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Berthold A, Luchsinger L, Siegrist M. The Perceived Influence of the COVID-19 Pandemic on the Medical Education of Residents in 2021 and 2022. J Grad Med Educ 2024; 16:318-322. [PMID: 38882422 PMCID: PMC11173043 DOI: 10.4300/jgme-d-23-00361.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 10/24/2023] [Accepted: 03/12/2024] [Indexed: 06/18/2024] Open
Abstract
Background Recent studies reported how the COVID-19 pandemic influenced the medical education community. However, little is known about the further influence of the pandemic over time and about the impact across the different medical disciplines. Objective Our objective was to investigate how residents working in different disciplines and on different tracks (full- vs part-time) perceived the influence of the COVID-19 pandemic in 2021 and 2022 on their education. Methods The data were collected with a questionnaire (developed by the Swiss Federal Institute of Technology and the Swiss Institute for Medical Education) as part of the Swiss national annual survey on medical education. We assessed the influence of the pandemic on medical residents from different specialties in 2021 and 2022 with 3 items: global effect on education, available time for education, and effect on teaching. Results The questionnaire had a response rate of 70% (8496 of 12 137) in 2021 and 2022 (8823 of 12 604). In 2021, residents reported that the pandemic had a negative influence (3.5 of 5; P<.001; 95% CI 0.49, 0.53) and impaired their education. The negative influence declined (t=7.91; P<.001; 95% CI 0.07, 0.11) but remained noticeable in 2022 (3.4 of 5; P<.001; 95% CI 0.41, 0.44). This pattern of results was similar among the different medical specialties. In both years, residents working full-time reported a more severe influence of the pandemic than those working part-time (eg, in 2021 impaired education: 3.1 of 4 vs 2.9 of 4; P<.01; 95% CI -0.26, -0.14). Conclusions The negative influence of the pandemic declined across all medical disciplines.
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Affiliation(s)
- Anne Berthold
- is Researcher, Consumer Behavior Group, ETH Zurich, Zurich, Switzerland
| | - Larissa Luchsinger
- is Researcher, Consumer Behavior Group, ETH Zurich, Zurich, Switzerland; and
| | - Michael Siegrist
- is Professor, Consumer Behavior Group, ETH Zurich, Zurich, Switzerland
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Hale AL, Gray WS, Gray BH. The Importance of Team Alignment and Retention in Vascular Center Development: A Clinician's Perspective. Ann Vasc Surg 2024; 101:1-5. [PMID: 38110078 DOI: 10.1016/j.avsg.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 12/07/2023] [Indexed: 12/20/2023]
Abstract
The healthcare landscape is in a state of constant evolution, presenting both challenges and opportunities. Recent trends, including the departure or retirement of medical professionals, the rise in travel and per diem positions, and the expansive growth of healthcare networks, have resulted in a palpable divide within the field. This divide often manifests as a shift from prioritizing patient care and staff well-being toward financial security and operational efficiency and productivity. Amid these ongoing changes, vascular centers possess the potential for a positive distinction that extends beyond their specialization to encompass their approaches to patient care and team dynamics. This article presents a 3-phase strategy for vascular clinicians and centers to consider as they seek to attract and retain top-tier staff, provide exceptional patient care, and attain sustainable growth and financial success.
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Affiliation(s)
| | | | - Bruce H Gray
- Department of Surgery/Vascular Medicine, University of South Carolina School of Medicine, Greenville, SC.
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Kegreiss S, Studer C, Beeler PE, Essig S, Tomaschek R. Impact of primary care physicians working part-time on patient care: A scoping review. Eur J Gen Pract 2023; 29:2271167. [PMID: 37909317 PMCID: PMC10990256 DOI: 10.1080/13814788.2023.2271167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/09/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Increasing numbers of primary care physicians (PCPs) are reducing their working hours. This decline may affect the workforce and the care provided to patients. OBJECTIVES This scoping review aims to determine the impact of PCPs working part-time on quality of patient care. METHODS A systematic search was conducted using the databases PubMed, CINAHL, Embase, and the Cochrane Library. Peer-reviewed, original articles with either quantitative, qualitative or mixed methods designs, published after 2000 and written in any language were considered. The search strings combined the two concepts: part-time work and primary care. Studies were included if they examined any effect of PCPs working part-time on quality of patient care. RESULTS The initial search resulted in 2,323 unique studies. Abstracts were screened, and information from full texts on the study design, part-time and quality of patient care was extracted. The final dataset included 14 studies utilising data from 1996 onward. The studies suggest that PCPs working part-time may negatively affect patient care, particularly the access and continuity of care domains. Clinical outcomes and patient satisfaction seem mostly unaffected or even improved. CONCLUSION There is evidence of both negative and positive effects of PCPs working part-time on quality of patient care. Approaches that mitigate negative effects of part-time work while maintaining positive effects should be implemented.
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Affiliation(s)
- Sebastian Kegreiss
- Joint Medical Master University of Lucerne and University of Zurich, Zurich, Switzerland
| | - Christian Studer
- Centre for Primary and Community Care, University of Lucerne, Lucerne, Switzerland
| | - Patrick E. Beeler
- Centre for Primary and Community Care, University of Lucerne, Lucerne, Switzerland
| | - Stefan Essig
- Centre for Primary and Community Care, University of Lucerne, Lucerne, Switzerland
| | - Rebecca Tomaschek
- Centre for Primary and Community Care, University of Lucerne, Lucerne, Switzerland
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Shanafelt TD, West CP, Sinsky CA, Trockel MT, Tutty MA, Wang H, Carlasare LE, Dyrbye LN. At-Risk Work Hours Among U.S. Physicians and Other U.S. Workers. Am J Prev Med 2023; 65:568-578. [PMID: 37178097 DOI: 10.1016/j.amepre.2023.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Systematic reviews by the WHO have shown an increased risk of morbidity and mortality related to ischemic heart disease and stroke among individuals working an average of ≥55 hours/week. METHODS A cross-sectional survey of U.S. physicians and a probability-based sample of the general U.S. working population (n=2,508) was conducted between November 20, 2020, and February 16, 2021 (data analyzed in 2022). Among 3,617 physicians who received a mailed survey, 1,162 (31.7%) responded; among 90,000 physicians who received an electronic survey, 6,348 (7.1%) responded. Mean weekly work hours were assessed. RESULTS The mean reported weekly work hours for physicians and U.S. workers in other fields were 50.8 hours and 40.7 hours, respectively (p<0.001). Less than 10% of U.S. workers in other fields (9.2%) reported working ≥55 hours/week compared with 40.7% of physicians. Although work hours decreased among physicians working less than full time, the decrease in work hours was smaller than the reported reduction in professional work effort. Specifically, for physicians who worked between half-time and full-time (i.e., full-time equivalent=50%-99%), work hours decreased by approximately 14% for each 20% reduction in full-time equivalent. On multivariable analysis of physicians and workers in other fields adjusting for age, gender, relationship status, and level of education, individuals with a professional/doctorate degree other than an MD/DO (OR=3.74; 95% CI=2.28, 6.09) and physicians (OR=8.62; 95% CI=6.44, 11.80) were more likely to work ≥55 hours/week. CONCLUSIONS A substantial proportion of physicians have work hours previously shown to be associated with adverse personal health outcomes.
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Affiliation(s)
- Tait D Shanafelt
- Stanford Department of Medicine, Stanford University, Palo Alto, California.
| | - Colin P West
- Mayo Clinic Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Mickey T Trockel
- Stanford Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California
| | | | - Hanhan Wang
- Stanford WellMD & WellPhD Center, Mayo Clinic, Rochester, Minnesota
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5
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Bretagne L, Mosimann S, Roten C, Perrig M, Genné D, Essig M, Mancinetti M, Méan M, Darbellay Farhoumand P, Huber LC, Weber E, Knoblauch C, Schoenenberger AW, Frick S, Wenemoser E, Ernst D, Bodmer M, Aujesky D, Baumgartner C. Association of part-time clinical work with well-being and mental health in General Internal Medicine: A survey among Swiss hospitalists. PLoS One 2023; 18:e0290407. [PMID: 37768911 PMCID: PMC10538797 DOI: 10.1371/journal.pone.0290407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/08/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION Burnout and low job satisfaction are increasing among the General Internal Medicine (GIM) workforce. Whether part-time compared to full-time clinical employment is associated with better wellbeing, job satisfaction and health among hospitalists remains unclear. MATERIALS AND METHODS We conducted an anonymized cross-sectional survey among board-certified general internists (i.e. hospitalists) from GIM departments in 14 Swiss hospitals. Part-time clinical work was defined as employment of <100% as a clinician. The primary outcome was well-being, as measured by the extended Physician Well-Being Index (ePWBI), an ePWBI ≥3 indicating poor wellbeing. Secondary outcomes included depressive symptoms, mental and physical health, and job satisfaction. We compared outcomes in part-time and full time workers using propensity score-adjusted multivariate regression models. RESULTS Of 199 hospitalists invited, 137 (69%) responded to the survey, and 124 were eligible for analysis (57 full-time and 67 part-time clinicians). Full-time clinicians were more likely to have poor wellbeing compared to part-time clinicians (ePWBI ≥3 54% vs. 31%, p = 0.012). Part-time compared to full-time clinical work was associated with a lower risk of poor well-being in adjusted analyses (odds ratio 0.20, 95% confidence interval 0.07-0.59, p = 0.004). Compared to full-time clinicians, there were fewer depressive symptoms (3% vs. 18%, p = 0.006), and mental health was better (mean SF-8 Mental Component Summary score 47.2 vs. 43.2, p = 0.028) in part-time clinicians, without significant differences in physical health and job satisfaction. CONCLUSIONS Full-time clinical hospitalists in GIM have a high risk of poor well-being. Part-time compared to full-time clinical work is associated with better well-being and mental health, and fewer depressive symptoms.
