 32.7% in 2019). Substantial state-level variation existed in the supply and demand of emergency clinician densities per 100,000 population.

CONCLUSION

The annual rate of emergency physician attrition was collectively more than 5%, well above the 3% assumed in a recently publicized projection, suggesting a potential overestimation of the anticipated future clinician surplus. Notably, the attrition of emergency physicians has disproportionately affected vulnerable rural areas. This work can inform emergency medicine workforce decisions regarding residency training, advanced practice provider utilization, and clinician employment.

Predictors of burnout among US healthcare providers: a systematic review

OBJECTIVE

One potential barrier to optimal healthcare may be provider burnout or occupational-related stress in the workplace. The objective of this study is to conduct a systematic review to identify the predictors of burnout among US. healthcare providers.

DESIGN

Systematic review using in-depth critical appraisal to assess risk of bias and present the quality of evidence in synthesised results from the prognostic studies.

DATA SOURCES

We searched 11 databases, registries, existing reviews and contacted experts through 4 October 2021.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

We included all studies evaluating potential predictors and documenting the presence and absence of associations with burnout assessed as a multidimensional construct. We excluded studies that relied solely on a single continuous subscale of burnout. Data were abstracted from eligible studies and checked for accuracy by a content expert and a methodologist.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently screened citations and full-text publications using predetermined eligibility criteria.

RESULTS

The 141 identified studies evaluated a range of burnout predictors. Findings for demographic characteristics were conflicting or show no association. Workplace factors, such as workload, work/life balance, job autonomy and perceived support from leadership, had stronger associations with risk for burnout. Mental health factors, such as anxiety, and physical health risks may increase the risk, although the direction of these associations is unclear as few prospective studies exist to address this question. Factors such as social support appear to have a protective effect.

CONCLUSION

We found the most evidence for workplace, mental health and psychosocial factors in predicting burnout but limited evidence for other potential predictors. However, more prospective studies are needed to improve our understanding about how to prevent provider burnout.

PROSPERO REGISTRATION NUMBER

CRD4202014836.

Job satisfaction and its related factors among emergency department physicians in China

Background

Job satisfaction is recognized as an important factor affecting the performance and quality of medical services of emergency department physicians. However, little is known about the status of job satisfaction among emergency department physicians in China. This study aimed to explore the current level of job satisfaction and its associated factors among emergency department physicians in China.

Methods

A nationwide cross-sectional survey was conducted in China from July to August 2018. A total of 10,457 emergency department physicians completed the questionnaire. The structured online questionnaire collected information on socio-demographic characteristics, work-related factors, work-family conflict, and job satisfaction. Student's t-test or ANOVA were used to compare the job satisfaction scores in different characters. The generalized linear model was used to investigate the related factors of job satisfaction among emergency department physicians.

Results

The respondents' job satisfaction average score was 12.2 ± 3.6, of which 42.01% were satisfied of which the job. The results showed that emergency department physicians over 41 years old, with a higher income and working in central and western regions were positively associated with job satisfaction. In contrast, bachelor degree and above, fixed posts, long years of service, a high frequency of night shift, perceived shortage of physicians, perceived medical errors, and higher work-family conflict scores were negatively correlated with job satisfaction among emergency department physicians.

Conclusion

Job satisfaction of emergency department physicians in China is low. It is suggested that hospital administrators could improve the job satisfaction of emergency department physicians by establishing an acceptable shift system, ensuring adequate emergency department staffing, increasing their income appropriately and alleviating work-family conflict.

Changes in Work Characteristics and Pediatrician Satisfaction: 2012-2020

OBJECTIVES

To examine the association of changes in pediatricians' work characteristics with their satisfaction using longitudinal data.

METHODS

Data from a cohort study, the American Academy of Pediatrics Pediatrician Life and Career Experience Study (PLACES), were used to examine self-reported work satisfaction from 2012 to 2020 among 2002-2004 and 2009-2011 residency graduates (N = 1794). Drawing from the Physician Worklife Study, work satisfaction was measured as a 4-item scale score and averaged [range, 1 (low)-5 (high)]. Mixed effects linear regression for longitudinal analysis examined work satisfaction with year as the lone explanatory variable and then with 11 variables that might change over time (time variant) to assess how changes in work might be linked to increased or decreased satisfaction.

RESULTS

In total, 85.9% of pediatricians in 2020 (September-December) thought their work was personally rewarding. Overall mean work satisfaction scale score displayed a small but significant (P < .001) decrease over time (3.80 in 2012 to 3.69 in 2020). Mixed effects modeling identified several changes associated with increasing work satisfaction over time: increased flexibility in work hours (B = 0.23; 95% confidence interval, 0.20 to 0.25) and personal support from physician colleagues (B = 0.18; 95% confidence interval, 0.15 to 0.21) had the largest associations. Pediatricians reporting increased stress balancing work and personal responsibilities and increased work hours had decreased satisfaction scores.

CONCLUSIONS

Early- to midcareer pediatricians expressed high levels of work satisfaction, though, satisfaction scale scores decreased slightly over time for the sample overall, including during 2020 (year 1 of the coronavirus disease 2019 pandemic). Pediatricians reporting increases in flexibility with work hours and colleague support showed the strongest increase in work satisfaction.

Cortisol awakening response in the airborne rescue service

BACKGROUND

Work-related stress may lead to mental and physical illnesses. Emergency physicians may be particularly vulnerable to developing such diseases due to their extreme emotional working environment.

AIMS

The purpose of the study was to analyse the hormonal stress burden of emergency physicians in the airborne rescue service to create an empirical basis for developing appropriate measures against chronic stress in the rescue service.

METHODS

Three salivary cortisol samples were collected after awakening in 15 min intervals-each on a flight rescue day, a clinic day and a free day-to calculate the extent of the hormonal stress load of the emergency physicians. A nested linear mixed-model analysis was used in 40 cases to investigate hormonal stress. Furthermore, professional years and gender were included in the calculations.

