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Lee H, Going M, Tivnan V, Tollefson M, Comander A, Frates E. Restoring Well-Being for Physicians Through Lifestyle Medicine. Am J Lifestyle Med 2024; 18:260-268. [PMID: 38559786 PMCID: PMC10979729 DOI: 10.1177/15598276231194290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
In the wake of the COVID-19 pandemic, physician burnout is a more relevant concern than ever. Pre-existing stressors in health care, such as poor work-life balance, perfectionism, and inadequate social support, have been exacerbated by uncertainty, increased risk exposure, and general anxiety. Burnout places not only physicians, but also patients, systems, and communities at risk. The promotion of physician well-being is critical to sustaining the health care system. Actions to reduce burnout and increase well-being can and should occur on multiple levels. Organizations and leaders must take steps to create a culture of support and respect for health care providers. Such steps may include improved time-off policies, destigmatizing the use of mental health services, and reducing administrative burden. Physician well-being may benefit from action on an individual level as well. The pillars of Lifestyle Medicine provide a framework for engaging in behaviors compatible with overall well-being, such as physical activity, social connection, and sleep. Lifestyle Medicine plays a key role in mitigating the impact of physician burnout, and will be essential to the success of the health care system moving forward.
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Affiliation(s)
- Hannah Lee
- Massachusetts General Hospital Cancer Center, Boston, MA, USA (HL, AC)
| | - Michelle Going
- Metropolitan State University of Denver, Denver, CO, USA (MG, MT)
| | | | | | - Amy Comander
- Massachusetts General Hospital Cancer Center, Boston, MA, USA (HL, AC)
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Albanesi R, Gitto L. Motivational dynamics and impact on performances: The case of physicians of university polyclinics in the NHS scenario. J Eval Clin Pract 2024; 30:42-45. [PMID: 37143442 DOI: 10.1111/jep.13856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 04/21/2023] [Indexed: 05/06/2023]
Abstract
RATIONALE The principle of inseparability of teaching, academic research and assistance to patients, to which university physicians are subject in carrying out their work, invites reflection, aimed at identifying a combination of the three activities characterised, at the same time, by efficiency and effectiveness. AIMS AND OBJECTIVES The present paper illustrates a paradigm based on the balance of intrinsic and extrinsic motivations with the purpose of identifying an efficient solution in the performance of the duties of university doctors. METHODS The analysis refers to Italy in terms of the main scenario, or, conversely, the achievement of more profit-related goals. RESULTS AND CONCLUSION Depending on the prevailing goal, it is possible to recognise the superiority of the constitutional principles.
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Affiliation(s)
- Rosa Albanesi
- Dipartimento di Economia, Università degli Studi di Messina, Messina, Italy
| | - Lara Gitto
- Dipartimento di Economia, Università degli Studi di Messina, Messina, Italy
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Toubassi D, Schenker C, Roberts M, Forte M. Professional identity formation: linking meaning to well-being. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:305-318. [PMID: 35913664 PMCID: PMC9341156 DOI: 10.1007/s10459-022-10146-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 07/10/2022] [Indexed: 06/15/2023]
Abstract
Trainee distress and burnout continue to be serious concerns for educational programs in medicine, prompting the implementation of numerous interventions. Although an expansive body of literature suggests that the experience of meaning at work is critical to professional wellbeing, relatively little attention has been paid to how this might be leveraged in the educational milieu. We propose that professional identity formation (PIF), the process by which trainees come to not only attain competence, but additionally to "think, act and feel" like physicians, affords us a unique opportunity to ground trainees in the meaningfulness of their work. Using the widely accepted tri-partite model of meaning, we outline how this process can contribute to wellbeing. We suggest strategies to optimize the influence of PIF on wellbeing, offering curricular suggestions, as well as ideas regarding the respective roles of communities of practice, teachers, and formative educational experiences. Collectively, these encourage trainees to act as intentional agents in the making of their novel professional selves, anchoring them to the meaningfulness of their work, and supporting their short and long-term wellbeing.
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Affiliation(s)
- Diana Toubassi
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
- University Health Network - Toronto Western FHT, 440 Bathurst Street - Suite 300, Toronto, ON, M5T 2S6, Canada.
| | - Carly Schenker
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Michael Roberts
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Milena Forte
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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Adarkwah CC, Labenz J, Hirsch O. Burnout and work satisfaction are differentially associated in gastroenterologists in Germany. F1000Res 2022; 11:368. [PMID: 35673351 PMCID: PMC9152463 DOI: 10.12688/f1000research.110296.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Burnout in the field of gastroenterology is an under-researched phenomenon. So far, only a few studies have dealt with this topic. There are large geographical variations in burnout rates with 16-20% of gastroenterologists in Mexico and Germany being at risk or having burnout, 30-40% in the United Kingdom, and 50-55% in South Korea, Canada, and the USA. The investigation of differential associations of burnout with important factors in gastroenterologists leading to tailored therapy recommendations is lacking. Therefore, we investigated the associations between work satisfaction and burnout in this specialization. METHODS We distributed an electronic survey to gastroenterologists organized mainly in the Federal Organization of Gastroenterology in Germany (the BVGD - Bundesverband Gastroenterologie Deutschland). The Maslach Burnout Inventory (MBI) and the Work Satisfaction Questionnaire (WSQ) were examined regarding their postulated internal structure in our sample of gastroenterologists. Canonical correlations were performed to examine the association between work satisfaction and burnout in endoscopy physicians. RESULTS An acceptable model fit was shown for both the MBI and the Work Satisfaction Questionnaire. The canonical correlation analysis resulted in two statistically significant canonical functions with correlations of .62 (p<.001) and .27 (p<.001). The full model across all functions was significant (χ 2 (18) = 386.26, p<.001). Burden, personal rewards, and global item regarding the job situation were good predictors for less exhaustion, while patient care and professional relations were good predictors for personal accomplishment. This supports the recognition of burnout as being a multidimensional construct which has to be thoroughly diagnosed. CONCLUSIONS Specific interventions should be designed to improve symptoms of burnout in endoscopy physicians according to their individual complaints as burnout is a multidimensional construct. Differential interventions should be offered on the basis of our study results in order to alleviate the issue of work satisfaction and burnout in endoscopy physicians.
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Affiliation(s)
- Charles Christian Adarkwah
- Department of General Practice and Family Medicine, Philipps-University, Marburg, 35043, Germany
- CAPHRI School for Public Health and Primary Care, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Joachim Labenz
- Medizinische Klinik, Diakonie Klinikum, Siegen, 57074, Germany
- Bundesverband Gastroenterologie Deutschland (BVGD) e. V., Berlin, 10707, Germany
| | - Oliver Hirsch
- Department of Psychology, FOM University of Applied Sciences, Siegen, 57078, Germany
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Adarkwah CC, Labenz J, Hirsch O. Burnout and work satisfaction are differentially associated in gastroenterologists in Germany. F1000Res 2022; 11:368. [PMID: 35673351 PMCID: PMC9152463 DOI: 10.12688/f1000research.110296.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Burnout in the field of gastroenterology is an under-researched phenomenon. So far, only a few studies have dealt with this topic. There are large geographical variations in burnout rates with 16-20% of gastroenterologists in Mexico and Germany being at risk or having burnout, 30-40% in the United Kingdom, and 50-55% in South Korea, Canada, and the USA. The investigation of differential associations of burnout with important factors in gastroenterologists leading to tailored therapy recommendations is lacking. Therefore, we investigated the associations between work satisfaction and burnout in this specialization. METHODS We distributed an electronic survey to gastroenterologists organized mainly in the Federal Organization of Gastroenterology in Germany (the BVGD - Bundesverband Gastroenterologie Deutschland). The Maslach Burnout Inventory (MBI) and the Work Satisfaction Questionnaire (WSQ) were examined regarding their postulated internal structure in our sample of gastroenterologists. Canonical correlations were performed to examine the association between work satisfaction and burnout in endoscopy physicians. RESULTS An acceptable model fit was shown for both the MBI and the Work Satisfaction Questionnaire. The canonical correlation analysis resulted in two statistically significant canonical functions with correlations of .62 (p<.001) and .27 (p<.001). The full model across all functions was significant (χ 2 (18) = 386.26, p<.001). Burden, personal rewards, and global item regarding the job situation were good predictors for less exhaustion, while patient care and professional relations were good predictors for personal accomplishment. This supports the recognition of burnout as being a multidimensional construct which has to be thoroughly diagnosed. CONCLUSIONS Specific interventions should be designed to improve symptoms of burnout in endoscopy physicians according to their individual complaints as burnout is a multidimensional construct. Differential interventions should be offered on the basis of our study results in order to alleviate the issue of work satisfaction and burnout in endoscopy physicians.