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Affiliation(s)
- Lisa Bretagne
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefanie Mosimann
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Christine Roten
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Perrig
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel Genné
- Department of Internal Medicine, Hospital of Biel-Bienne, Bienne, Switzerland
| | - Manfred Essig
- Department of General Internal Medicine, Tiefenau Hospital, Bern, Switzerland
| | - Marco Mancinetti
- Department of Medicine, University and Hospital of Fribourg, Fribourg, Switzerland
| | - Marie Méan
- Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland
| | | | - Lars C Huber
- Department of General Internal Medicine, Stadtspital Zürich Triemli, Zürich, Switzerland
| | - Elisabeth Weber
- Department of General Internal Medicine, Stadtspital Zürich Waid, Zürich, Switzerland
| | - Christoph Knoblauch
- Department of General Internal Medicine, Hospital of Nidwalden, Stans, Switzerland
| | - Andreas W Schoenenberger
- Department of General Internal Medicine, Cantonal Hospital of Münsterlingen, Münsterlingen, Switzerland
| | - Sonia Frick
- Department of General Internal Medicine, Hospital of Limmattal, Schlieren, Switzerland
| | - Eliane Wenemoser
- Department of General Internal Medicine, Hospital Region of Oberaargau, Langenthal, Switzerland
| | - Daniel Ernst
- Department of General Internal Medicine, Hospital of Thun, Thun, Switzerland
| | - Michael Bodmer
- Department of General Internal Medicine, Cantonal Hospital of Zug, Baar, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christine Baumgartner
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Jung FU, Luppa M, Riedel-Heller SG. [Physician working hours and effects on health, satisfaction and healthcare]. ZENTRALBLATT FUR ARBEITSMEDIZIN, ARBEITSSCHUTZ UND ERGONOMIE 2023; 73:1-7. [PMID: 37361962 PMCID: PMC10141868 DOI: 10.1007/s40664-023-00503-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 06/28/2023]
Abstract
Changes in the working environment with respect to innovative working time models are also increasingly affecting patient care. The number of physicians working part-time, for example, is continuously rising. At the same time, a general increase in chronic diseases and multimorbid conditions as well as the growing shortage of medical staff, leads to more workload and dissatisfaction among this profession. This short overview summarizes the current study situation and associated consequences regarding working hours of physicians and gives a first explorative overview of possible solutions.
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Affiliation(s)
- F. U. Jung
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät, Universität Leipzig, Ph.-Rosenthal-Str. 55, 04103 Leipzig, Deutschland
| | - M. Luppa
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät, Universität Leipzig, Ph.-Rosenthal-Str. 55, 04103 Leipzig, Deutschland
| | - S. G. Riedel-Heller
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät, Universität Leipzig, Ph.-Rosenthal-Str. 55, 04103 Leipzig, Deutschland
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du Bois K, Sterkens P, Lippens L, Baert S, Derous E. Beyond the Hype: (How) Are Work Regimes Associated with Job Burnout? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3331. [PMID: 36834026 PMCID: PMC9965496 DOI: 10.3390/ijerph20043331] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/09/2023] [Accepted: 02/11/2023] [Indexed: 06/18/2023]
Abstract
Job burnout affects countless workers and constitutes a major issue in working life. Prevention strategies such as offering part-time options and shorter working weeks have been widely advocated to address this issue. However, the relationship between shorter work regimes and burnout risk has not yet been investigated across diverse working populations applying validated measures and frameworks for job burnout. Building on the most recent operationalisation of job burnout and the seminal job demands-resources theory, the purpose of the current study is to investigate whether shorter work regimes are associated with lower burnout risk and whether the job demands-resources explain this association. To this end, a heterogenous sample of 1006 employees representative for age and gender completed the Burnout Assessment Tool (BAT) and Workplace Stressors Assessment Questionnaire (WSAQ). Our mediation analyses yield a very small but significant indirect association between work regimes and burnout risk through job demands, but no significant total or direct association between work regimes and burnout risk. Our result suggests that employees in shorter work regimes experience slightly fewer job demands, but are equally prone to developing burnout as their full-time counterparts. The latter finding raises concerns about the sustainability of burnout prevention that focuses on mere work regimes instead of the root causes of burnout.
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Affiliation(s)
- Kristen du Bois
- Faculty of Economics and Business Administration, Ghent University, 9000 Ghent, Belgium
- Faculty of Psychological and Educational Sciences, Ghent University, 9000 Ghent, Belgium
| | - Philippe Sterkens
- Faculty of Economics and Business Administration, Ghent University, 9000 Ghent, Belgium
- Faculty of Psychological and Educational Sciences, Ghent University, 9000 Ghent, Belgium
| | - Louis Lippens
- Faculty of Economics and Business Administration, Ghent University, 9000 Ghent, Belgium
- Faculty of Social Sciences, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Stijn Baert
- Faculty of Economics and Business Administration, Ghent University, 9000 Ghent, Belgium
- Research Foundation Flanders, University of Antwerp, 2000 Antwerp, Belgium
- Institute of Labor Economics (IZA), Université Catholique de Louvain, 1348 Ottignies-Louvain-la-Neuve, Belgium
| | - Eva Derous
- Faculty of Psychological and Educational Sciences, Ghent University, 9000 Ghent, Belgium
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Walsh MN, Arrighi JA, Cacchione JG, Chamis AL, Douglas PS, Duvernoy CS, Foody JM, Hayes SN, Itchhaporia D, Parmacek MS, Stefanescu Schmidt AC, Vetrovec GW, Waites TF, Warner JJ. 2022 ACC Health Policy Statement on Career Flexibility in Cardiology: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2022; 80:2135-2155. [PMID: 36244862 DOI: 10.1016/j.jacc.2022.08.748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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9
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Trockel J, Bohman B, Wang H, Cooper W, Welle D, Shanafelt TD. Assessment of the Relationship Between an Adverse Impact of Work on Physicians' Personal Relationships and Unsolicited Patient Complaints. Mayo Clin Proc 2022; 97:1680-1691. [PMID: 36058580 DOI: 10.1016/j.mayocp.2022.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 02/12/2022] [Accepted: 03/04/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the relationship between an adverse impact of work on physicians' personal relationships and unsolicited patient complaints about physician behavior - a well-established indicator of patient care quality. PARTICIPANTS AND METHODS We paired data from a physician wellness survey collected in April and May 2013 with longitudinal unsolicited patient complaint data collected independently from January 1, 2013, to December 31, 2016. Unsolicited patient complaints were used to calculate the Patient Advocacy Reporting System (PARS) score, an established predictor of clinical outcomes and malpractice suits. The primary outcome was PARS score tercile. Ordinal logistic regression mixed effects models were used to assess the association between the impact of work on a physician's personal relationships and PARS scores. RESULTS Of 2384 physicians eligible to participate, 831 (34.9%) returned surveys including 429 (51.6%) who consented for their survey responses to be linked to independent data and had associated PARS scores. In a multivariate model adjusting for gender and specialty category, each 1-point higher impact of work on personal relationships score (0-10 scale; higher score unfavorable) was associated with a 19% greater odds of being in the next higher PARS score tercile of unsolicited patient complaints (odds ratio, 1.19; 95% CI, 1.07-1.33) during the subsequent 4-year study period. CONCLUSION An adverse impact of work on physicians' personal relationships is associated with independently assessed, unsolicited patient complaints. Organizational efforts to mitigate an adverse impact of work on physicians' personal relationships are warranted as part of efforts to improve the quality of patient experience and malpractice risk.
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Affiliation(s)
| | - Bryan Bohman
- Stanford University School of Medicine, Stanford, CA, USA
| | - Hanhan Wang
- Stanford University School of Medicine, Stanford, CA, USA
| | - William Cooper
- Vanderbilt Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dana Welle
- Tribeca Companies, San Francisco, CA, USA
| | - Tait D Shanafelt
- Stanford University School of Medicine, Stanford, CA, USA. https://twitter.com/StanfordWellMD
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Bodendieck E, Jung FU, Luppa M, Riedel-Heller SG. Burnout and work-privacy conflict - are there differences between full-time and part-time physicians? BMC Health Serv Res 2022; 22:1082. [PMID: 36002851 PMCID: PMC9404597 DOI: 10.1186/s12913-022-08471-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/18/2022] [Indexed: 12/01/2022] Open
Abstract
Background Changes in everyday work with regard to working time models have reached the medical profession. The number of physicians working part-time is steadily increasing. At the same time, however, the population's need for care is also rising. This can reinforce the impending shortage of doctors in the future. The aim was to investigate differences in work-privacy conflict and burnout among physicians working full-time or part-time. Method The present study includes data from a baseline survey of the long-term study of physicians with different medical backgrounds. The analysis focused on a sub-sample of 598 physicians (not self-employed). The two main outcomes under investigation—burnout and work-privacy conflict—were measured using the Copenhagen Burnout Inventory adapted for health care professionals, as well as the associated subscale of the Copenhagen Psychosocial Questionnaire (COPSOQ). Data analyses included descriptive statistics followed by regression models. Results Descriptive analyses show, that 31.8% of physicians are working part-time, whereas 68.2% are working full-time. The part-time subsample is significantly older, and female physicians are more likely to work part-time. With regard to workload and work-privacy conflict, significant differences between part-time and full-time physicians were only observed in terms of work-privacy-conflict. However, regression analysis underline the importance of possible confounding variables (such as medical setting) within the relationship between job size and job-related well-being. Discussion Differences in working hour arrangements (full-time or part-time work) are only accompanied by less work-privacy conflict. No differences with regard to burnout (patient-related, work-related or personal) could be obtained. Rather, the data suggests that other job-related variables may play a role and should be further investigated.