RESULTS

The mixed model showed neither a main effect for measurement time nor for day but a significant interaction effect (P = 0.002). The cortisol level rises strongly on the flight rescue and the clinic day, while on the free day it shows a moderate increase. Professional years and gender also proved to be statistically significant for the cortisol level of emergency physicians (P < 0.001).

CONCLUSIONS

The results show a significantly higher cortisol increase on working days compared with a free day, which indicates a stronger stress burden on working days of emergency physicians in the airborne rescue service. Future studies should examine the stress level of emergency physicians in more detail to prove whether the working conditions of emergency physicians need to be modified.

Stress levels of Flemish emergency medicine residents and the implications for clinical practice and education

BACKGROUND

mergency physicians are often confronted with challenging situations. As acute stress can adversely affect the health of physicians and the safety of patients, both could benefit from the integration of performance psychology insights in the education of physicians. A better understanding of stress is a prerequisite for the successful integration of a stress management program into residency training.

METHODS

All Flemish emergency medicine residents were questioned about stressors, perceived stress, and the impact of stress on their performance. Furthermore, participants were asked to evaluate the role of training in performance under stress during residency.

RESULTS

The response rate was 47.0%. Almost half of the residents indicated to be moderately to highly stressed. Half of the residents said that their performance could improve significantly if they could control their stress completely. The large majority of the residents (91.5%) indicated to see an advantage in increased training in performance enhancing techniques during residency.

CONCLUSION

Although a training program could considerably contribute to reduce stress levels and its impact on performance, there is a gap between the needs of residents and the current training program. An evidence-based education program in stress reduction is urgently warranted.

Factors Influencing Career Decisions and Satisfaction Among Newly Practicing Ophthalmologists

PURPOSE

To describe the career choices of newly practicing ophthalmologists and explore factors influencing career decisions and satisfaction.

METHODS

A cross-sectional study was conducted using data from an electronic survey of ophthalmologists who completed training within the prior 5 years. The survey included questions about demographic information, medical education, current practice, factors affecting career choices, and career satisfaction. Statistical comparisons were made based on gender, type of practice, subspecialty training, and practice area.

RESULTS

Surveys were completed by 696 (32%) newly practicing ophthalmologists, including 276 (40%) women, 179 (29%) academicians, and 465 (67%) subspecialists. A higher proportion of female respondents entered academics than male respondents (36% vs 26%, P = .009). Female and male respondents pursued fellowship training with similar frequency (64% vs 68%, P = .32), but men were more likely to seek vitreoretinal fellowships (30% vs 11%, P < .001) and women were more likely to undertake fellowships in pediatric ophthalmology (21% vs 8%, P < .001), uveitis (10% vs 2%, P = .002), and neuro-ophthalmology (6% vs 2%, P = .042). A total of 514 (83%) respondents reported being happy with work life.

CONCLUSIONS

The career choices of newly practicing ophthalmologists differ based on gender, type of practice, subspecialty training, and practice area. Many factors affect career decisions, and they have varying influence on subgroups within ophthalmology. Ophthalmologists have high levels of career satisfaction. This information may prove useful when developing workforce strategies to meet future eye care needs. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

Career satisfaction among acute care resident physicians in Japan

Aim

With the introduction of the new national board certification system, sustainable education of acute care physicians has become an important topic. Prior surveys have addressed the job satisfaction of young acute care physicians. However, there have been limited nationwide surveys. The purpose of this study was to investigate the career satisfaction of senior acute care resident physicians, and to identify factors affecting their career satisfaction.

Methods

An anonymous multiple‐choice questionnaire was administered to candidates at the national board examination in 2018 regarding their career satisfaction. Data were analyzed with factor analysis and multivariable analysis with a logistic regression model to identify factors affecting career satisfaction.

Results

There were 427 respondents and the response rate was 98.2%. There were 332 male respondents (80.8%). Factors that correlated with career satisfaction were training systems, working conditions, personal learning, and stress‐related factors. High job satisfaction was found in 137 (36.6%) of the respondents. Logistic regression analysis showed that the factors significantly associated with high job satisfaction were: training systems (odds ratio [OR] 2.18; 95% confidence interval [CI], 1.43–3.33), working conditions (OR 1.78; 95% CI, 1.25–2.53), and personal learning (OR 1.55; 95% CI, 1.02–2.36). There was no significant correlation between high career satisfaction and intention to switch to another specialty.

Conclusion

High job satisfaction in senior acute care residents requires the development of a teaching environment, an optimized work environment, and encouragement of personal learning.

Are emergency physicians satisfied? An analysis of operational/organization factors

OBJECTIVE

Professional satisfaction is associated with career longevity, individual well-being, and patient care and safety. Lack of physician engagement promotes the opposite. This study sought to identify important facets contributing to decreased career satisfaction using a large national data set of practicing emergency physicians.

METHODS

We performed a secondary analysis of the national Longitudinal Study of Emergency Physicians survey conducted by the American Board of Emergency Medicine. The survey was composed of 57 variables including career satisfaction as well as occupational and psychological variables potentially associated with career satisfaction. Factor analysis was used to determine the important latent variables. Ordinal logistic regression was performed to determine statistical significance among the latent variables with overall career satisfaction.

RESULTS

A total of 863 participants were recorded. The overall mean career satisfaction rate was 3.9 on a 5-point Likert scale with 1 and 5 indicating "least satisfied" and "most satisfied," respectively. Our analysis revealed 9 factors related to job satisfaction. Two latent factors, exhaustion/stress and administration/respect, were statistically significant. When comparing satisfaction scores between sex, there was a statistically significant difference with men reporting a higher satisfaction rate (P = 0.0092). Age was also statistically significant with overall satisfaction lower for younger physicians than older physicians.

CONCLUSION

Our study found that emergency physicians are overall satisfied with emergency medicine, although with variability depending on sex and age. In addition, we characterized job satisfaction into 9 factors that significantly contribute to job satisfaction. Future work exploring these factors may help elucidate the development of targeted interventions to improve professional well-being in the emergency medicine workforce.