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Affiliation(s)
- Charles Christian Adarkwah
- Department of General Practice and Family Medicine, Philipps-University, Marburg, 35043, Germany
- CAPHRI School for Public Health and Primary Care, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Joachim Labenz
- Medizinische Klinik, Diakonie Klinikum, Siegen, 57074, Germany
- Bundesverband Gastroenterologie Deutschland (BVGD) e. V., Berlin, 10707, Germany
| | - Oliver Hirsch
- Department of Psychology, FOM University of Applied Sciences, Siegen, 57078, Germany
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Adarkwah CC, Labenz J, Hirsch O. Burnout and work satisfaction are differentially associated in gastroenterologists in Germany. F1000Res 2022; 11:368. [PMID: 35673351 PMCID: PMC9152463 DOI: 10.12688/f1000research.110296.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Burnout in the field of gastroenterology is an under-researched phenomenon. So far, only a few studies have dealt with this topic. There are large geographical variations in burnout rates with 16-20% of gastroenterologists in Mexico and Germany being at risk or having burnout, 30-40% in the United Kingdom, and 50-55% in South Korea, Canada, and the USA. The investigation of differential associations of burnout with important factors in gastroenterologists leading to tailored therapy recommendations is lacking. Therefore, we investigated the associations between work satisfaction and burnout in this specialization. METHODS We distributed an electronic survey to gastroenterologists organized mainly in the Federal Organization of Gastroenterology in Germany (the BVGD - Bundesverband Gastroenterologie Deutschland). The Maslach Burnout Inventory (MBI) and the Work Satisfaction Questionnaire (WSQ) were examined regarding their postulated internal structure in our sample of gastroenterologists. Canonical correlations were performed to examine the association between work satisfaction and burnout in endoscopy physicians. RESULTS An acceptable model fit was shown for both the MBI and the Work Satisfaction Questionnaire. The canonical correlation analysis resulted in two statistically significant canonical functions with correlations of .62 (p<.001) and .27 (p<.001). The full model across all functions was significant (χ 2 (18) = 386.26, p<.001). Burden, personal rewards, and global item regarding the job situation were good predictors for less exhaustion, while patient care and professional relations were good predictors for personal accomplishment. This supports the recognition of burnout as being a multidimensional construct which has to be thoroughly diagnosed. CONCLUSIONS Specific interventions should be designed to improve symptoms of burnout in endoscopy physicians according to their individual complaints as burnout is a multidimensional construct. Differential interventions should be offered on the basis of our study results in order to alleviate the issue of work satisfaction and burnout in endoscopy physicians.
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Affiliation(s)
- Charles Christian Adarkwah
- Department of General Practice and Family Medicine, Philipps-University, Marburg, 35043, Germany
- CAPHRI School for Public Health and Primary Care, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Joachim Labenz
- Medizinische Klinik, Diakonie Klinikum, Siegen, 57074, Germany
- Bundesverband Gastroenterologie Deutschland (BVGD) e. V., Berlin, 10707, Germany
| | - Oliver Hirsch
- Department of Psychology, FOM University of Applied Sciences, Siegen, 57078, Germany
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Knudsen HK, Brown R, Jacobson N, Horst J, Kim JS, Kim H, Madden LM, Haram E, Molfenter T. Prescribers' satisfaction with delivering medications for opioid use disorder. Subst Abuse Treat Prev Policy 2021; 16:78. [PMID: 34663379 PMCID: PMC8521499 DOI: 10.1186/s13011-021-00413-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Expanding access to medications for opioid use disorder (MOUD), such as buprenorphine and extended release (XR) naltrexone, is critical to addressing the US opioid epidemic, but little is known about prescriber satisfaction with delivering these two types of MOUD. The current study describes the satisfaction of prescribers delivering buprenorphine and XR-naltrexone while examining whether satisfaction is associated with current patient census and organizational environment. METHODS As part of a cluster randomized clinical trial (RCT) focused on expanding access to medication for opioid use disorder, 41 MOUD prescribers in Florida, Ohio, and Wisconsin completed a web-based survey. The survey included measures of prescriber satisfaction with delivering buprenorphine treatment and XR-naltrexone. In addition, the survey measured several prescriber characteristics and their perceptions of the organizational environment. RESULTS Prescribers were generally satisfied with their work in delivering these two types of MOUD. Prescribers reporting a greater number of patients (r = .46, p = .006), those who would recommend the center to others (r = .56, p < .001), and those reporting positive relationships with staff (r = .56, p < .001) reported significantly greater overall satisfaction with delivering buprenorphine treatment. Prescribers who more strongly endorsed feeling overburdened reported lower overall buprenorphine satisfaction (r = -.37, p = .02). None of the prescriber characteristics or perceptions of the organizational environment were significantly associated with overall satisfaction with delivering XR-naltrexone treatment. CONCLUSIONS The generally high levels of satisfaction with both types of MOUD is notable given that prescriber dissatisfaction can lead to turnover and impact intentions to leave the profession. Future research should continue to explore the prescriber characteristics and organizational factors associated with satisfaction in providing different types of MOUD. REGISTRATION ClinicalTrials.gov. NCT02926482. Date of registration: September 9, 2016. https://clinicaltrials.gov/ct2/show/NCT02926482 .
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Affiliation(s)
- Hannah K. Knudsen
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave., Room 204, KY 40508 Lexington, USA
| | - Randy Brown
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, 1100 Delaplaine Ct, WI 53715-1896 Madison, USA
| | - Nora Jacobson
- Institute for Clinical and Translational Research, University of Wisconsin-Madison, 4116 Signe Skott Cooper Hall, 701 Highland Ave, WI 53705 Madison, USA
| | - Julie Horst
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, WI 53706 Madison, USA
| | - Jee-Seon Kim
- Department of Educational Psychology, University of Wisconsin-Madison, 1025 West Johnson St, WI 53706-1706 Madison, USA
| | - Hanna Kim
- Department of Educational Psychology, University of Wisconsin-Madison, 1025 West Johnson St, WI 53706-1706 Madison, USA
| | - Lynn M. Madden
- Department of Internal Medicine, Yale University, APT Foundation, 1 Long Wharf Drive, Suite 321, CT 06511 New Haven, USA
| | - Eric Haram
- Haram Consulting, 413 River Road, ME 04008 Bowdoinham, USA
| | - Todd Molfenter
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, WI 53706 Madison, USA
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Shanafelt T, Trockel M, Rodriguez A, Logan D. Wellness-Centered Leadership: Equipping Health Care Leaders to Cultivate Physician Well-Being and Professional Fulfillment. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:641-651. [PMID: 33394666 PMCID: PMC8078125 DOI: 10.1097/acm.0000000000003907] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
These are challenging times for physicians. Extensive changes in the practice environment have altered the nature of physicians' interactions with patients and their role in the health care delivery system. Many physicians feel as if they are "cogs in the wheel" of austere corporations that care more about productivity and finances than compassion or quality. They often do not see how the strategy and plan of their organization align with the values of the profession. Despite their expertise, they frequently do not feel they have a voice or input in the operational plan of their work unit, department, or organization. At their core, the authors believe all of these factors represent leadership issues. Many models of leadership have been proposed, and there are a number of effective philosophies and approaches. Here, the authors propose a new integrative model of Wellness-Centered Leadership (WCL). WCL includes core skills and qualities from the foremost leadership philosophies along with evidence on the relationship between leadership and physician well-being and distills them into a single framework designed to cultivate leadership behaviors that promote engagement and professional fulfillment. The 3 elements of WCL are: care about people always, cultivate individual and team relationships, and inspire change. A summary of the mindset, behaviors, and outcomes of the elements of the WCL model is presented, and the application of the elements for physician leaders is discussed. The authors believe that learning and developing the skills that advance these elements should be the aspiration of all health care leaders and a foundational focus of leadership development programs. If cultivated, the authors believe that WCL will empower individual and team performance to address the current problems faced by health care organizations as well as the iterative innovation needed to address challenges that may arise in the decades to come.
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Affiliation(s)
- Tait Shanafelt
- T. Shanafelt is chief wellness officer, Jeanie and Stewart Ritchie Professor of Medicine, and associate dean, Stanford School of Medicine, Stanford, California; ORCID: http://orcid.org/0000-0002-7106-5202
| | - Mickey Trockel
- M. Trockel is clinical associate professor, Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford, California
| | - Ashleigh Rodriguez
- A. Rodriguez is currently a consultant, CMA Wellness Services, California Medical Association, Sacramento, California. At the time of writing, she was a graduate student, USC Marshall School of Business, Los Angeles, California
| | - Dave Logan
- D. Logan is chief executive officer, CMA Wellness Services, California Medical Association, Sacramento, and senior lecturer, Department of Management and Organization, University of Southern California, Los Angeles, California
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Messias E, Flynn V, Gathright M, Thrush C, Atkinson T, Thapa P. Loss of Meaning at Work Associated with Burnout Risk in Academic Medicine. South Med J 2021; 114:139-143. [PMID: 33655306 DOI: 10.14423/smj.0000000000001220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Meaning at work has been proposed as one of the key drivers of professional burnout in healthcare, but few studies have simultaneously measured this relation. METHODS In this cross-sectional analysis of 1637 individuals at the University of Arkansas for Medical Sciences, burnout was measured using the Copenhagen Burnout Inventory work-related subscale. RESULTS Meaningful work was measured using items adapted from the Work as Meaning Inventory. The prevalence of work-related burnout increased with each level of diminished meaning at work. From the highest ("always") to the lowest ("never") level of meaning at work, the prevalence of burnout was: 13, 26, 57, 84, and 94%, respectively. CONCLUSIONS Work-related burnout was inversely proportional to reported meaning at work in an academic medical center.
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Affiliation(s)
- Erick Messias
- From the Departments of Psychiatry, Surgery, and Internal Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - Victoria Flynn
- From the Departments of Psychiatry, Surgery, and Internal Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - Molly Gathright
- From the Departments of Psychiatry, Surgery, and Internal Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - Carol Thrush
- From the Departments of Psychiatry, Surgery, and Internal Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - Timothy Atkinson
- From the Departments of Psychiatry, Surgery, and Internal Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - Puru Thapa
- From the Departments of Psychiatry, Surgery, and Internal Medicine, University of Arkansas for Medical Sciences, Little Rock
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Alpar P, Driebe T. Motivation of Physicians to Use and Recommend Apps for the Treatment of Haemophilia. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211047752. [PMID: 34666532 PMCID: PMC8532214 DOI: 10.1177/00469580211047752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 09/02/2021] [Indexed: 01/09/2023]
Abstract
Digitalization of health care and the availability of suitable end devices lead to an increase in the use of telehealth applications. Most research on telehealth focuses on patients or organizations (like hospitals), while the role of physicians in this context is often neglected. In case of serious and chronic diseases, they play two major roles in the use of telehealth. Firstly, they may influence the patient's decision whether to use it at all (if more than one option is available, they may also influence the patient's choice of software). Secondly, if there is a need for a physicians' participation (eg, in telecare), an adoption decision by the physician to use the system is necessary. We develop a model to understand a physician's motivations to recommend the use of telehealth software to patients and to adopt it himself. The results demonstrate that physicians recommend telehealth based on their own use intention and the perceived performance improvements in patient treatment. Further, their own use intention is dependent on the usefulness of the system for their work. Potential disadvantages like decreased patient autonomy or cost of the system use do not influence the physician's decisions.