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Affiliation(s)
- E Bodendieck
- General Practice, Dresdner Straße 34a, 04808, Wurzen, Germany
| | - F U Jung
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Ph.-Rosenthal-Str. 55, 04103, Leipzig, Germany.
| | - M Luppa
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Ph.-Rosenthal-Str. 55, 04103, Leipzig, Germany
| | - S G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Ph.-Rosenthal-Str. 55, 04103, Leipzig, Germany
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11
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Emery A, Houchens N, Gupta A. Quality and Safety in the Literature: May 2022. BMJ Qual Saf 2022; 31:409-414. [PMID: 35440499 DOI: 10.1136/bmjqs-2022-014848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/16/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Albert Emery
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Nathan Houchens
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Ashwin Gupta
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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12
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Wang X, Qin H, Zhu Y, Wang Z, Ye B, Zhu X, Liang Y. Association of off-the-job training with work performance and work-family conflict among physicians: a cross-sectional study in China. BMJ Open 2022; 12:e053280. [PMID: 35017246 PMCID: PMC8753420 DOI: 10.1136/bmjopen-2021-053280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To determine whether experiences of off-the-job training in domestic (DT) and overseas study (OS) settings are associated with work performance and work-family conflict in physicians. DESIGN, SETTING AND PARTICIPANTS We conducted a national cross-sectional survey in 77 public hospitals across seven provinces in China between July 2014 and April 2015. Participants were 3182 physicians. EXPOSURE Participants were categorised into four groups: none, DT only, OS only and DT and OS. PRIMARY OUTCOME MEASURES Work performance was assessed by work engagement, career attrition and patient-centred care. Work-family conflict was assessed by affecting care for family, feeling guilty towards family and receiving complaints from family. RESULTS A total of 25.89% participants had experienced DT only, 8.71% OS only and 8.47% DT and OS. After adjustment for potential confounders, participants who had experiences of DT and OS compared with those with no training were more likely to report positive work performance (pride in work: OR=2.11, 95% CI: 1.43 to 3.10; enjoyment of work: OR=1.67, 95% CI: 1.11 to 2.51; turnover intention: OR=0.54, 95% CI: 0.38 to 0.77; early retirement: OR=0.63, 95% CI: 0.45 to 0.89; and exhaustion: OR=0.66, 95% CI: 0.45 to 0.98) and less work-family conflicts (feeling guilty towards family: OR=0.51, 95% CI: 0.35 to 0.74; and complaints from family: OR=0.66, 95% CI: 0.47 to 0.91). We found no obvious association between DT/OS experience with patient-centred care. CONCLUSIONS Physicians with DT and OS experiences are more likely to have better work performance and less work-family conflict than those without such experience. Physicians face increasing pressure to pursue continuing education and experience associated distress. Therefore, hospitals and government policy-makers should promote DT and OS.
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Affiliation(s)
- Xiaoyu Wang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hua Qin
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yimei Zhu
- Department of Media and Communication, University of Leicester, Leicester, UK
| | - Zixin Wang
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Beizhu Ye
- Department of Social Medicine and Health Management, School of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Xi Zhu
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Yuan Liang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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13
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Wagner EA, Jansen JH, DeLuna H, Anderson K, Doehring MC, Welch JL. Flexibility in Faculty Work-Life Policies at Medical Schools in the Big Ten Conference: A Ten-Year Follow-up Study. WOMEN'S HEALTH REPORTS 2022; 3:67-77. [PMID: 35199103 PMCID: PMC8855991 DOI: 10.1089/whr.2021.0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 12/22/2021] [Indexed: 11/24/2022]
Abstract
Background: Flexible work-life policies for medical school faculty are necessary to support career progress, advancement, retention, and job satisfaction. Objective: Our objective was to perform a 10-year follow-up descriptive assessment of the availability of flexible work-life policies for faculty in medical schools in the Big Ten Conference. Design: In this descriptive study, a modified objective scoring system was used to evaluate the flexibility of faculty work-life policies at 13 medical schools in the Big Ten Conference. Policy information was obtained from institutional websites and verified with the human resources offices. Scores from the 2011 study and 2020 were compared. Results: Michigan State and Ohio State Universities offered the most flexible policies (score 17.75/22) with the Universities of Maryland and Minnesota following (score 16/22). The largest delta scores, indicating more flexible policies in the past decade, were at University of Minnesota (5.25) and University of Michigan (5). Policies for parental leave and part-time faculty varied widely. Most schools earned an additional point in the newly added category of “flexible scheduling and return-to-work policies.” Nearly every institution reported dedicated lactation spaces and improved childcare options. Limitations: Limitations included missing policy data and interpretation bias in reviewing the policy websites, unavailable baseline data for schools that joined the Big Ten after the 2011 study, and unavailable baseline data for the additional category of return-to-work policies. Conclusions: While progress has been made, every institution should challenge themselves to review flexibility in work-life policies for faculty. It is important to advance a healthy competition with the goal to achieve more forward-thinking policies that improve retention, recruitment, and advancement of faculty. Big Ten institutions can continue to advance their policies by providing greater ease of access to options, further expansion of parental leave and childcare support, and offering more flexible policies for part-time faculty.
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Affiliation(s)
- Emily A. Wagner
- Department of Emergency Medicine, Regions Hospital, HealthPartners; Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jaclyn H. Jansen
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Cincinatti, OH, USA
| | - Hannah DeLuna
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Katherine Anderson
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Marla C. Doehring
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Julie L. Welch
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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14
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Poplau S, Linzer M, Allwood D, Montori V, Armbruster R, Koka S. Designing the careful and kind clinic: an evidence-based approach. BMJ LEADER 2021; 6:87-91. [DOI: 10.1136/leader-2021-000538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 11/28/2021] [Indexed: 11/04/2022]
Abstract
BackgroundThere is evidence that creating a ‘healthy workplace’ can be of profound importance for clinicians, team members and patients. Yet there have been few papers that have proposed mechanisms to take decades of research and translate this into a practical list of options for leaders and managers to take into account when structuring a clinic based on care and kindness to achieve optimal health.EvidenceWe bring together 20 years of scholarship linking care of the caregivers with outcomes for caregivers and patients. The data are used to support both structures and cultures that will result in satisfied and thriving healthcare team members, as well as satisfied and healthy patients.ResultsThe clinic based on care of the caregivers will be structured to address key aspects of worklife that are known to cause either satisfaction or burnout. Aspects of care, such as time pressure, chaotic environments and worker control of their workplace, will be taken into account in clinical design; organisational culture will be supportive and cohesive, emphasising quality, values and communication. Experiences based on gender and race will be measured and continuously improved; and performance will be evaluated in a new, human-centred manner.OutcomesThe careful and kind clinic will be a remarkable place to work; in contrast to industrialised healthcare, this will be an environment where health can indeed be optimised, for both workers and patients.
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15
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Kato H, Jena AB, Figueroa JF, Tsugawa Y. Association Between Physician Part-time Clinical Work and Patient Outcomes. JAMA Intern Med 2021; 181:1461-1469. [PMID: 34515730 PMCID: PMC8438618 DOI: 10.1001/jamainternmed.2021.5247] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Despite the growing number of physicians who reduce clinical time owing to research, administrative work, and family responsibilities, the quality of care provided by these physicians remains unclear. OBJECTIVE To examine the association between the number of days worked clinically per year by physicians and patient mortality. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional analysis was completed on a 20% random sample of Medicare fee-for-service beneficiaries 65 years and older who were admitted to the hospital with an emergency medical condition and treated by a hospitalist in 2011 through 2016. Because hospitalists typically work in shifts, hospitalists' patients are plausibly quasirandomized to hospitalists based on the hospitalists' work schedules (natural experiment). The associations between hospitalists' number of days worked clinically per year and 30-day patient mortality and readmission rates were examined, adjusting for patient and physician characteristics and hospital fixed effects (effectively comparing physicians within the same hospital). Data analysis was conducted from July 1, 2020, to July 2, 2021. EXPOSURES Physicians' number of days worked clinically per year. MAIN OUTCOMES AND MEASURES The primary outcome was 30-day patient mortality, and the secondary outcome was 30-day patient readmission. RESULTS Among 392 797 hospitalizations of patients treated by 19 170 hospitalists (7482 female [39.0%], 11 688 male [61.0%]; mean [SD] age, 41.1 [8.8] years), patients treated by physicians with more days worked clinically exhibited lower mortality. Adjusted 30-day mortality rates were 10.5% (reference), 10.0% (adjusted risk difference [aRD], -0.5%; 95% CI, -0.8% to -0.2%; P = .002), 9.5% (aRD, -0.9%; 95% CI, -1.2% to -0.6%; P < .001), and 9.6% (aRD, -0.9%; 95% CI, -1.2% to -0.6%; P < .001) for physicians in the first (bottom), second, third, and fourth (top) quartile of days worked clinically, respectively. Readmission rates were not associated with the numbers of days a physician worked clinically (adjusted 30-day readmissions for physicians in the bottom quartile of days worked clinically per year vs those in the top quartile, 15.3% vs 15.2%; aRD, -0.1%; 95% CI, -0.5% to 0.3%; P = .61). CONCLUSIONS AND RELEVANCE In this cross-sectional study, hospitalized Medicare patients treated by physicians who worked more clinical days had lower 30-day mortality. Given that physicians with reduced clinical time must often balance clinical and nonclinical obligations, improved support by institutions may be necessary to maintain the clinical performance of these physicians.