Maternity Experiences and Perceptions of Emergency Medicine Physicians

INTRODUCTION

Postpartum employment has been recognized as a significant obstacle to breastfeeding continuation rates in the general population. Multiple additional factors can influence emergency medicine (EM) physician mothers' ability to continue breastfeeding upon return to work. These include the unpredictable nature of emergency room volumes and acuity, absence of protected lactation time or facilities, and varying levels of support from colleagues. This study investigated a sample of female EM physicians' current perceptions and experiences regarding breastfeeding practices and identified modifiable work-place factors affecting their decision to wean. The authors hypothesized that EM physician mothers would have excellent breastfeeding initiation rates but be largely unable to maintain breastfeeding practices upon returning to work.

METHODS

A 34-item survey questionnaire evaluated demographics, perceptions, and experiences with breastfeeding with a convenience sample of EM attending and resident physicians from two Michigan academic community hospitals.

RESULTS

Thirty-nine surveys were completed, representing a participant response rate of 88.6%. Breastfeeding had been initiated by all respondent mothers, all of whom returned to full-time employment after delivery. Upon return to work, 15 (75%) respondents continued to exclusively breastfeed. The goal of participants was to breastfeed for an average of 7.1 months (± 4.1 months), although the average duration children were exclusively breastfed was 5.8 months (± 4.0 months).

CONCLUSIONS

Based on these results, the reasons for decreased breastfeeding after return to work in an EM residency program setting are multifactorial and include some modifiable interpersonal and institutional influences. These findings support the implementation of work-place strategies and policies to promote successful breastfeeding practices among EM resident and attending physician mothers returning to work.

Engagement and Workplace Satisfaction of Emergency Medicine Faculty in the United States

OBJECTIVES

The objective was to determine the drivers of workplace satisfaction and attrition for emergency medicine (EM) faculty in U.S. medical schools.

METHODS

Dimensions of workplace satisfaction measured in the Association of American Medical Colleges StandPoint Faculty Engagement Survey from 36 U.S. Liaison Committee on Medical Accreditation-accredited medical schools were analyzed by multiple regression analysis to determine the factors associated with overall workplace satisfaction and intention to leave. These were compared to faculty from non-EM clinical departments.

RESULTS

In total, 737 EM faculty (response rate 66%) completed the survey. Over 50% of EM faculty are less than 45 years old, of junior rank, and on a nontenure track, different than non-EM colleagues. Overall satisfaction with one's department as a place to work was 76% and one's medical school as a place to work was 69%, similar to other clinical faculty. Overall satisfaction is 87% for EM faculty with a formal mentor compared to 68% for those who do not. One's nature of work, departmental governance, collegiality and collaboration, and the clinical practice environment are significant factors in overall workplace satisfaction. EM faculty spend significantly more time on teaching and administrative tasks and less time on research than non-EM faculty. Overall functioning of the ED and ability to provide high-quality care in their practice environment is lower for EM than non-EM faculty. Survey dimensions were poor predictors of intention to leave.

CONCLUSIONS

Overall EM faculty have high workplace satisfaction similar to other specialties. Ensuring strong departmental leadership, improving the clinical practice environment, and increasing access to a formal mentor may be effective strategies to improve workplace satisfaction for EM faculty.

Exploring emergency physicians' professional identities: a Q-method study

Professional identities research in medical education has made significant contributions to the field. However, what comprises professional identities is rarely interrogated. This research tackles this relatively understudied component of professional identities research by understanding emergency medicine physicians' perspectives on the important elements that comprise their professional identities. Q-methodology was used to identify different clusters of viewpoints on professional identities; by extension, the core components that comprise emergency medicine physicians' professional identities are disclosed. Thirty-three emergency medicine physicians were recruited, through purposive sampling, from five hospitals across Taiwan. R software was used to analyse the Q-sorts, determine loadings on each viewpoint and formulate the viewpoint array. Analysis of interview data enhanced our understanding of these viewpoints. In total, twenty-five emergency medicine physicians loaded onto four distinct viewpoints, reflecting dominant perspectives of emergency medicine physicians' understanding of their professional identities. These distinct viewpoints demonstrated what emergency medicine physicians deemed significant in how they understood themselves. The viewpoints comprised: skills acquisition, capabilities and practical wisdom; coping ability and resilience; professional recognition and self-esteem; and wellbeing and quality of life. All viewpoints stressed the importance of trust between colleagues. These findings demonstrate the multitude of ways in which seemingly unified professional identities diverge across groups of individuals. An enhanced understanding of speciality work culture is gained. By understanding facets of professional identities, the development of future educational interventions and departmental initiatives, which might support key components of professional identities, can be explored.

A mandatory Emergency Medicine clerkship influences students' career choices in a developing system

BACKGROUND

Attracting medical students for a front-line specialty, Emergency Medicine, is challenging in many countries. The available literature is scarce and bounded to the mature emergency care and education systems. In the countries where emergency medicine is a new specialty and has different contextual needs, the perception of the students and their career interest in emergency medicine specialty is an unanswered question.

OBJECTIVE

We aimed to study the effects of a mandatory Emergency Medicine (EM) clerkship on students' perceptions and their future career choice to be emergency physicians.

METHODS

A voluntary de-identified survey was prospectively collected before and after the EM clerkship to capture students' perceptions in four domains (EM clerkship, EM physicians, EM patients, and EM specialty as a career choice). The survey included 24 statements having five-point Likert scale for each statement. Non-parametric Wilcoxon signed rank test was used for statistical analysis.

RESULTS

Sixty-seven students responded to both surveys (response rate of 85%). Students' perceptions have significantly improved on the EM physicians, and their job after attending the clerkship (p < 0.001). They found EM a respected (p = 0.038), flexible (p < 0.001), secure (p < 0.001), satisfying, and prestigious (p = 0.006) job. They found EM physicians compassionate (p < 0.011), have adequate patient contact (p < 0.045) and control on their time (0.004). Choosing EM as a future career has significantly increased after clerkship (p < 0.001).