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Affiliation(s)
- Paul Alpar
- School of Business and Economics, University of Marburg, Marburg, Germany
| | - Thomas Driebe
- School of Business and Economics, University of Marburg, Marburg, Germany
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11
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Castillo JL, Chang BP, Manfredi RA, Kaplan J. Well-being and burnout: One size does not fit all. J Am Coll Emerg Physicians Open 2020; 1:1039-1043. [PMID: 32838372 PMCID: PMC7280727 DOI: 10.1002/emp2.12077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/03/2020] [Accepted: 04/07/2020] [Indexed: 11/17/2022] Open
Abstract
Well-being and burnout are concepts that have become well described throughout emergency medicine. In the past, both well-being and burnout have been defined and addressed as a singular phenomenon, similar for all physicians, regardless of career stage. However, unique stressors may exist for physicians, as a function of their work environment and stage. In this concepts article we present clinician well-being as a dynamic and continuous process, subject to unique factors along the professional lifespan. Specific individual and system-level factors are discussed, ranging from demographic variables, to evolving administrative and professional responsibilities depending on the career stage of a clinician. This detailed description of stressors spanning an emergency physician's professional career may help create more targeted physician well-being and burnout interventions.
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Affiliation(s)
| | | | | | - Jay Kaplan
- LSU Health Sciences CenterNew OrleansLouisiana
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12
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Adarkwah CC, Labenz J, Birkner B, Beilenhoff UI, Hirsch O. Work satisfaction and burnout risk of gastroenterologists in Germany: results of a nationwide survey. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2020; 58:960-970. [DOI: 10.1055/a-1176-2344] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Abstract
Background More and more gastroenterologists are not satisfied with their working conditions and run the risk of developing burnout symptoms. Little is known about the job satisfaction and burnout risk among physicians working in endoscopy units in Germany. This study examines the risk of burnout and job satisfaction among gastroenterologists in Germany.
Methods An electronic survey was distributed to gastroenterologists organized mainly in the Federal Organization of Gastroenterology in Germany (BVGD, Berufsverband Gastroenterologie Deutschland e. V.). In addition to general demographic variables, job satisfaction was determined using the Work Satisfaction Questionnaires (WSQ), and burnout risk was determined using the Maslach Burnout Inventory (MBI).
Results A representative sample of gastroenterologists organized in the BVGD (Berufsverband Gastroenterologie Deutschland e. V.) took part in the study (n = 683, 22 %). Above all, we could demonstrate relevant differences with regard to burnout risk and job satisfaction depending on the place of work, clinic structure, position in the clinic, and age. Younger physicians had significantly higher depersonalization (p < 0.001) and exhaustion scores (p < 0.001) with almost medium and small effect sizes (δt = 0.45 and −0.31). The higher the position in the clinic, the higher the accomplishment scores (medium effect size 0.27). Older physicians were especially more satisfied in the areas of patient care (p < 0.001, medium effect size δt = −0.53). Employed doctors show a higher level of satisfaction in terms of “burden” compared to practice owners (p < 0.001, δt = −0.69). Compared to norms used in the EGPRN study which were adapted to physicians, almost one-third of our sample had high depersonalization scores, about 17 % had high exhaustion scores, and about half had low personal accomplishment scores showing a higher general burden among German gastroenterologists.
Conclusion Decreased work satisfaction and risk of burnout are important issues among German gastroenterologists. Specific actions should address this problem in order to avoid negative consequences, respectively.
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Affiliation(s)
- Charles Christian Adarkwah
- Lehrstuhl für Versorgungsforschung, Fakultät für Lebenswissenschaften, Universität Siegen, Siegen, Deutschland
- Abteilung für Allgemeinmedizin, Philipps-Universität Marburg, Marburg, Deutschland
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Joachim Labenz
- Diakonie Klinikum Siegen, Medizinische Klinik, Siegen, Deutschland
- Bundesverband Gastroenterologie Deutschland (BVGD) e. V
| | | | | | - Oliver Hirsch
- FOM Hochschule für Ökonomie und Management, Siegen, Deutschland
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Obremskey WT, Emery SE, Alman BA. Challenges and Solutions to Academic Orthopaedics in Current Health-Care Economics: AOA Critical Issues. J Bone Joint Surg Am 2020; 102:e38. [PMID: 32379126 DOI: 10.2106/jbjs.19.01054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- William T Obremskey
- Vanderbilt Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee
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Berg DD, Divakaran S, Stern RM, Warner LN. Fostering Meaning in Residency to Curb the Epidemic of Resident Burnout: Recommendations From Four Chief Medical Residents. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1675-1678. [PMID: 31299672 PMCID: PMC6821559 DOI: 10.1097/acm.0000000000002869] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Burnout has become commonplace in residency training, affecting more than half of residents and having negative implications for both their well-being and their ability to care for patients. During the authors' year as chief medical residents at Brigham and Women's Hospital in 2017-2018, they became intimately familiar with the burnout epidemic in residency training. The authors argue that addressing resident burnout requires residency programs and teaching hospitals to focus not on the individual contributors to burnout but instead on fostering meaning within residency to help residents find purpose and professional satisfaction in their work. In this Perspective, they highlight 4 important elements of residency that provide meaning: patient care, intellectual engagement, respect, and community. Patient care, intellectual engagement, and community provide residents with a focus that is larger than themselves, while respect is necessary for a resident's sense of belonging. The authors provide examples from their own experiences and from the literature to suggest ways in which residency programs and teaching hospitals can strengthen each of these elements within residency and curb the epidemic of burnout.
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Affiliation(s)
- David D Berg
- D.D. Berg is a cardiovascular medicine fellow, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. S. Divakaran is a cardiovascular medicine fellow, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. R.M. Stern is a hematology-oncology fellow, Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts. L.N. Warner is instructor in medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Oh YI, Kim H, Kim K. Factors Affecting Korean Physician Job Satisfaction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16152714. [PMID: 31366037 PMCID: PMC6695798 DOI: 10.3390/ijerph16152714] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/26/2019] [Accepted: 07/26/2019] [Indexed: 11/16/2022]
Abstract
This study examines job satisfaction of physicians in Korea and investigates factors affecting their satisfaction. The majority of the past studies tend to cover few minor factors- including stress and occupation professionality or insufficient scale of respondents in particular regions-thus leading to restricted explanations on job satisfaction of the overall physician pool in Korea. This study examines the level of job satisfaction of physicians in Korea and factors affecting their satisfaction by using the '2016 Korean Physician Survey (KPS)' data which included all physicians in Korea. Ordinal logistic regression analysis was conducted in this study in order to identify the factors affecting job satisfaction of physicians in terms of care environment attributes. These attributes included autonomy for care delivery, colleagues/staff/patient relations, income, healthcare resources, social reputation, personal leisure time, administration, restrictions and regulations, and work hours and loads. For the ordinal logistic regression analysis, general socio-demographic attributes, such as gender, age, specialty, job position, type of affiliated healthcare organization, working region, and length of service were controlled beforehand. The result of our measures, the affecting factors of job satisfaction for physicians, include being able to; maintain positive relations with patients through adequate time for consultation and necessary healthcare, have the autonomy to make clinical decisions, have healthy relations with peers and staff, obtain respect from family and society, work in an environment with desirable income and have adequate health resources, and have appropriate work hours and loads for those who facilitate high-quality care. Creating an environment in which physicians can focus on patient-oriented healthcare will contribute to promoting national healthcare.
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Affiliation(s)
- Young-In Oh
- Department of Health Services Management, The Graduate School of Kyung Hee University, Seoul 02447, Korea
- Research Institute for Healthcare Policy, Korean Medical Association, Seoul 04373, Korea
| | - Hyeongsu Kim
- Department of Preventive Medicine, School of Medicine, Konkuk University, Seoul 05029, Korea
| | - KyeHyun Kim
- Research Institute for Healthcare Policy, Korean Medical Association, Seoul 04373, Korea.
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Swendiman RA, Marcaccio CL, Han J, Hoffman DI, Weiner TM, Nance ML, Chou CM. Attitudes and Habits of Highly Humanistic Surgeons: A Single-Institution, Mixed-Methods Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1027-1032. [PMID: 30844930 DOI: 10.1097/acm.0000000000002690] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE Humanism in medicine is associated with increased patient satisfaction, trust of patients in their doctors, and better outcomes. The authors sought to identify attitudes, habits, and other factors that sustain humanism in academic surgical faculty, and compare these with attributes determined from a previous study of internal medicine faculty. METHOD A mixed-methods study design at University of Pennsylvania Health System was employed from 2016 to 2018 using a survey instrument and semistructured interviews. Surgical residents nominated faculty who exemplified humanism. In-depth interviews were then conducted with surgeons receiving the most nominations. The interviews were transcribed, and common themes were identified using the grounded theory method. These were compared with findings from a previous internal medicine study. RESULTS Ten faculty described three strongly shared attitudes: humility, responsibility, and a desire to live up to a high standard of professional behavior. Five habits were found important to sustaining these attitudes and their practice: self-reflection, finding deep connections with patients, maintaining personal and professional relationships, "having fun" at work, and paying it forward to surgical trainees. Surgeons also cited the importance of past role models in developing humanistic attitudes and sustaining practice. Responses were compared with previously documented attitudes and habits of humanistic internal medicine faculty at the institution. CONCLUSIONS This study identified recurring attitudes and habits that characterize humanistic behaviors in a cohort of academic surgeons. Learning from these exemplary humanistic surgeons may inform the development of future educational programs for residents and faculty in sustaining humanism.