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Affiliation(s)
- Hirotaka Kato
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles.,Graduate School of Business Administration, Keio University, Yokohama, Japan.,Graduate School of Health Management, Keio University, Tokyo, Japan
| | - Anupam B Jena
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.,Department of Medicine, Massachusetts General Hospital, Boston.,National Bureau of Economic Research, Cambridge, Massachusetts
| | - Jose F Figueroa
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles.,Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles
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16
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Hsiung KS, Colditz JB, McGuier EA, Switzer GE, VonVille HM, Folb BL, Kolko DJ. Measures of Organizational Culture and Climate in Primary Care: a Systematic Review. J Gen Intern Med 2021; 36:487-499. [PMID: 33140272 PMCID: PMC7878641 DOI: 10.1007/s11606-020-06262-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/21/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Primary care is increasingly contributing to improving the quality of patient care. This has imposed significant demands on clinicians with rising needs and limited resources. Organizational culture and climate have been found to be crucial in improving workforce well-being and hence quality of care. The objectives of this study are to identify organizational culture and climate measures used in primary care from 2008 to 2019 and evaluate their psychometric properties. METHODS Data sources include PubMed, PsycINFO, HAPI, CINAHL, and Mental Measurements Yearbook. Bibliographies of relevant articles were reviewed and a cited reference search in Scopus was performed. Eligibility criteria include primary health care professionals, primary care settings, and use of measures representing the general concept of organizational culture and climate. Consensus-Based Standards for the selection of health Measurement Instruments (COSMIN) guidelines were followed to evaluate individual studies for methodological quality, rate results of measurement properties, qualitatively pool studies by measure, and grade evidence. RESULTS Of 1745 initial studies, 42 studies met key study inclusion criteria, with 27 measures available for review (16 for organizational culture, 11 for organizational climate). There was considerable variability in measures, both conceptually and in psychometric quality. Many reported limited or no psychometric information. DISCUSSION Notable measures selected for frequent use and strength and applicability of measurement properties include the Culture Questionnaire adapted for health care settings, Practice Culture Assessment, and Medical Group Practice Culture Assessment for organizational culture. Notable climate measures include the Nurse Practitioner Primary Care Organizational Climate Questionnaire, Practice Climate Survey, and Task and Relational Climate Scale. This synthesis and appraisal of organizational culture and climate measures can help investigators make informed decisions in choosing a measure or deciding to develop a new one. In terms of limitations, ratings should be considered conservative due to adaptations of the COSMIN protocol for clinician populations. PROSPERO REGISTRATION NUMBER CRD 42019133117.
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Affiliation(s)
- Kimberly S Hsiung
- University of Pittsburgh School of Medicine, , Pittsburgh, PA, USA.
- Clinical and Translational Science Institute, University of Pittsburgh, , Pittsburgh, PA, USA.
| | - Jason B Colditz
- University of Pittsburgh School of Medicine, , Pittsburgh, PA, USA
| | | | - Galen E Switzer
- Department of Medicine, University of Pittsburgh, , Pittsburgh, PA, USA
- Center for Health Equity Research and Promotion (CHERP), Veterans Affairs Pittsburgh Healthcare System, , Pittsburgh, PA, USA
| | - Helena M VonVille
- Health Sciences Library System, University of Pittsburgh, , Pittsburgh, PA, USA
| | - Barbara L Folb
- Health Sciences Library System, University of Pittsburgh, , Pittsburgh, PA, USA
| | - David J Kolko
- University of Pittsburgh School of Medicine, , Pittsburgh, PA, USA
- UPMC Western Psychiatric Hospital, , Pittsburgh, PA, USA
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17
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Tekeli-Yesil S, Kiran S. A neglected issue in hospital emergency and disaster planning: Non-standard employment in hospitals. INTERNATIONAL JOURNAL OF DISASTER RISK REDUCTION : IJDRR 2020; 51:101823. [PMID: 32868987 PMCID: PMC7449888 DOI: 10.1016/j.ijdrr.2020.101823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/18/2020] [Accepted: 08/18/2020] [Indexed: 06/11/2023]
Abstract
Work organization and relationships have changed over recent decades. Following the recent COVID-19 pandemic, the norms concerning work-related standards will likely change even more significantly. There has been a shift away from standard employment to non-standard employment (NSE), which includes fixed-term, part-time, on-call, agency-related employment, dependent self-employment, dispatch, and temporary employment, etc. In nearly every sector. The health sector is no exception. However, the effects of non-standard employment on the disaster preparedness of health systems, particularly on hospitals' emergency and disaster plans, have not yet been adequately studied. Most crucial themes are engagement of non-standard employees in emergency and disaster planning and response, and the impact of non-standard employees in expanding hospitals' capacity in large-scale events. This short communication paper aims to discuss this neglected issue in hospital emergency and disaster planning. In order to see whether NSE is considered in hospital disaster and emergency plans, two hospital disaster and emergency planning guidelines-the Hospital Incident Command System, and the Hospital Emergency Response Checklist developed by the World Health Organization-were assessed regarding NSE in their respective contexts. Although these guidelines are comprehensive tools for hospital preparedness, NSE is not specifically considered in any of them. However, it is essential that NSE, with its trade-offs, is considered in disaster plans to maintain an effective implementation of them. Further research and actions are necessary, especially after the COVID-19 pandemic, to identify how this reflection should be conducted and to supply evidence for further measures and revising emergency and disaster planning guidelines.
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Affiliation(s)
| | - Sibel Kiran
- Department of Occupational Health and Safety, Institute of Public Health, Hacettepe University, Ankara, Turkey
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18
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Montañez-Hernández JC, Alcalde-Rabanal JE, Nigenda-López GH, Aristizábal-Hoyos GP, Dini L. Gender inequality in the health workforce in the midst of achieving universal health coverage in Mexico. HUMAN RESOURCES FOR HEALTH 2020; 18:40. [PMID: 32471421 PMCID: PMC7260833 DOI: 10.1186/s12960-020-00481-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 05/19/2020] [Indexed: 05/12/2023]
Abstract
BACKGROUND The third Sustainable Development Goal aims to ensure healthy lives and to promote well-being for all at all ages. The health system plays a key role in achieving these goals and must have sufficient human resources in order to provide care to the population according to their needs and expectations. METHODS This paper explores the issues of unemployment, underemployment, and labor wastage in physicians and nurses in Mexico, all of which serve as barriers to achieving universal health coverage. We conducted a descriptive, observational, and longitudinal study to analyze the rates of employment, underemployment, unemployment, and labor wastage during the period 2005-2017 by gender. We used data from the National Occupation and Employment Survey. Calculating the average annual rates (AAR) for the period, we describe trends of the calculated rates. In addition, for 2017, we calculated health workforce densities for each of the 32 Mexican states and estimated the gaps with respect to the threshold of 4.45 health workers per 1000 inhabitants, as proposed in the Global Strategy on Human Resources for Health. RESULTS The AAR of employed female physicians was lower than men, and the AARs of qualitative underemployment, unemployment, and labor wastage for female physicians are higher than those of men. Female nurses, however, had a higher AAR in employment than male nurses and a lower AAR of qualitative underemployment and unemployment rates. Both female physicians and nurses showed a higher AAR in labor wastage rates than men. The density of health workers per 1000 inhabitants employed in the health sector was 4.20, and the estimated deficit of workers needed to match the threshold proposed in the Global Strategy is 70 161 workers distributed among the 16 states that do not reach the threshold. CONCLUSIONS We provide evidence of the existence of gender gaps among physicians and nurses in the labor market with evident disadvantages for female physicians, particularly in labor wastage. In addition, our results suggest that the lack of physicians and nurses working in the health sector contributes to the inability to reach the health worker density threshold proposed by the Global Strategy.
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Affiliation(s)
| | | | - Gustavo Humberto Nigenda-López
- National School of Nursing and Obstetrics, National Autonomous University of Mexico, Camino Viejo a Xochimilco y Viaducto Tlalpan, Huipulco, 14370, Mexico City, Mexico
| | - Gladis Patricia Aristizábal-Hoyos
- National Autonomous University of Mexico, Av. De Los Barrios 1, Hab. Los Reyes Ixtacala Barrio de los Árboles/Barrio de los Héroes, 54090, Tlalnepantla de Baz, State of Mexico, Mexico
| | - Lorena Dini
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Allgemeinmedizin, Charitéplatz 1, 10117, Berlin, Germany
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19
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Carrieri D, Pearson M, Mattick K, Papoutsi C, Briscoe S, Wong G, Jackson M. Interventions to minimise doctors’ mental ill-health and its impacts on the workforce and patient care: the Care Under Pressure realist review. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
The growing incidence of mental ill-health in health professionals, including doctors, is a global concern. Although a large body of literature exists on interventions that offer support, advice and/or treatment to sick doctors, it has not yet been synthesised in a way that takes account of the complexity and heterogeneity of the interventions, and the many dimensions (e.g. individual, organisational, sociocultural) of the problem.
Objectives
Our aim was to improve understanding of how, why and in what contexts mental health services and support interventions can be designed to minimise the incidence of doctors’ mental ill-health. The objectives were to review interventions to tackle doctors’ mental ill-health and its impact on the clinical workforce and patient care, drawing on diverse literature sources and engaging iteratively with diverse stakeholder perspectives to produce actionable theory; and recommendations that support the tailoring, implementation, monitoring and evaluation of contextually sensitive strategies to tackle mental ill-health and its impacts.
Design
Realist literature review consistent with the Realist And Meta-narrative Evidence Syntheses: Evolving Standards quality and reporting standards.
Data sources
Bibliographic database searches were developed and conducted using MEDLINE (1946 to November week 4 2017), MEDLINE In-Process and Other Non-indexed Citations (1946 to 6 December 2017) and PsycINFO (1806 to November week 2 2017) (all via Ovid) and Applied Social Sciences Index and Abstracts (1987 to 6 December 2017) (via ProQuest) on 6 December 2017. Further UK-based studies were identified by forwards and author citation searches, manual backwards citation searching and hand-searching relevant journal websites.