CONCLUSIONS

Our mandatory EM clerkship significantly improved students' perceptions on EM specialty as a future career choice. A well-structured and mandatory EM clerkship can attract more students to be trained in the EM.

Does academic practice protect emergency physicians against burnout?

Burnout is a complex syndrome thought to result from long-term exposure to career-related stressors. Physicians are at higher risk for burnout than the general United States (US) working population, and emergency medicine has some of the highest burnout rates of any medical specialty. Burnout impacts physicians' quality of life, but it can also increase medical errors and negatively affect patient safety. Several studies have reported lower burnout rates and higher job satisfaction in academic medicine as compared with private practice. However, researchers have only begun to explore the factors that underlie this protective effect. This paper aims to review existing literature to identify specific aspects of academic practice in emergency medicine that may be associated with lower physician burnout rates and greater career satisfaction. Broadly, it appears that spending time in the area of emergency medicine one finds most meaningful has been associated with reduced physician burnout. Certain non-clinical academic work, including involvement in research, leadership, teaching, and mentorship, have been identified as specific activities that may protect against burnout and contribute to higher job satisfaction. Given the epidemic of physician burnout, hospitals and practice groups have a responsibility to address burnout, both by prevention and by early recognition and support. We discuss methods by which organizations can actively foster physician well-being and provide examples of 2 leading academic institutions that have developed comprehensive programs to promote physician wellness and prevent burnout.

Emergency Medicine Residents With Higher Levels of Debt Are Less Likely to Choose Academic Jobs, but There Is a Difference by Gender

OBJECTIVES

We sought to answer the following question: Does educational debt burden affect decisions by emergency medicine residents about whether to pursue academic versus community medicine jobs directly after residency?

METHODS

In this observational study, graduating residents across eight emergency medicine residencies were surveyed concurrent with their in-training examinations over 2 years to assess levels of educational debt and demographic information. Job types chosen by residents upon graduation were obtained from their respective program directors. The impact of debt on type of job chosen was assessed through multivariate logistic regression with demographic controls and program fixed effects, with additional analysis of observed differences by gender.

RESULTS

Information was collected on 159 residents from 14 graduating classes across eight programs representing six different states. Residents with higher levels of debt had lower odds of choosing an academic fellowship or faculty position upon graduation (odds ratio [OR] = 0.77, confidence interval [CI] = 0.60 to 0.98). On further analysis, higher debt predicted lower odds of choosing an academic position for men (OR = 0.59, CI = 0.41 to 0.82), but not for women (OR = 1.05, CI = 0.63 to 1.76).

CONCLUSIONS

When male emergency medicine residents have higher levels of debt, they are significantly less likely to pursue an academic fellowship or faculty position after residency. This may not be the case for female residents. Results may reflect differences in the factors that affect men and women's decisions about jobs after residency, which merits further study.

An environmental scan of wellness initiatives and programs at Canadian academic emergency medicine programs: How far have we come?

OBJECTIVES

We sought to conduct a major objective of the Canadian Association of Emergency Physicians (CAEP) Wellness Committee, an environmental scan of the academic emergency medicine programs across the 17 Canadian medical schools.

METHODS

An 89-question questionnaire was distributed to academic heads or wellness leads. The responses were verified by the lead author to ensure that the questions were answered completely and consistently.

RESULTS

While formal wellness programs may exist in varying degrees across the 17 universities, most were found to exist only at local, divisional, or departmental levels. A broad variability of established leadership positions exists. Shift practices varied greatly. In day to day practice, availability for food and debriefing were high and childcare, sleep rooms, and follow-up following critical incidents were low. Sabbaticals existed in the majority of centers. Roughly 50% of departments have gender equity program and annual retreats. Centers report programs for the initiation of leaves (82%), onboarding (64%), and reorientation (94%). Support of health benefits (76%) and pensions (76%) depended on type of appointment and relationship to the university. Fiscal transparency was reported in 53% of programs.

CONCLUSION

Wellness and burnout are critical issues for emergency medicine in Canada. This comprehensive review of wellness programs identifies areas of strength, but also allows identification of areas of improvement for future work. Individual centers can identify common options when developing or expanding their wellness programs.

Changes to the ACGME Common Program Requirements and Their Potential Impact on Emergency Medicine Core Faculty Protected Time

The Accreditation Council for Graduate Medical Education (ACGME), which regulates residency and fellowship training in the United States, recently revised the minimum standards for all training programs. These standards are codified and published as the Common Program Requirements. Recent specific revisions, particularly removing the requirement ensuring protected time for core faculty, are poised to have a substantial impact on emergency medicine training programs. A group of representatives and relevant stakeholders from national emergency medicine (EM) organizations was convened to assess the potential effects of these changes on core faculty and the training of emergency physicians. We reviewed the literature and results of surveys conducted by EM organizations to examine the role of core faculty protected time. Faculty nonclinical activities contribute greatly to the academic missions of EM training programs. Protected time and reduced clinical hours allow core faculty to engage in education and research, which are two of the three core pillars of academic EM. Loss of core faculty protected time is expected to have detrimental impacts on training programs and on EM generally. We provide consensus recommendations regarding EM core faculty clinical work hour limitations to maintain protected time for educational activities and scholarship and preserve the quality of academic EM.

Strategies for Provider Well-Being in the Emergency Department

A variety of operational and administrative factors have the potential to decrease wellness and negatively impact emergency physicians, in terms of both their on-the-job performance and their long-term career satisfaction. Among these are the issues of workload balance, physiologic and circadian stresses, and larger issues of malpractice risk and institutional support. This overview covers both emerging research on how these problems affect emergency physicians and strategies to help mitigate these challenges.

