Burnout and job satisfaction among physicians working in urologic departments who immigrated to Germany, taking into account the income structure of their country of origin

BACKGROUND

Studies are available on physician burnout and job satisfaction (JS) in relation to the specific income structure of the country of residence. However, no studies exist that investigate burnout of immigrated physicians taking into account the income structure of their country of origin (IS-COO) as well as duration of immigration.

OBJECTIVE

To determine the influence of IS-COO on JS, income satisfaction, and critical burnout thresholds in the domains of emotional exhaustion (EE), depersonalization (DP) and reduction in personal accomplishment (RPA) among urologists with a migrant background working at German hospitals.

METHODS

A questionnaire (Survey-Monkey®/101-items) was conducted among urologists of German hospitals with a migrant background. The online questionnaire was open for study participation from 1 August to 31 October 2020. The study included all physicians with a migration background who were born in a country other than Germany and were currently employed in a German department of urology. Physician burnout (Maslach-Burnout-Inventory) and JS were assessed using validated instruments. The influence of IS-COO and different covariates on the designated endpoints was tested using multivariate-models.

RESULTS

96 urologists with a median stay in Germany of 7 years participated and were stratified according to low (LIC/41.7%), middle (MIC/36.5%) and high (HIC/21.9%) income based on IS-COO. No significant influence of IS-COO on critical thresholds in each burnout domain could be found. Of urologists from LIC, MIC and HIC, 42%, 59% and 57%, respectively, showed rather or extreme JS (p = .446). There was also no significant difference between groups in income satisfaction (p = .838). However, in multivariate-models, duration of stay in Germany (≥7 vs. <7 years) had significant effects on DP (OR: 0.28, p = .038) and RPA (OR: 0.09, p = .014), but not on EE and JS.

CONCLUSION

IS-COO has no impact on burnout and JS among urologists who immigrated to Germany. Similarly, income satisfaction in the country of residence is not influenced by IS-COO.

The importance of right heart function in heart failure with preserved ejection fraction

Funding Acknowledgements

Type of funding sources: None.

Background

Heart failure (HF) is a complex clinical syndrome that is a frequent cause of morbidity and mortality. Although half of patients with HF have a preserved ejection fraction (HFpEF), the majority of studies have examined the prognostic impact of left heart parameters instead of the right. We thus evaluated associations of right heart hemodynamics and echocardiographic measures with outcomes in HFpEF subjects.

Purpose

To perform long-term mortality analysis of patients with decompensated HFpEF using strain imaging and right heart catheterization hemodynamics.

Methods

This was a retrospective cross-sectional study which included patients hospitalized for acute heart failure exacerbation as the primary admitting diagnosis based on clinical and laboratory parameters as determined by the primary medical team. Patients included were only those with HFpEF and with available echocardiographic and right heart catheterization (RHC) hemodynamic data done during the index admission. 2D strain analysis software was used to automatically calculate right ventricular free wall strain (RVFWS), fractional area change (FAC), and left ventricular global longitudinal strain (LVGLS). Demographic and clinical parameters were obtained including RHC hemodynamics. The outcome of interest was long term 6-year all-cause mortality. Right and left ventricular echocardiographic strain and hemodynamic parameters were compared between patients with mortality and those who survived using independent T tests and non-parametric methods as appropriate. Multivariable logistic regression was used to identify echocardiographic and hemodynamic factors independently associated with all-cause mortality. Results From a total of 100 patients, 47% were Caucasian and 53% were female. The mean age was 67.4 ± 14.3. There was an 18% long term all cause mortality rate. Of the right sided echocardiographic strain parameters, only RVFWS was statistically significantly lower among those who died (12.0 vs 15.7 p = 0.038). Meanwhile, 4 chamber LVGLS was significantly lower (13.8 vs 15.1 p = 0.016) and mean right atrial (RA) pressure was higher (13.6 vs 10.7 p = 0.076) although this did not reach statistical significance. Looking at echocardiographic strain and hemodynamic parameters as predictors of mortality, after adjusting for age, gender and race accounting for the major differences in these parameters between the survival groups, only RVFWS (OR 1.90, 95% CI 1.12-3.28; p = 0.02) and RA pressure (OR 1.85, 95% CI 1.12-3.28; p = 0.016) remained independently associated with long term all-cause mortality with C statistic of 0.751 for the overall predictive model.

Conclusion

Among patients with HFpEF admitted for acute heart failure exacerbation, baseline RVFWS and RA hemodynamic pressure measurements were independently associated with long term all-cause mortality. This suggests that right heart diagnostic parameters may hold more prognostic utility in HFpEF. Abstract Figure.  Abstract Figure.

Job Satisfaction and Evidence of Burnout Comparing Arab and Non-Arab Urologists with a Migration Background Working in German Hospitals

Background  In German hospitals, severe shortage of physicians can currently be partially compensated by hiring foreign physicians. Results on job satisfaction (JS) and physician burnout (PBO) in this important occupational group are currently not available.

Methods  The cross-sectional “Assessment of their urological work environment by foreign clinicians in Germany (EUTAKD)” study was conducted in 2020 using a 101-item questionnaire among physicians working in German urological departments who were born in a country outside Germany and having non-German citizenship. This study compared JS and the occurrence of PBO between Arab (group A, n = 57) and non-Arab (group B, n = 39) participants.

Results  Significant group differences with advantages for group B were analyzed in overall JS and also in other JS items. High scores in the PBO dimensions, that is, “emotional exhaustion” and “depersonalization,” were shown by 27.9 and 51.5% of the study participants, respectively, although there were no group differences found ( p = 0.972 and 0.237, respectively).