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Affiliation(s)
- Robert A Swendiman
- R.A. Swendiman is a general surgery resident, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. C.L. Marcaccio is a vascular surgery resident, Beth Israel Deaconess Medical Center, Boston, Massachusetts. J. Han is a cardiothoracic surgery resident, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. D.I. Hoffman is a medical student, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. T.M. Weiner is a pediatric surgeon, New Hanover Regional Medical Center, Wilmington, North Carolina, and adjunct professor of surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina. M.L. Nance is Josephine J. and John M. Templeton Jr. Endowed Chair in Pediatric Trauma, Children's Hospital of Philadelphia, and professor of pediatric surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. C.M. Chou is associate professor of clinical medicine, Department of Medicine, Division of General Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Ronis SD, Kleinman LC, Stange KC. A Learning Loop Model of Collaborative Decision-Making in Chronic Illness. Acad Pediatr 2019; 19:497-503. [PMID: 31009759 PMCID: PMC8127066 DOI: 10.1016/j.acap.2019.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 03/08/2019] [Accepted: 04/16/2019] [Indexed: 11/16/2022]
Abstract
Shared decision-making is a core attribute of quality health care that has proved challenging to implement and assess in pediatric practice. Current models of shared decision-making are limited, including their capacity to incorporate multiple stakeholders; to integrate downstream effects of subacute or minor decisions; and to account for the context(s) in which such decisions are being made and enacted. Based on a review of literature from organizational psychology, cognitive sciences, business, and medicine, we propose an iterative decision-making model of care planning and identify targets at several levels of influence warranting measurement in future studies. Our learning loop model posits the relationship between pediatric patients, their parents, and their clinicians as central to the collaborative decision-making process in the setting of chronic illness. The model incorporates the evolution of both context and developmental capacity over time. It suggests that "meta-learning" from the experience of and outcomes from iterative decision is a key factor that may influence relationships and thus continued engagement in collaboration by patients, their parents, and their clinicians. We consider the model in light of the needs of children with special health care needs, for whom understanding the ongoing iterative effects of decision making and clinician-parent-child dynamics are likely to be particularly important in influencing outcomes.
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Affiliation(s)
- Sarah D Ronis
- Department of Pediatrics, Case Western Reserve University, and UH Rainbow Center for Child Health and Policy, UH Rainbow Babies and Children's Hospital, Cleveland, Ohio (SD Ronis).
| | - Lawrence C Kleinman
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (LC Kleinman)
| | - Kurt C Stange
- Center for Community Health Integration, Department of Family Medicine & Community Health, Department of Population & Quantitative Health Sciences, Department of Sociology, Case Western Reserve University, Cleveland, Ohio (KC Stange)
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Domagała A, Peña-Sánchez JN, Dubas-Jakóbczyk K. Satisfaction of Physicians Working in Polish Hospitals-A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2640. [PMID: 30477273 PMCID: PMC6313796 DOI: 10.3390/ijerph15122640] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 11/20/2018] [Accepted: 11/21/2018] [Indexed: 11/16/2022]
Abstract
Physician satisfaction is a multidimensional concept associated with numerous factors. The objectives of the study were to evaluate the satisfaction of physicians practicing in hospitals in Poland and to identify factors associated with higher levels of satisfaction. A quantitative, cross-sectional survey of Polish hospitals was conducted between March and June 2018. All doctors working in the hospitals invited to the study were asked to fill in an online survey. Fifteen hospitals were included: seven general, five specialist, and three university ones. The total number of questionnaires analyzed was 1003. The questionnaire included 17 items to measure the level of satisfaction, classified into four dimensions: personal, professional, performance, and inherent. The statistical analyses included: assessment of association between levels of career satisfaction and basic demographic and work-related variables; and multivariable logistic regressions, conducted to determine which variables were associated with higher levels of career satisfaction. The mean level of career satisfaction, on a scale from 1 to 6, was 4.1 (SD = 0.69). Respondents reported high levels of inherent satisfaction: mean = 4.4 (SD = 0.66) and a low personal satisfaction: mean = 3.78 (SD = 0.98). 56.6% of respondents reported being satisfied, but only 8.2% reported a higher level of satisfaction (≥5). The satisfaction of Polish physicians is moderate. Gender, numbers of working hours/week, years of work experience, type of hospital, and stage of professional development were the identified factors associated with higher levels of career satisfaction.
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Affiliation(s)
- Alicja Domagała
- Department of Health Policy and Management, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, 31-531 Krakow, Poland.
| | - Juan Nicolás Peña-Sánchez
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK S7N5E5SK, Canada.
| | - Katarzyna Dubas-Jakóbczyk
- Department of Health Economics and Social Security, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, 31-531 Krakow, Poland.
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CONNECT Workshops to Enhance Physician and Patient Experience: Interviews Reveal the Physician Perspective. Pediatr Qual Saf 2018; 3:e116. [PMID: 31334448 PMCID: PMC6581472 DOI: 10.1097/pq9.0000000000000116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 09/20/2018] [Indexed: 12/30/2022] Open
Abstract
Supplemental Digital Content is available in the text. Introduction: Physicians’ relationships with patients are a critical determinant of job satisfaction, and patients who experience compassionate care have better outcomes. The CONNECT workshop at Seattle Children’s teaches communication strategies to optimize both patient and physician experience. This article describes participants’ experiences during the workshops and the impact on their subsequent behaviors and satisfaction. Methods: Thirteen semistructured interviews were conducted with physicians, representing 11 specialties. Researchers used a series of immersion-crystallization cycles through which they iteratively immersed themselves in the data by reviewing all transcripts and coming up with key themes. According to thematic findings, they adjusted the interview guides, adding or deleting probes. After crystallizing an initial list of key themes, they created a codebook, coded using qualitative analysis software and met after coding each transcript to discuss their codes, add, and change codes, and recode when necessary. Results: Researchers identified 2 thematic responses concerning workshop experience. Physicians valued colleague interaction (Theme A) and appreciated the nonprescriptive curriculum (Theme B). Likewise, 3 themes reflecting workshop impact also emerged. Physicians reported the workshop encouraged presence and self-awareness during patient encounters (Theme C). They learned to address patient-driven concerns (Theme D), and learned empathetic strategies to connect more deeply with patients (Theme E). Conclusion: This study offers perspectives from a diverse group of physicians concerning their experience with the communication workshop, including the opportunity for physicians to focus on self-discovery, authenticity, connect on a deeper level with colleagues, and adopt key strategies to enhance interactions with patients.
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Hirsch O, Adarkwah CC. The Issue of Burnout and Work Satisfaction in Younger GPs-A Cluster Analysis Utilizing the HaMEdSi Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2190. [PMID: 30297611 PMCID: PMC6210533 DOI: 10.3390/ijerph15102190] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/26/2018] [Accepted: 10/05/2018] [Indexed: 11/18/2022]
Abstract
The shortage of general practitioners (GPs) in Germany has become a relevant problem. Therefore, it is important to find the determinants that make primary care more attractive, and which support GPs remaining in practice. Our aim in this exploratory study was to search for relevant GP subgroups and their characteristics in order to find starting points for improvements or interventions. We attempted a comprehensive survey of all GPs in the German region of Siegen-Wittgenstein with about 280,000 inhabitants. There were 158 GPs in the total population; 85 of these (53.8%) took part in the study. There were 64 male GPs (75.3%) in our sample. The mean age of the participants was 53.5 years (SD 8.93). The questionnaire was composed of demographic questions, questions regarding future perspectives, the Motivation for Medical Education Questionnaire (MoME-Q), the Maslach Burnout Inventory (MBI), and the Work Satisfaction Questionnaire. K-means cluster analyses were used for subgrouping. A 2-cluster solution had good statistical quality criteria. Cluster 1 was characterised by elderly GPs who more frequently had a resident physician in their practices. These GPs had low burnout scores and high work satisfaction scores. Cluster 2 consisted of younger GPs who less frequently had a resident in their practices. They had average burnout scores according to published norms and lower work satisfaction scores. There seems to be an age cohort effect regarding burnout and work satisfaction. Having a resident physician seems to be protective. Interventions should be designed for younger GPs, especially members of generation Y, to reduce burnout and improve work satisfaction.
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Affiliation(s)
- Oliver Hirsch
- Department of Psychology, FOM University of Applied Sciences, 57078 Siegen, Germany.
| | - Charles Christian Adarkwah
- Department of Health Services Research and General Practice, Faculty of Life Sciences, University of Siegen, 57076 Siegen, Germany.
- Department of General Practice and Family Medicine, Philipps-University, 35043 Marburg, Germany.
- CAPHRI School for Public Health and Primary Care, Department of Health Services Research, Maastricht University, 6229 GT Maastricht, The Netherlands.
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Malhotra J, Wong E, Thind A. Canadian family physician job satisfaction - is it changing in an evolving practice environment? An analysis of the 2013 National Physician Survey database. BMC FAMILY PRACTICE 2018; 19:100. [PMID: 29935531 PMCID: PMC6015660 DOI: 10.1186/s12875-018-0786-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 05/31/2018] [Indexed: 11/12/2022]
Abstract
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.