Physician Well-Being

Burnout is a work-related condition. Although stress may be a part of emergency medicine, excessive levels of chronic stress can lead to maladaptive behaviors and burnout. Burnout can lead to decreased physician longevity and performance and poorer patient outcomes. The first step is recognizing burnout in providers. Efforts can then be made to identify modifiable or unnecessary sources of stress to help reduce chronic stress and burnout. Solutions should be found to eliminate or ameliorate individual-level and system-level sources of stress.

Burnout Rates in Pediatric Emergency Medicine Physicians

OBJECTIVE

Burnout is a syndrome in which a reduced sense of personal accomplishment, depersonalization, and emotional exhaustion develop in response to prolonged stress. It is well known that physicians suffer high rates of burnout; emergency medicine physicians experience significantly increased rates of burnout, whereas physicians in other specialties, like pediatrics, may be spared. Pediatric emergency medicine physicians are on the frontline of care for the critically ill child, which could put them at high risk for burnout. This study evaluates the rate of burnout in pediatric emergency medicine physicians.

METHODS

We conducted a survey assessing burnout using a sample of pediatric emergency medicine physicians who subscribe to an open Listserv server maintained by Brown University. Burnout was measured using a validated instrument, the Maslach Burnout Inventory-Human Services Survey, which was distributed by e-mail to the study group.

RESULTS

Respondents averaged a score of 9 (95% confidence interval [CI], 8-10), 23 (95% CI, 21-25), and 39 (95% CI, 38-40) in the subscales of depersonalization, emotional exhaustion, and personal accomplishment, respectively. This placed our cohort into the average range for all subscales. The percentage of respondents who scored in the high levels of burnout (moderate to high scores in both depersonalization and emotional exhaustion and low to moderate scores in personal accomplishment) was 25% (95% CI, 18-32).

CONCLUSIONS

Unlike previous literature showing burnout prevalence in excess of 60% in emergency medicine physicians and 38% in pediatricians, our pediatric emergency medicine physicians fared better with only 25% (95% CI, 18-32), showing elevated levels of burnout.

Wellness, burnout, and the dermatologist: Fundamentals for practice longevity

Physician wellness is a critical component of any effective health care system, as physicians serve essential roles as diagnosticians, surgeons, and leaders in medical care. Physician burnout, defined as a combination of the presence of emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment, is an increasingly recognized problem in the US health care system, as rates of burnout among physicians are on the rise, now exceeding 50%. To date, few studies have examined the impact of burnout on dermatologists specifically, but existing studies evaluating physicians collectively have shed light on the problem that exists in our specialty. This review focuses on the causes of physician dissatisfaction and burnout and provides an overview on interventions to mitigate them while emphasizing wellness; where applicable, special emphasis is placed on dermatologists.

[Burnout syndrome and associated factors among physicians in two University Hospitals in Antananarivo]

La profession médicale est un métier stressant, pouvant engendrer un syndrome d'épuisement professionnel ou burnout syndrom (BOS). Le but de cette étude était de déterminer les degrés du BOS (faible, moyen, élevé) de par ses dimensions et les facteurs liés à l'activité professionnelle du médecin qui lui étaient corrélés. Il s'agit d'une étude transversale, en 2012, par auto-questionnaire, auprès des médecins du Centre Hospitalier de Soavinandriana et du Centre Hospitalier Universitaire, Joseph Ravoahangy Andrianavalona. Des tests de corrélation et de régression linéaire ont été effectués (SigmaStat^® 3.5). Le taux de réponse à l'enquête a été de 47,1% sur 138 médecins hospitaliers. Le nombre de dossiers retenus était de 48. La population de l'étude était à prédominance masculine (sex ratio: 1,8) avec un âge médian de 37 [25-59] ans. Les internes de spécialité et les médecins assistants représentaient 56,3% de la population. Selon l'ancienneté 16,7% étaient dans le métier depuis moins d'un an. Le burnout syndrom a été observé dans 51,2 % des cas avec un degré élevé pour 4,2% des médecins. Le titre avait une corrélation significative avec le syndrome d'épuisement professionnel et son degré (p=0,0142 et p=0,0362), notamment l'épuisement émotionnel (p=0,0414). L'apparition du BOS n'était ni corrélé avec l'ancienneté du médecin ni avec le secteur d'activité. Le BOS existe en milieu hospitalier, surtout lié au titre du médecin. Il est essentiel de le diagnostiquer au plus tôt pour en éviter ses conséquences délétères.

Well-Being among Emergency Medicine Resident Physicians: Results from the ABEM Longitudinal Study of Emergency Medicine Residents

BACKGROUND

The Longitudinal Study of Emergency Medicine Residents (LSEMR) conducted by the American Board of Emergency Medicine queries a randomized cohort of emergency medicine (EM) residents. It is designed to identify residents' perceptions of their training, sources of stress, well-being level, and career choice satisfaction over time.

OBJECTIVES

This study utilizes LSEMR to identify resident well-being levels, career satisfaction, factors producing stress, and whether a specific cohort is more stressed than the overall respondent group.

METHODS

Data from five longitudinal cohorts were analyzed using descriptive statistics to assess stressors, career satisfaction, and self-reported resident well-being. Participants' answers were reported on a 5-point Likert scale.

RESULTS

There were 766 residents who completed the survey in five cohorts. Respondents were 30 years old (median 29), male (66%), and predominantly White (79%). The most frequently encountered problems included "time devoted to documentation and bureaucratic issues," "knowing enough," and "crowding in the emergency department." In contrast, the least frequently reported problems included "gender discrimination," "EMS support," "minority discrimination," and "other residents." Respondents thought being an EM resident was fun and would select EM again. Less than 20% indicated they had seriously considered transferring to another EM program. Resident reports of health concerns changed over time, with fewer residents reporting they were exceptionally healthy in 2016.

CONCLUSIONS

Residents are, overall, happy with their career choice. However, concern was expressed regarding continued well-being in training. Sources of stress in training are identified. Strategies should be developed to decrease identified stressors and increase well-being among EM residents.