Conclusion  Prospective longitudinal studies of appropriate intervention measures aimed at increasing JS and decreasing PBO are needed.

Job Satisfaction and Intentions to Leave of Foreign-National Urologists Working at German Hospitals: Results of the Cross-Sectional EUTAKD Study

BACKGROUND

Studies exist that identify factors associated with higher professional satisfaction among clinicians. However, there are no reliable findings for clinicians with a migration background as to whether there is a correlation between particular dimensions of professional satisfaction and the desire to leave their current specialty or country of employment. For the first time, these data were collected within a questionnaire-based study from urological clinicians with a migration background (UCMBs) working in Germany.

MATERIAL AND METHODS

A SurveyMonkey® with 101 items relating to characterizing features of the study participants and questions about job satisfaction (n = 39) was opened for UCMBs between August and October 2020. The influence of different dimensions of job satisfaction on the desire to quit the urological specialty/leave Germany was analyzed (group A: neither want to leave urology nor Germany; group B: can at least imagine leaving the urological profession and/or Germany).

RESULTS

Eighty-one UCMBs were distributed almost equally in groups A (50.6%) and B (49.4%). Occupational satisfaction was higher in several respects in group A. Three dimensions that differed significantly with regard to occupational satisfaction were used to create an aggregate score ranging from 3 to 15 points as follows: (1) relationship to superiors (p = 0.014), (2) career opportunities in the clinic (p < 0.001), and (3) opportunities for the further development of surgical skills (p = 0.006). For each point value of this aggregate score, the UCMB's desire to quit urology or leave Germany (or at least uncertainty about this question) decreased by a relative value of 34.6% (odds ratio: 0.654, 95% confidence interval: 0.496-0.861, p = 0.002).

CONCLUSIONS

Various dimensions of job satisfaction have been identified, the improvement of which could contribute to the long-term retention of UCMBs at German urological clinics.

[Relationship between non-medical reading and burnout as well as professional satisfaction among urologists with migrant background: results of the EUTAKD survey study conducted at German hospitals]

BACKGROUND

There are no study results on the private and professional satisfaction and the burnout risk of urologists with a migrant background at German hospitals to date. Non-medical reading has been described to have an influence on lower burnout rates among physicians of different specialties.

MATERIAL AND METHODS

A SurveyMonkey questionnaire with 101 items on criteria characterising the study participant, questions on private and professional satisfaction and the complete Maslach Burnout Inventory was opened to urologists with a migrant background at German clinics between August and October 2020. The impact of non-medical reading on professional satisfaction and burnout was comparatively assessed (group A: ≤1 book/12 months versus group B: ≥2 books/12 months).

RESULTS

Eighty-one study participants were included. They were almost equally distributed into groups A (49.4%) and B (50.6%). In several items on personal and professional satisfaction, there was a significantly higher satisfaction in group B. In the burnout dimensions of emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA), a high risk of burnout was present in 27.9%, 35.3% and 73.5% of the study participants. A group comparison revealed significant advantages for Group B in the PA dimension in both the sum score (p=0.001) and the categorical comparison (p=0.002). Study participants in Group B also had a significantly lower DP dimension sum score compared with Group A (p=0.047). The group variable was independently associated with a combined score of EE and DP on the one hand (OR 0.316; p=0.031) and the PA dimension on the other (OR 0.170; p=0.024).

CONCLUSIONS

Reading non-medical books was associated with higher professional satisfaction and a lower burnout risk among urologists with a migrant background at German hospitals.

Assessment of Vascular Patency and Inflammation with Intravascular Optical Coherence Tomography in Patients with Superficial Femoral Artery Disease Treated with Zilver PTX Stents

PURPOSE

Zilver PTX nitinol self-expanding drug-eluting stent with paclitaxel coating is effective for treatment of superficial femoral artery (SFA) disease. However, as with any stent, it induces a measure of vascular inflammatory response. The current clinical trial (NCT02734836) aimed to assess vascular patency, remodeling, and inflammatory markers with intravascular optical coherence tomography (OCT) in patients with SFA disease treated with Zilver PTX stents.

METHODS

Serial OCT examinations were performed in 13 patients at baseline and 12-month follow-up. Variables evaluated included neointimal area, luminal narrowing, thrombus area, stent expansion as well as measures of inflammation including, peri-strut low-intensity area (PLIA), macrophage arc, neovascularization, stent strut apposition and coverage.

RESULTS

Percentage of malapposed struts decreased from 10.3 ± 7.9% post-intervention to 1.1 ± 2.2% at 12-month follow-up, but one patient showed late-acquired stent malapposition (LASM). The percent of uncovered struts at follow-up was 3.0 ± 4.5%. Average expansion of stent cross-sectional area from baseline to follow-up was 35 ± 19%. The average neointimal area was 7.8 ± 3.8 mm². Maximal luminal narrowing was 61.1 ± 25.0%, and average luminal narrowing was 35.4 ± 18.2%. Average peri-strut low-intensity area (PLIA) per strut was 0.017 ± 0.018 mm². Average number of neovessels per mm of stent was 0.138 ± 0.181. Average macrophage angle per frame at follow-up was 7 ± 11°. Average thrombus area at follow-up was 0.0093 ± 0.0184 mm².

CONCLUSION

At 12-month follow-up, OCT analysis of Zilver PTX stent shows outward remodeling and minimal neointimal growth, but evidence of inflammation including PLIA, neovessels, thrombus and macrophages.

SUMMARY

Thirteen patients with PAD had paclitaxel-coated stents implanted in their SFAs and were then imaged with OCT at baseline and 12-month follow-up. OCT proxy metrics of inflammation were quantified.