Review methods
We included all studies that focused on mental ill-health; all study designs; all health-care settings; all studies that included medical doctors/medical students; descriptions of interventions or resources that focus on improving mental ill-health and minimising its impacts; all mental health outcome measures, including absenteeism (doctors taking short-/long-term sick leave); presenteeism (doctors working despite being unwell); and workforce retention (doctors leaving the profession temporarily/permanently). Data were extracted from included articles and the data set was subjected to realist analysis to identify context–mechanism–outcome configurations.
Results
A total of 179 out of 3069 records were included. Most were from the USA (45%) and had been published since 2009 (74%). More included articles focused on structural-level interventions (33%) than individual-level interventions (21%), but most articles (46%) considered both levels. Most interventions focused on prevention, rather than treatment/screening, and most studies referred to doctors/physicians in general, rather than to specific specialties or career stages. Nineteen per cent of the included sources provided cost information and none reported a health economic analysis. The 19 context–mechanism–outcome configurations demonstrated that doctors were more likely to experience mental ill-health when they felt isolated or unable to do their job, and when they feared repercussions of help-seeking. Healthy staff were necessary for excellent patient care. Interventions emphasising relationships and belonging were more likely to promote well-being. Interventions creating a people-focused working culture, balancing positive/negative performance and acknowledging positive/negative aspects of a medical career helped doctors to thrive. The way that interventions were implemented seemed critically important. Doctors needed to have confidence in an intervention for the intervention to be effective.
Limitations
Variable quality of included literature; limited UK-based studies.
Future work
Use this evidence synthesis to refine, implement and evaluate interventions.
Study registration
This study is registered as PROSPERO CRD42017069870.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 19. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Daniele Carrieri
- College of Medicine and Health, University of Exeter, Exeter, UK
- Wellcome Centre for Cultures and Environments of Health, University of Exeter, Exeter, UK
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, Faculty of Health Sciences, University of Hull, Hull, UK
| | - Karen Mattick
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Simon Briscoe
- Exeter HSDR Evidence Synthesis Centre, Institute of Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mark Jackson
- Wellcome Centre for Cultures and Environments of Health, University of Exeter, Exeter, UK
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20
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Olson K, Marchalik D, Farley H, Dean SM, Lawrence EC, Hamidi MS, Rowe S, McCool JM, O'Donovan CA, Micek MA, Stewart MT. Organizational strategies to reduce physician burnout and improve professional fulfillment. Curr Probl Pediatr Adolesc Health Care 2019; 49:100664. [PMID: 31588019 DOI: 10.1016/j.cppeds.2019.100664] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Burnout is highly prevalent among physicians and has been associated with negative outcomes for physicians, patients, staff, and health-care organizations. Reducing physician burnout and increasing physician well-being is a priority. Systematic reviews suggest that organization-based interventions are more effective in reducing physician burnout than interventions targeted at individual physicians. This consensus review by leaders in the field across multiple institutions presents emerging trends and exemplary evidence-based strategies to improve professional fulfillment and reduce physician burnout using Stanford's tripartite model of physician professional fulfillment as an organizing framework: practice efficiency, culture, and personal resilience to support physician well-being. These strategies include leadership traits, latitude of control and autonomy, collegiality, diversity, teamwork, top-of-license workflows, electronic health record (EHR) usability, peer support, confidential mental health services, work-life integration and reducing barriers to practicing a healthy lifestyle. The review concludes with evidence-based recommendations on establishing an effective physician wellness program.
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Affiliation(s)
- Kristine Olson
- Yale School of Medicine, Yale New Haven Health, 20 York Street, New Haven, CT 06510, United States.
| | - Daniel Marchalik
- Medstar Health, Georgetown University School of Medicine, Washington, DC, United States
| | - Heather Farley
- Christiana Care Health System, Sidney Kimmel Medical College at Thomas Jefferson University, Wilmington, DE, United States
| | - Shannon M Dean
- University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | | | - Maryam S Hamidi
- Department of Psychiatry and Behavioral Sciences, Stanford Medicine WellMD Center, Stanford University, Stanford, CA, United States
| | - Susannah Rowe
- Boston Medical Center, Boston University School of Medicine, Boston, MA, United States
| | - Joanne M McCool
- The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | | | - Mark A Micek
- University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Miriam T Stewart
- The Children's Hospital of Philadelphia, Philadelphia, PA, United States
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22
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Sharp KL, Whitaker-Worth D. Burnout of the female dermatologist: How traditional burnout reduction strategies have failed women. Int J Womens Dermatol 2019; 6:32-33. [PMID: 32025558 PMCID: PMC6997828 DOI: 10.1016/j.ijwd.2019.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 08/05/2019] [Accepted: 08/11/2019] [Indexed: 11/16/2022] Open
Abstract
Dermatology is known as specialty that traditionally exhibits high levels of professional satisfaction, largely attributed to regular clinic hours and a lack of in-house call. Yet, the 2018 Medscape Dermatologist Lifestyle Survey showed that nearly one-third of dermatologists either currently experience or have experienced burnout during their careers. Although male and female dermatologists report similar burnout rates, 36% of female dermatologists reportedly work part-time compared with 14% of male dermatologists. The fact that female and male dermatologists experience similar rates of burnout even though women are more likely to work part-time suggests that female dermatologists might have additional or unique reasons for experiencing burnout compared with their male counterparts. Women in dermatology likely experience burnout, at least in part, as a result of stress from the demands of life outside of work. However, despite increasing interest in the development of burnout prevention strategies, efforts to reduce burnout have so far failed to acknowledge or address the unique reasons why female dermatologists may experience burnout. This article aims to better characterize causes of burnout that may disproportionately contribute to female burnout and to provide actionable steps to address burnout in female dermatologists.
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Affiliation(s)
- Kelley L Sharp
- University of Hartford, West Hartford, CT, United States
| | - Diane Whitaker-Worth
- University of Connecticut Health Center, Dermatology Department, Farmington, CT, United States
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Tran B, Lenhart A, Ross R, Dorr DA. Burnout and EHR use among academic primary care physicians with varied clinical workloads. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE PROCEEDINGS. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE 2019; 2019:136-144. [PMID: 31258965 PMCID: PMC6568076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Burnout is becoming increasingly prevalent among primary care physicians. Recent studies have attributed electronic health record (EHR) related tasks as a potential source of physician burnout. In this cross-sectional study, EHR use was compared to self-reported burnout for 107 faculty physicians at 10 university-affiliated primary care clinics. Physicians who self-reported burnout spent more time managing their inbox and in the EHR after hours. Burnout was associated with lower rates of same day chart closure, longer completion time for inbox messages, and more incomplete messages. Burnout, while related to overall workload, had a complex relationship with EHR use, which was influenced by but could not wholly explained by clinical workload. Our results suggest that burnout is less prevalent with less allocated clinical time, however, more research is necessary to identify the optimal balance between clinical duties and academic pursuits. Segmenting providers based on relative workload to determine variation within similar groups may help optimize EHR use.
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Affiliation(s)
- Brian Tran
- Oregon Health & Science University, Portland, Oregon, USA
| | | | - Rachel Ross
- Oregon Health & Science University, Portland, Oregon, USA
| | - David A Dorr
- Oregon Health & Science University, Portland, Oregon, USA
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Olson K, Sinsky C, Rinne ST, Long T, Vender R, Mukherjee S, Bennick M, Linzer M. Cross-sectional survey of workplace stressors associated with physician burnout measured by the Mini-Z and the Maslach Burnout Inventory. Stress Health 2019; 35:157-175. [PMID: 30467949 DOI: 10.1002/smi.2849] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 10/16/2018] [Accepted: 11/13/2018] [Indexed: 11/12/2022]
Abstract
Rising physician burnout has adverse effects on healthcare. This study aimed to identify remediable stressors associated with burnout using the 10-item Mini-Z and the Maslach Burnout Inventory (MBI), and to compare performance of the Mini-Z's single-item burnout metric against the 22-item MBI. Surveys were emailed to 4,118 clinicians affiliated with an academic health system; 1,252 clicked the link, and 557 responded (completion rate 44%). Four hundred seventy-five practicing physicians were included: academic faculty (372), hospital employed (52), and private practitioners (81). Prevalence of burnout via the MBI was 56.6%. Predictors of burnout were poor control over workload [OR = 8.24, 95% CI 4.(81, 14.11)], inefficient teamwork [OR = 7.61, 95% (CI 3.28, 17.67)], insufficient documentation time [OR = 5.83, 95% (CI 3.35, 10.15)], hectic-chaotic work atmosphere [OR = 3.49, 95% (CI 2.12, 5.74)], lack of value-alignment with leadership [OR = 3.27, 95% (CI 2.12, 5.74)], and excessive electronic medical record time at home [OR = 1.99, 95% CI (1.21, 3.27)]. Academic faculty experienced more burnout than private practitioners (59.9% vs. 42.0%, p = 0.013). Odds of burnout associated with stressors were generally concordant via Mini-Z's burnout metric versus the MBI. The Mini-Z is a brief, valid method to identify stressors associated with burnout and guide interventions.