Gender Differences and Work-Family Conflicts among Emergency Physicians with Intention to Leave

Backgrounds

The objective of this study was to investigate the relationships among intention to leave, emergency physician clinical activities, work-family conflicts, and gender differences in emergency physicians (EPs).

Methods

The survey instrument was a self-administered questionnaire containing basic demographic information and characteristics of clinical activities. The work-family conflicts were assessed by the Chinese version of the work-family conflict (WIF) scale. The questionnaires were mailed to board-certified EPs between January 2014 and August 2014. Student's t-test, Chi-square test, and one-way analysis of variance (ANOVA) were used to test the difference between subgroups. Logistic regression analysis was performed to determine the factors associated with intention to leave and gender differences.

Results

The study included 222 respondents for analysis after exclusions. Compared with physicians not planning to leave, those planning to leave ED practice showed higher dissatisfaction with their clinical work hours (50.0% versus 31.4%, p = 0.035) and night/day shift ratio (52.9% versus 31.0%, p = 0.013) and tended to work with night/day shift ratio exceeding 40% (67.6% versus 45.7%, p = 0.019). Female physicians were more likely to leave ED practice (females versus males, 26.5% versus 10.1%, p = 0.008). A significantly higher level of WIF scale was noted in the group with intention to leave ED practice (3.7 ± 0.6 versus 3.3 ± 0.7, p = 0.001).

Conclusions

Females and EPs with higher level of WIF scale were more likely to leave emergency clinical practice. Instead of the number of clinical practice hours, the satisfaction with the clinical work hours and night shift frequency were significantly associated with the intention to leave.

Impact of a One Day Crisis Resource Management Training on the Work Satisfaction among Emergency Department Healthcare Staff

Objective: To evaluate the impact of a single day Crisis Resource Management (CRM) oriented team training, combining didactic and simulation sessions, on work satisfaction of the healthcare staff working in an Emergency Department. Methods: Seventy health professionals with different qualifications, working in an emergency department, were enrolled in the study. After enrollment, participants were asked to complete a work satisfaction questionnaire and to choose a day for the training session according to their availability. Each training session took place in the simulation center and consisted of several elements: didactic session and simulation session, followed by instructor facilitated debriefing. The lecture was focused on medical errors and CRM principles. Two months after, they were asked to complete again the work satisfaction questionnaire. Results: There were no significant improvements on the items evaluated through the work satisfaction questionnaire for none of the professional categories involved, except for ‘the possibility to refer the patient to a specialist whenever was considered necessary’ for the doctors. Improvements were seen for the same professional category on the following items: workload, leisure time, level of stress at work, time and energy spent on administrative tasks. Conclusions: The findings of this study do not support the effectiveness of a single day CRM training as a tool to improve the work satisfaction among medical staff in ED. Further research is necessary.

Canadian family physician job satisfaction - is it changing in an evolving practice environment? An analysis of the 2013 National Physician Survey database

Background

To explore the determinants of job satisfaction and work-life balance satisfaction of family physicians in Canada.

Methods

This is a secondary analysis of the Canadian 2013 National Physician’s Survey using descriptive statistics and binomial logistic regression. An estimated 34,753 family physicians practicing in Canada at the time of survey administration in 2013 were eligible for the survey. The main outcome measures were respondent satisfaction with professional life and satisfaction with work-life balance.

Results

The survey had a response rate of 17%. Seventy-two percent of respondents were satisfied with their professional lives, and 49% were satisfied with their work-life balance. Male family physicians had lower odds of satisfaction with their work-life balance than their female counterparts (OR = 0.86, 95% CI 0.82–0.92). Family physicians using an electronic medical record had higher odds of dissatisfaction with their professional lives (OR = 1.13, 95% CI 1.05–1.22) and work-life balance (OR = 1.22, 95% CI 1.15–1.30) than those not using an EMR. Family physicians not in a focused practice had greater odds of dissatisfaction (OR = 1.61, 95% CI 1.50–1.72) with both their professional lives and work-life balance (OR = 1.29, 95% CI 1.22–1.37) compared to their colleagues who have one or more areas of clinical focus.

Conclusions

Canadian family physicians are more satisfied with their professional lives than with their work-life balance. Novel findings that family physicians with one or more clinical areas of focus are more satisfied with their work and work-life balance satisfaction, and that family physicians using electronic health records are less satisfied with their work and their work-life balance merit further inquiry.

Electronic supplementary material

The online version of this article (10.1186/s12875-018-0786-6) contains supplementary material, which is available to authorized users.

Associations between psychosocial work factors and provider mental well-being in emergency departments: A systematic review

BACKGROUND

Emergency departments (ED) are complex and dynamic work environments with various psychosocial work stressors that increase risks for providers' well-being. Yet, no systematic review is available which synthesizes the current research base as well as quantitatively aggregates data on associations between ED work factors and provider well-being outcomes.

OBJECTIVE

We aimed at synthesizing the current research base on quantitative associations between psychosocial work factors (classified into patient-/ task-related, organizational, and social factors) and mental well-being of ED providers (classified into positive well-being outcomes, affective symptoms and negative psychological functioning, cognitive-behavioural outcomes, and psychosomatic health complaints).

METHODS

A systematic literature search in eight databases was conducted in December 2017. Original studies were extracted following a stepwise procedure and predefined inclusion criteria. A standardized assessment of methodological quality and risk of bias was conducted for each study with the Quality Assessment Tool for Quantitative Studies from the Effective Public Health Practice Project. In addition to a systematic compilation of included studies, frequency and strength of quantitative associations were synthesized by means of harvest plots. Subgroup analyses for ED physicians and nurses were conducted.