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Affiliation(s)
- Jana Malhotra
- Department of Family Medicine, University of Ottawa, 309-1580 Merivale Road, Ottawa, ON, K2G 4B5, Canada.
| | - Eric Wong
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, PO Box 5777, Stn B, London, ON, N6A 4V2, Canada
| | - Amardeep Thind
- Schulich Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, Western University, WCPHFM 4131, 1465 Richmond Street, London, ON, N6G 2M1, Canada.,Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, WCPHFM 4131, 1465 Richmond Street, London, ON, N6G 2M1, Canada
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McNamara K, Meaney S, O'Donoghue K. Intrapartum fetal death and doctors: a qualitative exploration. Acta Obstet Gynecol Scand 2018; 97:890-898. [DOI: 10.1111/aogs.13354] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/21/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Karen McNamara
- Pregnancy Loss Research Group; Department of Obstetrics and Gynaecology; University College Cork; Cork Ireland
| | - Sarah Meaney
- Pregnancy Loss Research Group; Department of Obstetrics and Gynaecology; University College Cork; Cork Ireland
- National Perinatal Epidemiology Center; University College Cork; Cork Ireland
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group; Department of Obstetrics and Gynaecology; University College Cork; Cork Ireland
- The Irish Center for Fetal and Neonatal Translational Research (INFANT); University College Cork; Cork Ireland
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Luthar SS, Curlee A, Tye SJ, Engelman JC, Stonnington CM. Fostering Resilience among Mothers under Stress: “Authentic Connections Groups” for Medical Professionals. Womens Health Issues 2017; 27:382-390. [DOI: 10.1016/j.whi.2017.02.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 02/27/2017] [Indexed: 01/12/2023]
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Gilles I, Mayer M, Courvoisier N, Peytremann-Bridevaux I. Joint analyses of open comments and quantitative data: Added value in a job satisfaction survey of hospital professionals. PLoS One 2017; 12:e0173950. [PMID: 28296974 PMCID: PMC5352002 DOI: 10.1371/journal.pone.0173950] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 03/02/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To obtain a comprehensive understanding of the job opinions of hospital professionals by conducting qualitative analyses of the open comments included in a job satisfaction survey and combining these results with the quantitative results. DESIGN A cross-sectional survey targeting all Lausanne University Hospital professionals was performed in the fall of 2013. MATERIAL AND METHODS The survey considered ten job satisfaction dimensions (e.g. self-fulfilment, workload, management, work-related burnout, organisational commitment, intent to stay) and included an open comment section. Computer-assisted qualitative analyses were conducted on these comments. Satisfaction rates on the included dimensions and professional groups were entered as predictive variables in the qualitative analyses. PARTICIPANTS Of 10 838 hospital professionals, 4978 participated in the survey and 1067 provided open comments. Data from 1045 respondents with usable comments constituted the analytic sample (133 physicians, 393 nurses, 135 laboratory technicians, 247 administrative staff, including researchers, 67 logistic staff, 44 psycho-social workers, and 26 unspecified). RESULTS Almost a third of the comments addressed scheduling issues, mostly related to problems and exhaustion linked to shifts, work-life balance, and difficulties with colleagues' absences and the consequences for quality of care and patient safety. The other two-thirds related to classic themes included in job satisfaction surveys. Although some comments were provided equally by all professional groups, others were group specific: work and hierarchy pressures for physicians, healthcare quality and patient safety for nurses, skill recognition for administrative staff. Overall, respondents' comments were consistent with their job satisfaction ratings. CONCLUSION Open comment analysis provides a comprehensive understanding of hospital professionals' job experiences, allowing better consideration of quality initiatives that match the needs of professionals with reality.
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Affiliation(s)
- Ingrid Gilles
- University Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Mauro Mayer
- University Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Nelly Courvoisier
- University Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
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de Oliveira Vasconcelos Filho P, de Souza MR, Elias PEM, D'Ávila Viana AL. Physicians' job satisfaction and motivation in a public academic hospital. HUMAN RESOURCES FOR HEALTH 2016; 14:75. [PMID: 27923402 PMCID: PMC5142149 DOI: 10.1186/s12960-016-0169-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 11/22/2016] [Indexed: 05/20/2023]
Abstract
BACKGROUND Physician shortage is a global issue that concerns Brazil's authorities. The organizational structure and the environment of a medical institution can hide a low-quality life of a physician. This study examines the relationship between the hospital work environment and physicians' job satisfaction and motivation when working in a large public academic hospital. METHODS The study was restricted to one large, multispecialty Brazil's hospital. Six hundred hospital physicians were invited to participate by e-mail. A short version of the Physician Worklife Survey (PWS) was used to measure working satisfaction. Physicians were also asked for socio-demographic information, medical specialty, and the intention to continue working in the hospital. RESULTS Data from 141 questionnaires were included in the analyses. Forty-five physicians graduated from the hospital's university, and they did not intend to leave the hospital under any circumstance (affective bond). The motivating factor for beginning the career at the hospital and to continue working there were the connection to the medical school and the hospital status as a "prestigious academic hospital"; the physicians were more satisfied with the career than the specialty. Only 30% completely agreed with the statement "If I had to start my career over again, I would choose my current specialty," while 45% completely agreed with the statement "I am not well compensated given my training and experience." The greater point of satisfaction was the relationship with physician colleagues. They are annoyed about the amount of calls they are requested to take and about how work encroaches on their personal time. No significant differences between medical specialties were found in the analysis. CONCLUSIONS The participants were satisfied with their profession. The fact that they remained at the hospital was related to the academic environment, the relationship with colleagues, and the high prestige in which society holds the institution. The points of dissatisfaction were inadequate remuneration and the fact that work invaded personal time. Routinely, there is a need for organizations to examine the impact of their structures, policies, and procedures on the stress and quality of life of physicians.
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Affiliation(s)
- Paulo de Oliveira Vasconcelos Filho
- Department of Preventive Medicine, School of Medicine of University of São Paulo, Av. Dr Arnaldo, 455 2° andar, São Paulo, 01246-903, SP, Brazil.
- , .
- , 435/21 R Estado de Israel, Sao Paulo, 04022-001, SP, Brazil.
| | - Miriam Regina de Souza
- Department of Preventive Medicine, School of Medicine of University of São Paulo, Av. Dr Arnaldo, 455 2° andar, São Paulo, 01246-903, SP, Brazil
| | - Paulo Eduardo Mangeon Elias
- Department of Preventive Medicine, School of Medicine of University of São Paulo, Av. Dr Arnaldo, 455 2° andar, São Paulo, 01246-903, SP, Brazil
| | - Ana Luiza D'Ávila Viana
- Department of Preventive Medicine, School of Medicine of University of São Paulo, Av. Dr Arnaldo, 455 2° andar, São Paulo, 01246-903, SP, Brazil
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Stress and burnout among gynecologic oncologists: A Society of Gynecologic Oncology Evidence-based Review and Recommendations. Gynecol Oncol 2016; 143:421-427. [PMID: 27575910 DOI: 10.1016/j.ygyno.2016.08.319] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 08/10/2016] [Accepted: 08/17/2016] [Indexed: 11/20/2022]
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Shanafelt TD, Hasan O, Dyrbye LN, Sinsky C, Satele D, Sloan J, West CP. Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. Mayo Clin Proc 2015; 90:1600-13. [PMID: 26653297 DOI: 10.1016/j.mayocp.2015.08.023] [Citation(s) in RCA: 1477] [Impact Index Per Article: 164.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 08/18/2015] [Accepted: 08/24/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate the prevalence of burnout and satisfaction with work-life balance in physicians and US workers in 2014 relative to 2011. PATIENTS AND METHODS From August 28, 2014, to October 6, 2014, we surveyed both US physicians and a probability-based sample of the general US population using the methods and measures used in our 2011 study. Burnout was measured using validated metrics, and satisfaction with work-life balance was assessed using standard tools. RESULTS Of the 35,922 physicians who received an invitation to participate, 6880 (19.2%) completed surveys. When assessed using the Maslach Burnout Inventory, 54.4% (n=3680) of the physicians reported at least 1 symptom of burnout in 2014 compared with 45.5% (n=3310) in 2011 (P<.001). Satisfaction with work-life balance also declined in physicians between 2011 and 2014 (48.5% vs 40.9%; P<.001). Substantial differences in rates of burnout and satisfaction with work-life balance were observed by specialty. In contrast to the trends in physicians, minimal changes in burnout or satisfaction with work-life balance were observed between 2011 and 2014 in probability-based samples of working US adults, resulting in an increasing disparity in burnout and satisfaction with work-life balance in physicians relative to the general US working population. After pooled multivariate analysis adjusting for age, sex, relationship status, and hours worked per week, physicians remained at an increased risk of burnout (odds ratio, 1.97; 95% CI, 1.80-2.16; P<.001) and were less likely to be satisfied with work-life balance (odds ratio, 0.68; 95% CI, 0.62-0.75; P<.001). CONCLUSION Burnout and satisfaction with work-life balance in US physicians worsened from 2011 to 2014. More than half of US physicians are now experiencing professional burnout.
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Affiliation(s)
| | - Omar Hasan
- American Medical Association, Chicago, IL
| | - Lotte N Dyrbye
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Daniel Satele
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Jeff Sloan
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Colin P West
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
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Hess S, Sidler P, Chmiel C, Bögli K, Senn O, Eichler K. Satisfaction of health professionals after implementation of a primary care hospital emergency centre in Switzerland: A prospective before–after study. Int Emerg Nurs 2015; 23:286-93. [DOI: 10.1016/j.ienj.2015.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 04/09/2015] [Accepted: 04/09/2015] [Indexed: 10/23/2022]
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Pololi LH, Evans AT, Civian JT, Gibbs BK, Coplit LD, Gillum LH, Brennan RT. Faculty Vitality-Surviving the Challenges Facing Academic Health Centers: A National Survey of Medical Faculty. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:930-936. [PMID: 25692560 DOI: 10.1097/acm.0000000000000674] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE Faculty with high vitality are essential to the missions of academic health centers (AHCs). Because little is known about how to measure or enhance faculty vitality, the authors assessed current faculty vitality and identified its predictors. METHOD In a stratified random sample of 26 nationally representative U.S. AHCs, the authors surveyed 4,578 full-time faculty during 2007-2009. The validated survey measured detailed faculty perceptions of their professional experiences and organizational culture. Vitality was measured with a previously evaluated five-item scale. RESULTS Of the faculty invited, 2,381 (52%) responded, with 2,218 eligible for analysis. Respondents included 512 (23%) underrepresented in medicine minority (URMM) faculty and 1,172 (53%) women. In a multivariable model including individual- and AHC-level factors, the strongest predictors of vitality were faculty members' perceptions of four dimensions of AHC culture: Relationships/inclusion, Values alignment, Work-life integration, and Institutional support (all P < .001). Weaker predictors were faculty age, institution type (public/private), and the AHC's National Institutes of Health funding rank (all P ≤ .03). Half of the respondents scored high on vitality, whereas 25% had low, or suboptimal, scores. Holding perceptions of culture constant, neither female nor URMM faculty had vitality scores that were different on average from male or nonminority faculty. CONCLUSIONS A large percentage of faculty lack the vitality essential to meeting the AHC missions of discovery, education, and patient care. Enhancing faculty vitality, and AHC resilience, requires more attention to strengthening relationships, improving the misalignment between faculty and institutional values, and improving work-life integration.