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Affiliation(s)
- Kristine Olson
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Christine Sinsky
- Professional Satisfaction, American Medical Association, Chicago, Illinois, USA
| | - Seppo T Rinne
- Department of Internal Medicine, Center for Healthcare Organization & Implementation Research, Veterans Affairs, Bedford, Massachusetts, USA
| | - Theodore Long
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ronald Vender
- Associate Dean of Clinical Affairs, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sandip Mukherjee
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael Bennick
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mark Linzer
- Department of Medicine, Hennepin Healthcare System, University of Minnesota, and Minneapolis Medical Research Foundation, Minneapolis, Minnesota, USA
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Jackson TN, Morgan JP, Jackson DL, Cook TR, McLean K, Agrawal V, Taubman KE, Truitt MS. The Crossroads of Posttraumatic Stress Disorder and Physician Burnout: A National Review of United States Trauma and Nontrauma Surgeons. Am Surg 2019. [DOI: 10.1177/000313481908500217] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Posttraumatic stress disorder (PTSD) among trauma surgeons is three times that of the general population, and physician burnout (PBO) among surgeons is rising. Given that PTSD and PBO are both stress-based syndromes, we aim to identify the prevalence and risk factors for PTSD among trauma and nontrauma surgeons, and determine if a relationship exists. A cross-sectional survey of surgeons was conducted between September 2016 and May 2017. Respondents were screened for PTSD and PBO. Traumatic stressors were identified, and 20 potential risk factors were assessed. The respondents (n = 1026) were grouped into trauma (n = 350) and nontrauma (n = 676). Between the cohorts, there was no significant difference in prevalence of screening positive for PTSD (17% vs 15%) or PBO (30% vs 25%). A relationship was found between PTSD and PBO (P < 0.001). The most common traumatic stressor was overwhelming work responsibilities. Potential risk factors for PTSD differed, but overlapping risk factors included hospital culture, hospital support, and salary (P < 0.05). Our findings of an association between PTSD and PBO is concerning. Interventions to reduce rates of PTSD should target changing the existing culture of surgery, improving hospital support, and ensuring equitable pay.
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Affiliation(s)
| | - Jake P. Morgan
- Department of Graduate Medical Education, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | | | - Taylor R. Cook
- Department of Graduate Medical Education, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Kevin McLean
- Department of Graduate Medical Education, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Vaidehi Agrawal
- Department of Graduate Medical Education, Methodist Dallas Medical Center, Dallas, Texas
| | - Kevin E. Taubman
- Department of Surgery, University of Oklahoma Tulsa, Tulsa, Oklahoma
| | - Michael S. Truitt
- Department of Graduate Medical Education, Methodist Dallas Medical Center, Dallas, Texas
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Heuser CC, Gibbins KJ, Herrera CA, Theilen LH, Holmgren CM. Moms in medicine: Job satisfaction among physician-mothers in obstetrics and gynecology. Work 2019; 60:201-207. [PMID: 29865100 DOI: 10.3233/wor-182734] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Physician satisfaction is linked to positive patient outcomes. Mothers form an increasing fraction of the obstetrics and gynecology (ob/gyn) workforce. OBJECTIVE Define factors that affect physician satisfaction among ob/gyn physicians who are also mothers. METHODS We constructed and validated a Redcap survey and invited members of online ob/gyn-mom groups to participate. Characteristics of participants' professional and personal lives were evaluated for possible association with the satisfaction outcomes. Comparison testing was performed using Chi-squared test or Fisher's exact test for categorical variables, Student's t-test for parametric variables, and Wilcoxon Rank-Sum test for non-parametric variables. RESULTS Responses were received from 232 participants. A majority reported being unsatisfied with their time to spend with children (66%), partner (70%), and on personal hobbies/activites (75%). Eighty-percent rate professional morale as very/somewhat positive. Women who rated their morale as very/somewhat positive worked fewer hours per week than women with neutral/negative responses (43.6 vs 49.7, p = 0.01). Women with positive morale were also less likely to work over 50 h/week (39.5% vs 56.8%, p = 0.04). CONCLUSIONS Ob/gyn physician-mothers have high professional morale but are dissatisfied with time for extra-professional activities. Longer clinical hours correlate with dissatisfaction based on several measurements.
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Affiliation(s)
- Cara C Heuser
- Department of Maternal-Fetal Medicine, Intermountain Healthcare, Murray, UT, USA.,University of Utah, Division of Maternal Fetal Medicine, Salt Lake City, UT, USA
| | - Karen J Gibbins
- University of Utah, Division of Maternal Fetal Medicine, Salt Lake City, UT, USA
| | - Christina A Herrera
- University of Utah, Division of Maternal Fetal Medicine, Salt Lake City, UT, USA
| | - Lauren H Theilen
- University of Utah, Division of Maternal Fetal Medicine, Salt Lake City, UT, USA
| | - Calla M Holmgren
- Department of Maternal-Fetal Medicine, Intermountain Healthcare, Murray, UT, USA.,University of Utah, Division of Maternal Fetal Medicine, Salt Lake City, UT, USA
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Part-Time Pediatric Radiology: The Realities and Perceptions of Part-Time Employment in the Academic Setting. AJR Am J Roentgenol 2018; 211:971-977. [DOI: 10.2214/ajr.18.19922] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Pericin I, Mansfield G, Larkin J, Collins C. Future career intentions of recent GP graduates in Ireland: a trend analysis study. BJGP Open 2018; 2:bjgpopen18X101409. [PMID: 30564707 PMCID: PMC6181082 DOI: 10.3399/bjgpopen18x101409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 12/14/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND A lack of manpower and negative health statistics have increased the workload for Irish GPs. Consequently, recent GP graduates are considering emigration or part-time employment. AIM To report on trends of the current status and future work intentions of recent GP graduates in Ireland. DESIGN & SETTING Quantitative study based on online surveys in the Irish setting. METHOD A 'career intentions' survey was emailed to all recent GP graduates in Ireland, in 2014, 2015, and 2017. The data presented includes GPs who graduated in the previous 4 years at each survey time point. The average response rate across the three surveys was 38.2%. RESULTS The number of graduates who had already emigrated increased over the survey years, accounted for 16.9% in 2014, 17.4% in 2015, and 19.2% in 2017 survey. The majority of doctors who emigrated did so in the first 2 years after graduation (74.7%). 'Quality of life' became the most frequent reason for emigration over the survey years, accounting for 32.0% in the 2017 survey. In the 2014 survey, 47.3% of graduates stated that they intend to work part-time in 5 years; this rose to 51.2% in 2015, reaching 60.0% in 2017. Female participants were more than twice as likely to plan to work part time in 5 years compared to their male colleagues, across all three surveys. CONCLUSION The first and second years after graduation were the most critical for emigration. Interventions in this period may reduce the 'brain drain' of Irish GPs. Part-time working is becoming more attractive and should be considered in future workforce planning.
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Affiliation(s)
- Ivana Pericin
- Research Assistant, Research Department, Irish College of General Practitioners, Dublin, Ireland
| | | | - James Larkin
- Research Assistant, Research Department, Irish College of General Practitioners, Dublin, Ireland
| | - Claire Collins
- Director of Research, Research Department, Irish College of General Practitioners, Dublin, Ireland
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Rimsza ME, Ruch-Ross H, Simon HK, Pendergass TW, Mulvey HJ. Factors Influencing Pediatrician Retirement: A Survey of American Academy of Pediatrics Chapter Members. J Pediatr 2017; 188:275-279. [PMID: 28606370 DOI: 10.1016/j.jpeds.2017.05.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 04/26/2017] [Accepted: 05/15/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To assess the factors that may influence physicians' desire to retire through an analysis of data collected through the American Academy of Pediatrics (AAP) State Pediatrician Workforce Survey. STUDY DESIGN An electronic survey was sent to retired and nonretired US pediatricians who held AAP membership. The respondents were asked about the importance of 12 factors that would influence or had influenced their decision to retire. The physicians who were not yet retired also were asked: "If you could afford to today, would you retire from medicine?" RESULTS The survey was completed by 8867 pediatricians. Among the nonretired respondents, 27% reported that they would retire today if it were affordable. Increasing regulation of medicine, decreasing clinical autonomy, and insufficient reimbursement were rated as very important factors by >50% of these pediatricians. Among retired pediatricians, 26.9% identified the effort to keep up with clinical advances and changes in practice as a very important factor in their decision to retire. Younger physicians were significantly more likely to rate maintenance of certification requirements, insufficient reimbursement, lack of professional satisfaction, and family responsibilities as very important factors. Rural pediatricians were more interested in retiring than those working in academic settings. There were no sex differences. CONCLUSIONS Twenty-seven percent of pediatricians in practice today would retire today if it were affordable. Identifying and addressing the important factors that influence a pediatrician's desire to retire can potentially reduce the retirement rate of pediatricians and thus increase access to care for children.
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Affiliation(s)
- Mary E Rimsza
- Division of Workforce & Medical Education Policy, American Academy of Pediatrics, Elk Grove Village, IL.
| | - Holly Ruch-Ross
- Division of Workforce & Medical Education Policy, American Academy of Pediatrics, Elk Grove Village, IL
| | - Harold K Simon
- Departments of Pediatrics and Emergency Medicine, Emory University School of Medicine, and Childrens Healthcare of Atlanta, Atlanta, GA
| | | | - Holly J Mulvey
- Division of Workforce & Medical Education Policy, American Academy of Pediatrics, Elk Grove Village, IL
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Milner A, Witt K, Spittal MJ, Bismark M, Graham M, LaMontagne AD. The relationship between working conditions and self-rated health among medical doctors: evidence from seven waves of the Medicine In Australia Balancing Employment and Life (Mabel) survey. BMC Health Serv Res 2017; 17:609. [PMID: 28851354 PMCID: PMC5576303 DOI: 10.1186/s12913-017-2554-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/16/2017] [Indexed: 11/10/2022] Open
Abstract
Background Psychosocial job stressors, such as low control and high demands, have been found to influence the health and wellbeing of doctors. However, past research in this area has relied on cross-sectional data, which limits causal inferences about the influence of psychosocial job stressors on health. In this study, we examine this relationship longitudinally while also assessing whether the relationship between psychosocial job stressors and health is modified by gender. Methods The data source was seven annual waves of the Medicine in Australia: Balancing Employment and Life (MABEL) survey. The outcome was self-rated health (measured using the SF-12), and key exposures reflected job control, job demands, work-life balance variables, employment arrangements, and aggression experienced at work. We used longitudinal fixed and random effects regression models to assess within and between-person changes in health. Results Excessive job demands, low job control, feelings of not being rewarded at work, and work-life imbalance were associated with higher within-person odds of poorer self-rated health. Gender differences were apparent. For female doctors, work arrangements and work-life imbalance were associated with poorer self-rated health whilst task-based job stressors were associated with poorer self-rated health in male doctors. Conclusions These results suggest the importance of addressing adverse working environments among doctors. Trial registration Not applicable. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2554-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Allison Milner
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Melbourne, 3010, Australia. .,Work, Health and Wellbeing Unit, Population Health Research Centre, School of Health & Social Development, Deakin University, Melbourne, Australia.