RESULTS

N = 1956 records were retrieved. After removal of duplicates, 1473 records were screened for titles and abstracts. 199 studies were eligible for full-text review. Finally, 39 original studies were included whereof 37 reported cross-sectional surveys. Concerning the methodological quality of included studies, the majority was evaluated as weak to moderate with considerable risk of bias. Most frequently surveyed provider outcomes were affective symptoms (e.g., burnout) and positive well-being outcomes (e.g., job satisfaction). 367 univariate associations and 370 multivariate associations were extracted with the majority being weak to moderate. Strong associations were mostly reported for social and organizational work factors.

CONCLUSIONS

To the best of our knowledge, this review is the first to provide a quantitative summary of the research base on associations of psychosocial ED work factors and provider well-being. Conclusive results reveal that peer support, well-designed organizational structures, and employee reward systems balance the negative impact of adverse work factors on ED providers' well-being. This review identifies avenues for future research in this field including methodological advances by using quasi-experimental and prospective designs, representative samples, and adequate confounder control.

TRIAL REGISTRATION

Protocol registration number: PROSPERO 2016 CRD42016037220.

Public unawareness of physician reimbursement

Objectives

To assess subjects' perception of healthcare costs and physician reimbursement.

Background

The lack of transparency in healthcare reimbursement leaves patients and physicians unaware of the distribution of health care dollars.

Methods

Anonymous survey‐based study by means of convenience sampling. Participants were asked to estimate the total hospital cost and physician fee for one of the six medical procedures (n = 250).

Results

On the average for all 6 procedures, patients estimated the total cost was $36,177, ∼1,540% more than the actual Medicare rate of $7,333. Similarly, patients estimated the physician fee was $7,694, 1,474% more the actual Medicare rate of $589.

Conclusion

Patients' perception of the total cost and physician fee are significantly higher than Medicare rates for all 6 procedures. This lack of insight may have widespread negative implications on the patient–physician relationship, on political trends to reduce physician reimbursement, and on a physician's desire to continue practicing medicine.

Probability of Early Retirement Among Emergency Physicians

OBJECTIVES

Early retirement occurs when one's job satisfaction suffers due to employment mismatch resulting from factors such as inadequate compensation. Medical doctors report high levels of job stress and burnout relative to other professionals. These levels are highest among emergency physicians (EPs), and despite general improvements in their working conditions, early retirement continues to become more common in this population. The purpose of this study was to identify the factors influencing EPs intention to retire early and to develop a probability equation for its prediction.

METHODS

A secondary analysis of data from the 2015 Korean Society of Emergency Physicians Survey was performed. The variables potentially influencing early retirement were organized into personal characteristics, extrinsic factors, and intrinsic factors. Logistic regression analysis was performed to identify risk factors and to develop a probability equation; these findings were then arranged in a nomogram.

RESULTS

Of the 377 survey respondents included in the analysis, 48.0% intended to retire early. Risk factors for early retirement included level of satisfaction with the specialty and its outlook, slanderous reviews, emergency room safety, health status, workload intensity, age, and hospital type. Intrinsic factors (i.e., slanderous reviews and satisfaction with the specialty and its outlook) had a stronger influence on early retirement than did extrinsic factors.

CONCLUSIONS

To promote career longevity among EPs, it is vital to improve emergency room safety and workload intensity, to enhance medical professionalism through a stronger vision of emergency medicine, and to strengthen the patient-doctor relationship.

Factors influencing medical students' choice of emergency medicine as a career specialty-a descriptive study of Saudi medical students

Background

Choosing a medical specialty is a poorly understood process. Although studies conducted around the world have attempted to identify the factors that affect medical students’ choice of specialty, data is scarce on the factors that influence the choice of specialty of Saudi Arabian medical students, in particular those planning a career in emergency medicine (EM). In this study, we investigated whether Saudi medical students choosing EM are influenced by different factors to those choosing other specialties.

Methods

A cross-sectional survey was conducted at King Saud bin Abdulaziz University for Health Sciences (KSAUHS), Riyadh, Saudi Arabia. The questionnaire distributed among all undergraduate and postgraduate medical students of both sexes in the second and third phases (57% were males and 43% were females).

Results

A total of 436 students answered the questionnaire, a response rate of 53.4%. EM group was most influenced by hospital orientation and lifestyle and least influenced by social orientation and prestige provided by their specialty. Unlike controllable lifestyle (CL) group and primary care (PC) group, EM reported lesser influence of social orientation on their career choice. When compared with students primarily interested in the surgical subspecialties (SS), EM group were less likely to report prestige as an important influence. Moreover, students interested in SS reported a leaser influence of medical lifestyle in comparison to EM group. When compared with CL group, EM group reported more interest in medical lifestyle.

Conclusions

We found that students primarily interested in EM had different values and career expectations to other specialty groups. The trends in specialty choice should be appraised to meet future needs.

Emergency Physician Job Satisfaction in Hong Kong

Objective

We aimed to explore the visibility of emergency medicine (EM) journals in mainland China based on the coverage by major indexing and abstracting information agencies and services.

Methodology

We first searched each journal by entering its title in Google's search engine, and then entered its home page to collect associated information, like publication cycle, journal language, publisher, editorial board, authors, and journal website. Second, to collect the inclusion information, totally ten databases were selected on the basis that they were considered as representative sources within the biomedicine. We adopted two forms for searching every journal: searching for every Chinese EM journal title (both English title and Chinese ‘ping yin’ title), and searching for the word ‘China’ from the fields provided for publisher of sources or for country of publication of sources indexed.

Results

Currently, in Mainland China, there were 13 EM journals, 12 in Chinese and one in English. Among them, both Science Citation Index Expanded (SCIE) and BIOSIS Previews (BP) did not include any EM journals; both MEDLINE and Abstract Journals (AJ) included only one, respectively; Scopus, EMBASE, Index Copernicus (IC), and Japan Science and Technology Agency (JST) indexed two journals, respectively; Western Pacific Region Index Medicus (WPRIM) included four journals, and Chemical Abstracts (CA) included six journals.