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Affiliation(s)
- Linda H Pololi
- L.H. Pololi is director, National Initiative on Gender, Culture and Leadership in Medicine: C - Change, resident scholar, Women's Studies Research Center, and senior scientist, Brandeis University, Waltham, Massachusetts. A.T. Evans is chief, Division of Hospital Medicine, and professor of medicine, Weill Cornell Medical College, New York, New York. J.T. Civian is senior analyst, Women's Studies Research Center, Brandeis University, Waltham, Massachusetts. B.K. Gibbs is associate vice chancellor for diversity, University of New Mexico Health Science Center, and assistant professor of family medicine, University of New Mexico Medical School of Medicine, Albuquerque, New Mexico. He was formerly at Johns Hopkins School of Medicine, Baltimore, Maryland. L.D. Coplit is associate dean for faculty development and associate professor of medicine, Frank H. Netter, MD School of Medicine at Quinnipiac University, Bridgeport, Connecticut. L.H. Gillum is associate dean for academic and faculty affairs, Oakland University William Beaumont School of Medicine, Rochester, Michigan. R.T. Brennan is research associate, Harvard School of Public Health, Boston, Massachusetts
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Chou CM, Kellom K, Shea JA. Attitudes and habits of highly humanistic physicians. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:1252-8. [PMID: 25006710 DOI: 10.1097/acm.0000000000000405] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE Humanism is fundamental to excellent patient care and is therefore an essential concept for physicians to teach to learners. However, the factors that help attending physicians to maintain their own humanistic attitudes over time are not well understood. The authors attempted to identify attitudes and habits that highly humanistic physicians perceive allow them to sustain their humanistic approach to patient care. METHOD In 2011, the authors polled internal medicine residents at the University of Pennsylvania to identify attending physicians who exemplified humanistic patient care. In this cross-sectional, qualitative study, the authors used a semistructured script to interview the identified attending physicians to determine attitudes and habits that they believed contribute to their sustenance of humanistic patient care. RESULTS Attitudes for sustaining humanism in this cohort of humanistic physicians included humility, curiosity, and a desire to live up to a standard of behavior. Many of the physicians deliberately worked at maintaining their humanistic attitudes. Habits that humanistic physicians engaged in to sustain their humanism included self-reflection, connecting with patients, teaching and role modeling, and achieving work-life balance. Physicians believed that treating their patients humanistically serves to prevent burnout in themselves. CONCLUSIONS Identification of factors that highly humanistic attending physicians perceive help them to sustain a humanistic outlook over time may inform the design of programs to develop and sustain humanism in teaching faculty.
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Affiliation(s)
- Carol M Chou
- Dr. Chou is associate professor of clinical medicine, Division of General Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Ms. Kellom is senior research coordinator, Mixed Methods Research Lab, Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania. Dr. Shea is professor of medicine, associate dean for medical education research, director of evaluation and assessment, and interim chief, Division of General Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Exploring personal interests of physicians in hospitals and specialty clinics. Soc Sci Med 2014; 100:93-8. [DOI: 10.1016/j.socscimed.2013.10.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 10/04/2013] [Accepted: 10/29/2013] [Indexed: 01/26/2023]
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Owen RR, Drummond KL, Viverito KM, Marchant K, Pope SK, Smith JL, Landes RD. Monitoring and managing metabolic effects of antipsychotics: a cluster randomized trial of an intervention combining evidence-based quality improvement and external facilitation. Implement Sci 2013; 8:120. [PMID: 24103648 PMCID: PMC3852845 DOI: 10.1186/1748-5908-8-120] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 10/03/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Treatment of psychotic disorders consists primarily of second generation antipsychotics, which are associated with metabolic side effects such as overweight/obesity, diabetes, and dyslipidemia. Evidence-based clinical practice guidelines recommend timely assessment and management of these conditions; however, research studies show deficits and delays in metabolic monitoring and management for these patients. This protocol article describes the project 'Monitoring and Management for Metabolic Side Effects of Antipsychotics,' which is testing an approach to implement recommendations for these practices. METHODS/DESIGN This project employs a cluster randomized clinical trial design to test effectiveness of an evidence-based quality improvement plus facilitation intervention. Eligible study sites were VA Medical Centers with ≥300 patients started on a new antipsychotic prescription in a six-month period. A total of 12 sites, matched in pairs based on scores on an organizational practice survey, were then randomized within pairs to intervention or control conditions.Study participants include VA employees involved in metabolic monitoring and management of patients treated with antipsychotics at participating sites. The intervention involves researchers partnering with clinical stakeholders to facilitate tailoring of local implementation strategies to address barriers to metabolic side-effect monitoring and management. The intervention includes a Design Phase (initial site visit and subsequent development of a local implementation plan); Implementation Phase (guided by an experienced external facilitator); and a Sustainability Phase. Evaluation includes developmental, implementation-focused, progress-focused and interpretative formative evaluation components, as well as summative evaluation. Evaluation methods include surveys, qualitative data collection from provider participants, and quantitative data analysis of data for all patients prescribed a new antipsychotic medication at a study site who are due for monitoring or management of metabolic side effects during the study phases. Changes in rates of recommended monitoring and management actions at intervention and control sites will be compared using time series analyses. DISCUSSION Improving monitoring for metabolic side effects of antipsychotics, as well as promoting timely evidence-based management when these effects emerge, will lead to improved patient safety and long-term outcomes. This article discusses key strengths and challenges of the study. TRIAL REGISTRATION NCT01875861.
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Affiliation(s)
- Richard R Owen
- VA Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Dr., North Little Rock, AR, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences College of Medicine, 4301 West Markham, Little Rock, AR, USA
| | - Karen L Drummond
- VA Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Dr., North Little Rock, AR, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences College of Medicine, 4301 West Markham, Little Rock, AR, USA
| | - Kristen M Viverito
- VA Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Dr., North Little Rock, AR, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences College of Medicine, 4301 West Markham, Little Rock, AR, USA
| | - Kathy Marchant
- VA Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Dr., North Little Rock, AR, USA
| | - Sandra K Pope
- VA Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Dr., North Little Rock, AR, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences College of Medicine, 4301 West Markham, Little Rock, AR, USA
| | - Jeffrey L Smith
- VA Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Dr., North Little Rock, AR, USA
- VA Mental Health Quality Enhancement Research Initiative (MH QUERI), Central Arkansas Veterans Healthcare System, 2200 Fort Roots Dr., North Little Rock, AR, USA
| | - Reid D Landes
- VA Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Dr., North Little Rock, AR, USA
- Department of Biostatistics, University of Arkansas for Medical Sciences College of Medicine, 4301 West Markham, Little Rock, AR, USA
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Gilewski T. The joys and challenges of caring for patients. Am Soc Clin Oncol Educ Book 2013:0011300327. [PMID: 23714538 DOI: 10.14694/edbook_am.2013.33.e327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Optimal care of patients involves the integration of both the scientific and humanistic aspects of medicine. However, the tremendous focus on technology can easily overshadow the personal effect of patient care. The complex relationship between the physician and the patient is a reciprocal one. Not only does the physician influence the experience of the patient, but the patient may leave a significant impression on the physician. Their interactions provide a myriad of opportunities for greater insight into the human condition, but may also contribute toward the struggle of physicians to maintain their own well-being. Enhanced awareness of the significance of these human interactions is at the core of caring for patients.
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Affiliation(s)
- Teresa Gilewski
- From the Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, NY
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Granek L, Krzyzanowska MK, Tozer R, Mazzotta P. Difficult Patient Loss and Physician Culture for Oncologists Grieving Patient Loss. J Palliat Med 2012; 15:1254-60. [DOI: 10.1089/jpm.2012.0245] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Leeat Granek
- Department of Sociology of Health, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Monika K. Krzyzanowska
- Department of Medical Oncology and Hematology, Princess Margaret Hospital, Toronto, Ontario, Canada
| | | | - Paolo Mazzotta
- Palliative Care Consult Team, Sunnybrook Health Sciences Centre, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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Chen MS, Lee CB. Between professional dignity and economic interests--evidence based on a survey of Taiwan's primary care physicians. Int J Health Plann Manage 2012; 28:153-71. [PMID: 22806914 DOI: 10.1002/hpm.2126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 06/20/2012] [Accepted: 06/21/2012] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE If the entirety of professional autonomy must be compromised in the face of a state-run social insurance, physicians may choose to preserve only certain dimensions of their professional autonomy. This study tests the relative importance of the target-income hypothesis versus the professional allegiance hypothesis in explaining physicians' behavior by collating economic interests against professional dignity. DATA AND METHOD A self-administered questionnaire was used to collect the response data from the 1244 physicians who practiced as office-based providers under the contract with the National Health Insurance (NHI) in the South Region of Taiwan and had experienced a change in the utilization review system; 394 (31%) physicians completed the questionnaire. Chi-squared analysis, logistical ordered regression, and odds-ratio analysis were conducted to test the effects of the physicians' experience with the utilization review system on their satisfaction with the NHI program. RESULT The ordered logistical regression verified the hypotheses of physicians' experiences on the satisfaction of the professional-controlled review system, and the odds-ratio analysis suggested that the physicians might give considerable value to their professional dignity. This effect was strong enough to balance out that of the loss in economic interests as the odds ratio was 0.5667 with the 95% confidence interval being (0.1014, 3.1682), which includes the odds ratio of 1. CONCLUSION Economic incentives should not always take center stage if the policy makers are to co-opt physicians. The professional allegiance hypothesis is at work as strongly as the target-income hypothesis.