| | - Katrina Witt
- Turning Point, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Matthew J Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Marie Bismark
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Melissa Graham
- Centre for Health through Action on Social Exclusion, School of Health and Social development, Deakin University, Melbourne, Australia
| | - Anthony D LaMontagne
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Melbourne, 3010, Australia.,Work, Health and Wellbeing Unit, Population Health Research Centre, School of Health & Social Development, Deakin University, Melbourne, Australia
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Tsai MH, Muller IR, Stelzer SR, Urman RD, Adams DC. Antifragile Systems and Physician Wellness. Anesth Analg 2017; 125:1056-1059. [PMID: 28753172 DOI: 10.1213/ane.0000000000002328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Mitchell H Tsai
- From the *Department of Anesthesiology and †Department of Orthopaedics and Rehabilitation (by courtesy), University of Vermont College of Medicine, Burlington, Vermont; and ‡Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Schmit Jongbloed LJ, Cohen-Schotanus J, Borleffs JCC, Stewart RE, Schönrock-Adema J. Physician job satisfaction related to actual and preferred job size. BMC MEDICAL EDUCATION 2017; 17:86. [PMID: 28494758 PMCID: PMC5425993 DOI: 10.1186/s12909-017-0911-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 04/20/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Job satisfaction is essential for physicians' well-being and patient care. The work ethic of long days and hard work that has been advocated for decades is acknowledged as a threat for physicians' job satisfaction, well-being, and patient safety. Our aim was to determine the actual and preferred job size of physicians and to investigate how these and the differences between them influence physicians' job satisfaction. METHOD Data were retrieved from a larger, longitudinal study among physicians starting medical training at Groningen University in 1982/83/92/93 (N = 597). Data from 506 participants (85%) were available for this study. We used regression analysis to investigate the influence of job size on physicians' job satisfaction (13 aspects) and ANOVA to examine differences in job satisfaction between physicians wishing to retain, reduce or increase job size. RESULTS The majority of the respondents (57%) had an actual job size less than 1.0 FTE. More than 80% of all respondents preferred not to work full-time in the future. Respondents' average actual and preferred job sizes were .85 FTE and .81 FTE, respectively. On average, respondents who wished to work less (35% of respondents) preferred a job size reduction of 0.18 FTE and those who wished to work more (12%) preferred an increase in job size of 0.16 FTE. Job size influenced satisfaction with balance work-private hours most (β = -.351). Physicians who preferred larger job sizes were - compared to the other groups of physicians - least satisfied with professional accomplishments. CONCLUSIONS A considerable group of physicians reported a gap between actual and preferred job size. Realizing physicians' preferences as to job size will hardly affect total workforce, but may greatly benefit individual physicians as well as their patients and society. Therefore, it seems time for a shift in work ethic.
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Affiliation(s)
- Lodewijk J. Schmit Jongbloed
- Schmit Jongbloed Advies, Hofbrouckerlaan 30, 2341 LP Oegstgeest, The Netherlands
- University Medical Center Groningen and University of Groningen, A. Deusinglaan 1, 9713, AV Groningen, The Netherlands
| | - Janke Cohen-Schotanus
- University Medical Center Groningen and University of Groningen, A. Deusinglaan 1, 9713, AV Groningen, The Netherlands
| | - Jan C. C. Borleffs
- University Medical Center Groningen and University of Groningen, A. Deusinglaan 1, 9713, AV Groningen, The Netherlands
| | - Roy E. Stewart
- University Medical Center Groningen and University of Groningen, A. Deusinglaan 1, 9713, AV Groningen, The Netherlands
| | - Johanna Schönrock-Adema
- University Medical Center Groningen and University of Groningen, A. Deusinglaan 1, 9713, AV Groningen, The Netherlands
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Chuang E, Brunner J, Mak S, Hamilton AB, Canelo I, Darling J, Rubenstein LV, Yano EM. Challenges with Implementing a Patient-Centered Medical Home Model for Women Veterans. Womens Health Issues 2017; 27:214-220. [PMID: 28063848 PMCID: PMC6824838 DOI: 10.1016/j.whi.2016.11.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/23/2016] [Accepted: 11/29/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Veterans Health Administration (VA) Patient Aligned Care Team (PACT) initiative aims to ensure that all patients receive care consistent with medical home principles. Women veterans' unique care needs and minority status within the VA pose challenges to delivery of equitable, comprehensive primary care for this population. Currently, little is known about whether and/or how PACT should be tailored to better meet women veterans' needs. METHODS In 2014, we conducted semistructured interviews with 73 primary care providers and staff to examine facilitators and barriers encountered in providing PACT-principled care to women veterans. Respondents were located in eight VA medical centers in eight different states across the United States. RESULTS Respondents perceived PACT as improving continuity of care for patients and as increasing ability of nursing staff to practice at the top of their license. However, the implementation of core medical home features and team huddles was inconsistent and varied both within and across medical centers. Short staffing, inclusion of part-time providers on teams, balancing performance requirements for continuity and same-day access, and space constraints were identified as ongoing barriers to PACT implementation. Challenges unique to care of women veterans included a higher prevalence of psychosocial needs, the need for specialized training of primary care personnel, and short staffing owing to additional sharing of primary care support staff with specialist providers. CONCLUSION Providers and staff face unique challenges in delivering comprehensive primary care to women veterans that may require special policy, practice, and management action if benefits of PACT are to be fully realized for this population.
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Affiliation(s)
- Emmeline Chuang
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California.
| | - Julian Brunner
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Selene Mak
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Alison B Hamilton
- HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Health Care System, Los Angeles, California
| | - Ismelda Canelo
- HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Health Care System, Los Angeles, California
| | - Jill Darling
- HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Health Care System, Los Angeles, California
| | - Lisa V Rubenstein
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California; HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Health Care System, Los Angeles, California
| | - Elizabeth M Yano
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California; HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Health Care System, Los Angeles, California
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Hlubocky FJ, Back AL, Shanafelt TD. Addressing Burnout in Oncology: Why Cancer Care Clinicians Are At Risk, What Individuals Can Do, and How Organizations Can Respond. Am Soc Clin Oncol Educ Book 2017; 35:271-9. [PMID: 27249706 DOI: 10.1200/edbk_156120] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Despite their benevolent care of others, today, more than ever, the cancer care professional who experiences overwhelming feelings of exhaustion, cynicism, and inefficacy is in grave jeopardy of developing burnout. Clinicians are repeatedly physically and emotionally exposed to exceedingly long hours in direct care with seriously ill patients/families, limited autonomy over daily responsibilities, endless electronic documentation, and a shifting medical landscape. The physical and emotional well-being of the cancer care clinician is critical to the impact on quality care, patient satisfaction, and overall success of their organizations. The prevention of burnout as well as targeting established burnout need to be proactively addressed at the individual level and organizational level. In fact, confronting burnout and promoting wellness are the shared responsibility of both oncology clinicians and their organizations. From an individual perspective, oncology clinicians must be empowered to play a crucial role in enhancing their own wellness by identification of burnout symptoms in both themselves and their colleagues, learning resilience strategies (e.g., mindful self-compassion), and cultivating positive relationships with fellow clinician colleagues. At the organizational level, leadership must recognize the importance of oncology clinician well-being; engage leaders and physicians in collaborative action planning, improve overall practice environment, and provide institutional wellness resources to physicians. These effective individual and organizational interventions are crucial for the prevention and improvement of overall clinician wellness and must be widely and systematically integrated into oncology care.
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Affiliation(s)
- Fay J Hlubocky
- From the Department of Medicine, Section of Hematology Oncology, The University of Chicago Medicine, Chicago, IL; Division of Oncology, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA; Mayo Clinic, Rochester, MN
| | - Anthony L Back
- From the Department of Medicine, Section of Hematology Oncology, The University of Chicago Medicine, Chicago, IL; Division of Oncology, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA; Mayo Clinic, Rochester, MN
| | - Tait D Shanafelt
- From the Department of Medicine, Section of Hematology Oncology, The University of Chicago Medicine, Chicago, IL; Division of Oncology, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA; Mayo Clinic, Rochester, MN
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Shanafelt TD, Noseworthy JH. Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout. Mayo Clin Proc 2017; 92:129-146. [PMID: 27871627 DOI: 10.1016/j.mayocp.2016.10.004] [Citation(s) in RCA: 948] [Impact Index Per Article: 135.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/05/2016] [Accepted: 10/10/2016] [Indexed: 12/20/2022]
Abstract
These are challenging times for health care executives. The health care field is experiencing unprecedented changes that threaten the survival of many health care organizations. To successfully navigate these challenges, health care executives need committed and productive physicians working in collaboration with organization leaders. Unfortunately, national studies suggest that at least 50% of US physicians are experiencing professional burnout, indicating that most executives face this challenge with a disillusioned physician workforce. Burnout is a syndrome characterized by exhaustion, cynicism, and reduced effectiveness. Physician burnout has been shown to influence quality of care, patient safety, physician turnover, and patient satisfaction. Although burnout is a system issue, most institutions operate under the erroneous framework that burnout and professional satisfaction are solely the responsibility of the individual physician. Engagement is the positive antithesis of burnout and is characterized by vigor, dedication, and absorption in work. There is a strong business case for organizations to invest in efforts to reduce physician burnout and promote engagement. Herein, we summarize 9 organizational strategies to promote physician engagement and describe how we have operationalized some of these approaches at Mayo Clinic. Our experience demonstrates that deliberate, sustained, and comprehensive efforts by the organization to reduce burnout and promote engagement can make a difference. Many effective interventions are relatively inexpensive, and small investments can have a large impact. Leadership and sustained attention from the highest level of the organization are the keys to making progress.