Conclusion

Only a few Chinese EM journals are indexed or abstracted in the international databases. More work should be done to achieve higher visibility of EM journals. (Hong Kong j.emerg.med. 2015;22:41-45)

Burnout in Orthopaedic Surgeons: A Challenge for Leaders, Learners, and Colleagues: AOA Critical Issues

Burnout, depression, suicidal ideation, and dissatisfaction with work-life balance have been reported in all medical specialties and at all stages of medical education and practice experience. Burnout consists of progressive emotional, attitudinal, and physical exhaustion. Physicians with burnout may treat patients as objects and feel emotionally depleted. Burnout is characterized by a loss of enthusiasm for work (emotional exhaustion), feelings of cynicism (depersonalization), and a low sense of personal accomplishment. The most complete study of emotional burnout among different medical specialties demonstrated that orthopaedic surgery is one of the specialties with the highest burnout rate. Qualitative descriptive studies are available. There was a 45.8% burnout rate among physicians in the U.S. in 2012, and a 2014 update suggested even higher rates. Burnout has a correlation with medical education. Burnout rates are similar to those in the general population when medical students enter school, and increase steadily through medical education prior to residency. Burnout rates in residents are high, reported to be between 41% and 74% across multiple specialties. This impacts our young physician workforce in orthopaedics. The purpose of this review is to provide the available information that characterizes burnout and addresses the issues inherent to preventing burnout, and to build awareness in orthopaedic surgeons. Wellness "goes beyond merely the absence of distress and includes being challenged, thriving, and achieving success in various aspects of personal and professional life." The challenge for the orthopaedic community is to develop interventions and strategies that are personalized to the individuals in this specialty.

Assessing the Influence of a Fitbit Physical Activity Monitor on the Exercise Practices of Emergency Medicine Residents: A Pilot Study

Background

Targeted interventions have improved physical activity and wellness of medical residents. However, no exercise interventions have focused on emergency medicine residents.

Objective

This study aimed to measure the effectiveness of a wearable device for tracking physical activity on the exercise habits and wellness of this population, while also measuring barriers to adoption and continued use.

Methods

This pre-post cohort study enrolled 30 emergency medicine residents. Study duration was 6 months. Statistical comparisons were conducted for the primary end point and secondary exercise end points with nonparametric tests. Descriptive statistics were provided for subjective responses.

Results

The physical activity tracker did not increase the overall self-reported median number of days of physical activity per week within this population: baseline 2.5 days (interquartile range, IQR, 1.9) versus 2.8 days (IQR 1.5) at 1 month (P=.36). There was a significant increase in physical activity from baseline to 1 month among residents with median weekly physical activity level below that recommended by the Centers for Disease Control and Prevention at study start, that is, 1.5 days (IQR 0.9) versus 2.4 days (IQR 1.2; P=.04), to 2.0 days (IQR 2.0; P=.04) at 6 months. More than half (60%, 18/30) of participants reported a benefit to their overall wellness, and 53% (16/30) reported a benefit to their physical activity. Overall continued use of the device was 67% (20/30) at 1 month and 33% (10/30) at 6 months.

Conclusions

The wearable physical activity tracker did not change the overall physical activity levels among this population of emergency medicine residents. However, there was an improvement in physical activity among the residents with the lowest preintervention physical activity. Subjective improvements in overall wellness and physical activity were noted among the entire study population.

[Work satisfaction and exhaustion among psychiatrists in psychiatric emergency services]

BACKGROUND AND AIM

Psychiatric emergency services (PES) have recently occupied a new and growing place in the landscape of mental health services. However, few data are available on the way psychiatrists practice in the PES. Our aim was to survey psychiatrists working in PES, focusing on their job satisfaction and the theoretical models they use in their everyday practice.

METHOD

We sent a survey to a sample of 508 psychiatrists working in PES in France.

RESULTS

Two hundred and thirty-seven psychiatrists returned the survey, yielding a response rate of 47%. On a 0 to 10 scale, the mean level of job satisfaction was 6.7 (SD: 1.92). Participants reported that facing a variety of clinical situations and playing a key-coordinating role in the mental health system were the two most specific features of emergency psychiatry. The main sources of dissatisfaction were organizational issues and stressful clinical experiences, including violence or hostility. Sixty-three percent (n=150) of participants reported using more than two theoretical models in their practice, while the use of crisis models was reported by almost 40% of them. When assessed for suggestions to improve the PES, the majority of participants indicated that efforts should be focused on organizational factors.

CONCLUSION

While emergency psychiatry could appear as an ungrateful practice, the majority of psychiatrists who responded to our survey reported satisfaction with their work and highlighted its unique particularities. Future research and collaborations are needed to identify organizational models of PES and their better integration in mental health networks.

The relationship between leadership and physician well-being: a scoping review

To date, research has established the individual and organizational factors that impair well-being. Thus, we are aware of the organizational “cogs and wheels” that drive well-being, and there is a sense that we can potentially utilize effective leadership to push and pull these in the appropriate directions. However, reviews of leadership in health care point to the lack of academic rigor and difficulty in reaching solid conclusions. Conversely, there is an accepted belief that the most important determinant of the development and maintenance of cultures is current – and future – leadership. Thus, leadership is assumed to be an important element of organizational functioning without the requisite evidence base. Medicine is a unique organizational environment in which the health of physicians may be a significant risk factor for inadequate patient safety and suboptimal care. Globally, physicians are reporting increasing levels of job burnout, especially among younger physicians in training. Not surprisingly, higher levels of physician burnout are associated with suboptimal care for patients and medical error, as well as maladaptive coping strategies among physicians that serve to exacerbate the former. This review is a scoping analysis of the existing literature to address the central question: is there a relationship between organizational leadership and physician well-being? The objectives of the review are as follows: 1) identify the degree to which physician health is under threat; 2) evaluate the evidence linking leadership with physician well-being; 3) identify alternative ways to approach the problem; and 4) outline avenues for future research. Finally, enhancing progress in the field is discussed in the contexts of theory, methodology, and impact.