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Affiliation(s)
- Michael S Chen
- Department of Social Welfare, National Chung Cheng University, Chiayi County, Taiwan
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Rizvi R, Raymer L, Kunik M, Fisher J. Facets of Career Satisfaction for Women Physicians in the United States: A Systematic Review. Women Health 2012; 52:403-21. [DOI: 10.1080/03630242.2012.674092] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
Although the practice of oncology can be extremely rewarding, it is also one of the most demanding and stressful areas of medicine. Oncologists are faced with life and death decisions on a daily basis, administer incredibly toxic therapies with narrow therapeutic windows, must keep up with the rapid pace of scientific and treatment advances, and continually walk a fine line between providing palliation and administering treatments that lead to excess toxicity. Personal distress precipitated by such work-related stress may manifest in a variety of ways including depression, anxiety, fatigue, and low mental quality of life. Burnout also seems to be one of the most common manifestations of distress among physicians, with studies suggesting a prevalence of 35% among medical oncologists, 38% among radiation oncologists, and 28% to 36% among surgical oncologists. Substantial evidence suggests that burnout can impact quality of care in a variety of ways and has potentially profound personal implications for physicians including suicidal ideation. In this review, we examine the causes, consequences, and personal ramifications of oncologist burnout and explore the steps oncologists can take to promote personal well-being and professional satisfaction.
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Affiliation(s)
- Tait Shanafelt
- All authors: Mayo Clinic College of Medicine, Rochester, MN
| | - Lotte Dyrbye
- All authors: Mayo Clinic College of Medicine, Rochester, MN
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Labarda MP. Career shift phenomenon among doctors in tacloban city, philippines: lessons for retention of health workers in developing countries. ASIA PACIFIC FAMILY MEDICINE 2011; 10:13. [PMID: 21977902 PMCID: PMC3204289 DOI: 10.1186/1447-056x-10-13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 10/06/2011] [Indexed: 05/31/2023]
Abstract
BACKGROUND At the height of the global demand for nurses in the 1990s, a phenomenon of grave concern arose. A significant number of medical doctors in the Philippines shifted careers in order to seek work as nurses overseas. The obvious implications of such a trend require inquiry as to the reasons for it; hence, this cross-sectional study. The data in the study compared factors such as personal circumstances, job satisfaction/dissatisfaction, perceived benefits versus costs of the alternative job, and the role of social networks/linkages among doctors classified as career shifters and non-shifters. METHODOLOGY A combined qualitative and quantitative method was utilized in the study. Data gathered came from sixty medical doctors practicing in three major hospitals in Tacloban City, Philippines, and from a special nursing school also located in the same city. Respondents were chosen through a non-probability sampling, specifically through a chain referral sampling owing to the controversial nature of the research. A set of pre-set criteria was used to qualify doctors as shifters and non-shifters. Cross-tabulation was carried out to highlight the differences between the two groups. Finally, the Wilcoxon-Mann-Whitney test was utilized to assess if these differences were significant. RESULTS Among the different factors investigated, results of the study indicated that the level of job satisfaction or dissatisfaction and certain socio-demographic factors such as age, length of medical practice, and having children to support, were significantly different among shifters and non-shifters at p ≤ 0.05. This suggested that such factors had a bearing on the intention to shift to a nursing career among physicians. CONCLUSION Taken in the context of the medical profession, it was the level of job satisfaction/dissatisfaction that was the immediate antecedent in the intention to shift careers among medical doctors. Personal factors, specifically age, support of children, and the length of medical practice gained explanatory power when they were linked to job satisfaction or dissatisfaction. On the other hand, factors such as perceived benefits and costs of the alternative job and the impact of social networks did not differ between shifters and non-shifters. It would then indicate that efforts to address the issue of physician retention need to go beyond economic incentives and deal with other sources of satisfaction or dissatisfaction among practicing physicians. Since this was an exploratory study in a particular locale in central Philippines, similar studies in other parts of the country need to be done to gain better understanding of this phenomenon at a national level.
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Affiliation(s)
- Meredith P Labarda
- School of Health Sciences, University of the Philippines-Manila in Palo, Leyte, the Philippines.
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Perneger TV, Deom M, Cullati S, Bovier PA. Growing discontent of Swiss doctors, 1998-2007. Eur J Public Health 2011; 22:478-83. [DOI: 10.1093/eurpub/ckr114] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Burns H, Auvergne L, Haynes-Maslow LE, Liles EA, Perrin EM, Steiner MJ. A qualitative analysis of career transitions made by internal medicine-pediatrics residency training graduates. N C Med J 2011; 72:191-5. [PMID: 21901912 PMCID: PMC3418526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Physicians who complete combined residency training in internal medicine and pediatrics (med-peds) have a variety of career options after training. Little is known about career transitions among this group or among other broadly trained physicians. METHODS To better understand these career transitions, we conducted semistructured, in-depth, telephone interviews of graduates of the University of North Carolina-Chapel Hill School of Medicine med-peds program who self-identified as having had a career transition since completing training. We qualitatively analyzed interview transcripts, to develop themes describing their career transitions. RESULTS Of 106 physicians who graduated during 1980-2007, 20 participated in interviews. Participants identified factors such as personality, work environment, lifestyle, family, and finances as important to career transition. Five other themes emerged from the data; the following 4 were confirmed by follow-up interviews: (1) experiences during residency were not sufficient to predict future job satisfaction; work after the completion of training was necessary to discover career preferences; (2) a major factor motivating job change was a perceived lack of control in the workplace; (3) participants described a sense of regret if they did not continue to see both adult and pediatric patients as a result of their career change; (4) participants appreciated their broad training and, regardless of career path, would choose to pursue combined residency training again. LIMITATIONS We included only a small number of graduates from a single institution. We did not interview graduates who had no career transitions after training. CONCLUSIONS There are many professional opportunities for physicians trained in med-peds. Four consistent themes surfaced during interviews about med-peds career transitions. Future research should explore how to use these themes to help physicians make career choices and employers retain physicians.
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Affiliation(s)
- Harriett Burns
- Charles Drew Community Health Center, Burlington, North Carolina, USA.
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Abstract
When physicians are unwell, the performance of health-care systems can be suboptimum. Physician wellness might not only benefit the individual physician, it could also be vital to the delivery of high-quality health care. We review the work stresses faced by physicians, the barriers to attending to wellness, and the consequences of unwell physicians to the individual and to health-care systems. We show that health systems should routinely measure physician wellness, and discuss the challenges associated with implementation.
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Affiliation(s)
- Jean E Wallace
- Department of Sociology, Faculty of Social Sciences, University of Calgary, Calgary, AB, Canada.
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Abstract
INTRODUCTION There is concern in the US about the burden and potential ramifications of dissatisfaction among physicians. The purpose of this article is to systematically review the literature on US physician satisfaction. METHODS A MEDLINE search with the medical subject headings (MeSH) phrases: (physicians OR physician's role OR physician's women) AND (job satisfaction OR career satisfaction OR burnout), limited to humans and abstracts, with 1157 abstracts reviewed. After exclusions by 2 independent reviewers, 97 articles were included. Physician type sampled, sample size/response rate, satisfaction type, and satisfaction results were extracted for each study. Satisfaction trends were extracted from those studies with longitudinal or repeated cross sectional design. Variables associated with satisfaction were extracted from those studies that included multivariate analyses. RESULTS Physician satisfaction was relatively stable, with small decreases primarily among primary care physicians (PCPs). The major pertinent mediating factors of satisfaction for hospitalists include both physician factors (age and specialty), and job factors (job demands, job control, collegial support, income, and incentives). CONCLUSIONS The majority of factors associated with satisfaction are modifiable. Tangible recommendations for measuring and diminishing dissatisfaction are given.
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Affiliation(s)
- Danielle Scheurer
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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Isett KR, Ellis AR, Topping S, Morrissey JP. Managed care and provider satisfaction in mental health settings. Community Ment Health J 2009; 45:209-21. [PMID: 19002581 DOI: 10.1007/s10597-008-9171-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Accepted: 10/21/2008] [Indexed: 10/21/2022]
Abstract
We assess the satisfaction of mental health providers using four dimensions from the medical practice literature--degree of autonomy, relationship with patients, compensation, and administrative burden--and extend current work on professional satisfaction to include frontline service providers rather than only psychiatrists or other physicians. In contrast to results reported for primary care settings, we find that the impact of managed care on satisfaction is minimal for the mental health providers in our study of a Medicaid capitation demonstration in the southeastern US. Instead, variables relevant to everyday working conditions have an important effect on job satisfaction.
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Affiliation(s)
- Kimberley R Isett
- Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
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Takahashi O, Ohde S, Jacobs JL, Tokuda Y, Omata F, Fukui T. Residents' experience of scholarly activities is associated with higher satisfaction with residency training. J Gen Intern Med 2009; 24:716-20. [PMID: 19396500 PMCID: PMC2686770 DOI: 10.1007/s11606-009-0970-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2008] [Revised: 02/06/2009] [Accepted: 03/19/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND The Ministry of Health, Labour and Welfare of Japan has been promoting participation in scholarly activities for physicians during residency training. However, there is debate regarding whether this is worthwhile for residents. OBJECTIVE To evaluate residents' opinions of engaging in scholarly activities and identify factors associated with overall satisfaction with their training program. DESIGN Cross-sectional national survey. PARTICIPANTS 1,124 second-year residents in teaching hospitals in Japan in 2007 MEASUREMENTS Collected data included demographics, teaching hospital characteristics and resources, residents' research experiences, including type of activities, barriers to performing scholarly activities, residents' opinions of scholarly requirements, and resident satisfaction with their residency program. RESULTS 1,124 residents/1,500 responded for a response rate of 74.9%. Our data showed that 60.2% of Japanese residents engaged in some type of scholarly activity. Barriers included: "No resident time"; "No mentor;" and "No resident interest." Sixty-three percent of residents thought that research should be a residency requirement. In multivariate logistic analysis, residents' overall satisfaction with their residency program was significantly associated with participation in research activity (odds ratio (OR), 1.5; 95% confidence interval (CI), 1.1-2.1); male gender (OR, 1.5; 95% CI: 1.1-2.2); satisfaction with residency compensation (OR, 3.8; 95% CI, 2.6-5.0), and satisfaction with the residency curriculum (OR, 19.5; 95% CI, 13.7-27.7). CONCLUSIONS The majority of residents surveyed thought that research activity was worthwhile. Residents' participation in research activity was associated with higher levels of satisfaction with residency training. Implementing measures to overcome existing barriers may have educational benefits for residents.
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Affiliation(s)
- Osamu Takahashi
- Division of General Internal Medicine, Department of Medicine, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
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Ommen O, Driller E, Köhler T, Kowalski C, Ernstmann N, Neumann M, Steffen P, Pfaff H. The relationship between social capital in hospitals and physician job satisfaction. BMC Health Serv Res 2009; 9:81. [PMID: 19445692 PMCID: PMC2698840 DOI: 10.1186/1472-6963-9-81] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Accepted: 05/16/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Job satisfaction in the hospital is an important predictor for many significant management ratios. Acceptance in professional life or high workload are known as important predictors for job satisfaction. The influence of social capital in hospitals on job satisfaction within the health care system, however, remains to be determined. Thus, this article aimed at analysing the relationship between overall job satisfaction of physicians and social capital in hospitals. METHODS The results of this study are based upon questionnaires sent by mail to 454 physicians working in the field of patient care in 4 different German hospitals in 2002. 277 clinicians responded to the poll, for a response rate of 61%. Analysis was performed using three linear regression models with physician overall job satisfaction as the dependent variable and age, gender, professional experience, workload, and social capital as independent variables. RESULTS The first regression model explained nearly 9% of the variance of job satisfaction. Whereas job satisfaction increased slightly with age, gender and professional experience were not identified as significant factors to explain the variance. Setting up a second model with the addition of subjectively-perceived workload to the analysis, the explained variance increased to 18% and job satisfaction decreased significantly with increasing workload. The third model including social capital in hospital explained 36% of the variance with social capital, professional experience and workload as significant factors. CONCLUSION This analysis demonstrated that the social capital of an organisation, in addition to professional experience and workload, represents a significant predictor of overall job satisfaction of physicians working in the field of patient care. Trust, mutual understanding, shared aims, and ethical values are qualities of social capital that unify members of social networks and communities and enable them to act cooperatively.
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Affiliation(s)
- Oliver Ommen
- Center for Health Services Research Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany.
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Gibson DD, Borges NJ. Aligning Career Expectations With the Practice of Medicine. JOURNAL OF CAREER DEVELOPMENT 2009. [DOI: 10.1177/0894845309335240] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined physicians' level of satisfaction with their job and the match between expectations and actual practice of specialty. Quantitative results suggested that physicians (N = 211) had a moderately high level of overall job satisfaction with no significant differences found between men and women physicians. Among those in primary care, medical specialties, surgical specialties, or supporting specialties, overall job satisfaction was found to be higher for surgical specialists compared to primary care physicians. Qualitative comments from two open-ended questions identified 20 themes regarding how closely the participants' expectations matched with the realities of the practice of medicine. Six themes are described in detail. Approximately 85% of physicians felt their expectations for their specialty matched their actual experience in the field. Helping students to understand how their expectations align with the actual practice of medicine and specific specialties is important to their development as a physician and to job satisfaction, and has implications for career counseling and advising in undergraduate and graduate medical education.
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Wada K, Arimatsu M, Higashi T, Yoshikawa T, Oda S, Taniguchi H, Kawashima M, Aizawa Y. Physician job satisfaction and working conditions in Japan. J Occup Health 2009; 51:261-6. [PMID: 19305116 DOI: 10.1539/joh.o8023] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The aim of this study was to determine factors of working conditions associated with job satisfaction among physicians in Japan. METHODS We sent a questionnaire to all the physicians who graduated from a medical school in Japan. Physicians who were satisfied with their job were determined as those who selected "very satisfied" and "satisfied" in response to the question: "Overall, are you satisfied with your job?" Working conditions were determined from 10 different aspects: income fairness, hospital resources, career satisfaction, difficulty in patient care, lack of personal time, administrative work, workload, and relationships with physician colleagues, staff and patients. Logistic regression analysis was used to explore the association between working conditions and job satisfaction. RESULTS Among the respondents, 209 (55.4%) men and 62 (61.4%) women were determined to be satisfied with their job. Job satisfaction was associated with income fairness for both men (corrected odds ratio 1.31, 95% confidence interval 1.09 to 1.47) and women (1.35, 1.05 to 1.53). For men, job satisfaction was associated with good hospital resources (1.45, 1.29 to 1.57), high career satisfaction (1.41, 1.23 to 1.57), good relationships with physician colleagues (1.33, 1.12 to 1.49), and good relationships with hospital staff (1.28, 1.07 to 1.45). For women, job satisfaction was associated with good relationships with patients (1.41, 1.07 to 1.56). CONCLUSIONS Certain working conditions were important factors for job satisfaction among physicians. These factors should be discussed for improving working conditions.
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Affiliation(s)
- Koji Wada
- Department of Preventive Medicine and Public Health, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa, Japan.
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Utsugi-Ozaki M, Bito S, Matsumura S, Hayashino Y, Fukuhara S. Physician job satisfaction and quality of care among hospital employed physicians in Japan. J Gen Intern Med 2009; 24:387-92. [PMID: 19130149 PMCID: PMC2642562 DOI: 10.1007/s11606-008-0886-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Revised: 08/07/2008] [Accepted: 11/10/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Physician job satisfaction is reportedly associated with interpersonal quality of care, such as patient satisfaction, but its association with technical quality of care, as determined by whether patients are offered recommended services, is unknown. OBJECTIVE We explored whether the job satisfaction of hospital-employed physicians in Japan is associated with the technical quality of care, with an emphasis on process qualities as measured by quality indicators. DESIGN Cross-sectional study linking data from physician surveys with data abstracted from outpatient charts. PARTICIPANTS A total of 53 physicians working at 13 hospitals in Japan participated. Medical records covering 568 patients were reviewed. MEASUREMENTS Disease-specific indicators related to the care of patients with hypertension, type 2 diabetes, and asthma, as well as disease-independent measures of the process of care were abstracted. We analyzed the association between the quality of care score for individual physicians, which is defined as the percentage of quality indicators satisfied among the total for which their patients were eligible, and physician job satisfaction, which was measured by a validated scale. RESULTS No statistically significant association between physician job satisfaction and quality of care was observed. A 1-standard deviation (SD) increment in the physician job satisfaction scale was associated with an increase of only 0.3% for overall quality (P = 0.85), -3.0% for hypertension (P = 0.22), 2.5% for type 2 diabetes (P = 0.44), 8.0% for asthma (P = 0.21), and -0.4% for cross-cutting care (P = 0.76). CONCLUSION Contrary to the positive association reported between physician job satisfaction and high quality of interpersonal care, no association was seen between physician job satisfaction and the technical quality of care.
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Affiliation(s)
- Makiko Utsugi-Ozaki
- Department of Epidemiology and Healthcare Research, Graduate School of Public Health and Medicine, Kyoto University, Kyoto, Japan.
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Wear D, Aultman JM, Zarconi J, Varley JD. Derogatory and cynical humour directed towards patients: views of residents and attending doctors. MEDICAL EDUCATION 2009; 43:34-41. [PMID: 19148979 DOI: 10.1111/j.1365-2923.2008.03171.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
CONTEXT A study of medical students' perspectives on derogatory and cynical humour was published in 2006. The current study examines residents' and attending doctors' perspectives on the same phenomenon in three clinical departments of psychiatry, internal medicine and surgery. METHODS Two focus groups were conducted in each of the three clinical departments, one with residents and one with attending doctors,during the 2006-07 academic year. Seventy doctors participated, including 49 residents and 21 attendings. The same semi-structured format was used in each group. Questions focused on characterisations of derogatory and cynical humour along with motives and rules for its use.All focus groups were audiotaped and the tapes transcribed. Each transcript was read independently by each researcher as part of an inductive process to discover the categories that describe and explain the uses, motives and effects of such humour. RESULTS Three categories that appeared in the first study with medical students - locations for humour, the humour game, and not-funny humour - emerged as virtually identical,whereas two others--objects of humour and motives for humour - were more fully elaborated. DISCUSSION Discussions of derogatory and cynical humour should occur in any department where teaching and role modelling are priorities. In addition, the tenets of appreciative inquiry and the complex responsive process,particularly as they are used at the Indiana University School of Medicine, offer medical educators valuable tools for addressing this phenomenon.
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Affiliation(s)
- Delese Wear
- Department of Behavioral Sciences, Northeastern Ohio UniversitiesCollege of Medicine, Rootstown, Ohio, USA.
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