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Affiliation(s)
- Tait D Shanafelt
- Director of the Program on Physician Well-being, Mayo Clinic, Rochester, MN.
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Lachish S, Svirko E, Goldacre MJ, Lambert T. Factors associated with less-than-full-time working in medical practice: results of surveys of five cohorts of UK doctors, 10 years after graduation. HUMAN RESOURCES FOR HEALTH 2016; 14:62. [PMID: 27737659 PMCID: PMC5064899 DOI: 10.1186/s12960-016-0162-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 10/04/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND The greater participation of women in medicine in recent years, and recent trends showing that doctors of both sexes work fewer hours than in the past, present challenges for medical workforce planning. In this study, we provide a detailed analysis of the characteristics of doctors who choose to work less-than-full-time (LTFT). We aimed to determine the influence of these characteristics on the probability of working LTFT. METHODS We used data on working patterns obtained from long-term surveys of 10,866 UK-trained doctors. We analysed working patterns at 10 years post-graduation for doctors of five graduating cohorts, 1993, 1996, 1999, 2000 and 2002 (i.e. in the years 2003, 2006, 2009, 2010 and 2012, respectively). We used multivariable binary logistic regression models to examine the influence of a number of personal and professional characteristics on the likelihood of working LTFT in male and female doctors. RESULTS Across all cohorts, 42 % of women and 7 % of men worked LTFT. For female doctors, having children significantly increased the likelihood of working LTFT, with greater effects observed for greater numbers of children and for female doctors in non-primary care specialties (non-GPs). While >40 % of female GPs with children worked LTFT, only 10 % of female surgeons with children did so. Conversely, the presence of children had no effect on male working patterns. Living with a partner increased the odds of LTFT working in women doctors, but decreased the odds of LTFT working in men (independently of children). Women without children were no more likely to work LTFT than were men (with or without children). For both women and men, the highest rates of LTFT working were observed among GPs (~10 and 6 times greater than non-GPs, respectively), and among those not in training or senior positions. CONCLUSIONS Family circumstances (children and partner status) affect the working patterns of women and men differently, but both sexes respond similarly to the constraints of their clinical specialty and seniority. Thus, although women doctors comprise the bulk of LTFT workers, gender is just one of several determinants of doctors' working patterns, and wanting to work LTFT is evidently not solely an issue for working mothers.
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Affiliation(s)
- Shelly Lachish
- Nuffield Department of Population Health, UK Medical Careers Research Group, Unit of Health-Care Epidemiology, University of Oxford, Old Road Campus, Oxford, OX3 7LF, United Kingdom
| | - Elena Svirko
- Nuffield Department of Population Health, UK Medical Careers Research Group, Unit of Health-Care Epidemiology, University of Oxford, Old Road Campus, Oxford, OX3 7LF, United Kingdom
| | - Michael J Goldacre
- Nuffield Department of Population Health, UK Medical Careers Research Group, Unit of Health-Care Epidemiology, University of Oxford, Old Road Campus, Oxford, OX3 7LF, United Kingdom
| | - Trevor Lambert
- Nuffield Department of Population Health, UK Medical Careers Research Group, Unit of Health-Care Epidemiology, University of Oxford, Old Road Campus, Oxford, OX3 7LF, United Kingdom.
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Linzer M, Poplau S, Babbott S, Collins T, Guzman-Corrales L, Menk J, Murphy ML, Ovington K. Worklife and Wellness in Academic General Internal Medicine: Results from a National Survey. J Gen Intern Med 2016; 31:1004-10. [PMID: 27138425 PMCID: PMC4978678 DOI: 10.1007/s11606-016-3720-4] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 02/26/2016] [Accepted: 04/19/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND General internal medicine (GIM) careers are increasingly viewed as challenging and unsustainable. OBJECTIVE We aimed to assess academic GIM worklife and determine remediable predictors of stress and burnout. DESIGN We conducted an email survey. PARTICIPANTS Physicians, nurse practitioners, and physician assistants in 15 GIM divisions participated. MAIN MEASURES A ten-item survey queried stress, burnout, and work conditions such as electronic medical record (EMR) challenges. An open-ended question assessed stressors and solutions. Results were categorized into burnout, high stress, high control, chaos, good teamwork, high values alignment, documentation time pressure, and excessive home EMR use. Frequencies were determined for national data, Veterans Affairs (VA) versus civilian populations, and hospitalist versus ambulatory roles. A General Linear Mixed Model (GLMM) evaluated associations with burnout. A formal content analysis was performed for open-ended question responses. KEY RESULTS Of 1235 clinicians sampled, 579 responded (47 %). High stress was present in 67 %, with 38 % burned out (burnout range 10-56 % by division). Half of respondents had low work control, 60 % reported high documentation time pressure, half described too much home EMR time, and most reported very busy or chaotic workplaces. Two-thirds felt aligned with departmental leaders' values, and three-quarters were satisfied with teamwork. Burnout was associated with high stress, low work control, and low values alignment with leaders (all p < 0.001). The 45 VA faculty had less burnout than civilian counterparts (17 % vs. 40 %, p < 0.05). Hospitalists described better teamwork than ambulatory clinicians and fewer hospitalists noted documentation time pressure (both p < 0.001). Key themes from the qualitative analysis were short visits, insufficient support staff, a Relative Value Unit mentality, documentation time pressure, and undervaluing education. CONCLUSIONS While GIM divisions overall demonstrate high stress and burnout, division rates vary widely. Sustainability efforts within GIM could focus on visit length, staff support, schedule control, clinic chaos, and EMR stress.
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Affiliation(s)
- Mark Linzer
- Division of General Internal Medicine, Hennepin County Medical Center, 701 Park Avenue (P7), Minneapolis, MN, 55415, USA.
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
| | - Sara Poplau
- Division of General Internal Medicine, Hennepin County Medical Center, 701 Park Avenue (P7), Minneapolis, MN, 55415, USA
- Minneapolis Medical Research Foundation, Minneapolis, MN, USA
| | - Stewart Babbott
- Department of Medicine, University of Kansas, Kansas City, KS, USA
| | - Tracie Collins
- Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Wichita, KS, USA
| | | | - Jeremiah Menk
- Biostatistical Design and Analysis Center, Clinical and Translational Sciences Institute, University of Minnesota, Minneapolis, MN, USA
| | - Mary Lou Murphy
- Center for Physician Wellness and Professional Fulfillment, Stanford Medicine, Palo Alto, CA, USA
| | - Kay Ovington
- Society of General Internal Medicine and Association of Chiefs and Leaders in General Internal Medicine, Alexandria, VA, USA
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Shanafelt TD, Hasan O, Hayes S, Sinsky CA, Satele D, Sloan J, West CP, Dyrbye LN. Parental satisfaction of U.S. physicians: associated factors and comparison with the general U.S. working population. BMC MEDICAL EDUCATION 2016; 16:228. [PMID: 27567665 PMCID: PMC5002113 DOI: 10.1186/s12909-016-0737-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 08/12/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Physicians work considerably longer hours and are less satisfied with work-life balance than U.S. workers in other fields. There is, however, minimal data on physicians' parental satisfaction. METHODS To evaluate differences in parental satisfaction among physicians and workers in other fields, we surveyed U.S. physicians as well as a probability-based sample of the general U.S. working population between August 2014-October 2014. Parental satisfaction and the perceived impact of career on relationships with children were evaluated. RESULTS Among 6880 responding physicians (cooperation rate 19.2 %), 5582 (81.1 %) had children. Overall, physicians were satisfied in their relationships with their children, with 4782 (85.9 %) indicating that they were either very satisfied [n = 2738; (49.2 %)] or satisfied [n = 2044 (36.7 %)]. In contrast, less than half believed their career had made either a major [n = 1212; (21.8 %)] or minor positive [n = 1260; (22.7 %)] impact on their relationship with their children, with a slightly larger proportion indicating a major (n = 2071 [37.2 %]) or minor (n = 501 [9 %]) negative impact. Women physicians were less likely to believe their career had made a positive impact as were younger physicians. Hours worked/week inversely correlated with the belief that career had made a positive impact on relationships with children. Both men (OR: 2.75; p < 0.0001) and women (OR: 4.33; p < 0.0001) physicians were significantly more likely to report that their career had a negative impact on relationships with their children than the sex-matched U.S. working population. CONCLUSIONS U.S. physicians report generally high satisfaction in their relationships with their children. Despite their high satisfaction, physicians have a more negative perception of the impact of their career on relationships with their children than U.S. workers in general.
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Affiliation(s)
- Tait D Shanafelt
- Mayo Clinic, Rochester, MN, USA.
- Department of Internal Medicine, 200 First Street, Rochester, MN, 55905, USA.
| | - Omar Hasan
- American Medical Association, Chicago, IL, USA
| | | | | | - Daniel Satele
- Mayo Clinic, Rochester, MN, USA
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Jeff Sloan
- Mayo Clinic, Rochester, MN, USA
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Colin P West
- Mayo Clinic, Rochester, MN, USA
- Department of Internal Medicine, 200 First Street, Rochester, MN, 55905, USA
| | - Lotte N Dyrbye
- Mayo Clinic, Rochester, MN, USA
- Department of Internal Medicine, 200 First Street, Rochester, MN, 55905, USA
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Shanafelt TD, Mungo M, Schmitgen J, Storz KA, Reeves D, Hayes SN, Sloan JA, Swensen SJ, Buskirk SJ. Longitudinal Study Evaluating the Association Between Physician Burnout and Changes in Professional Work Effort. Mayo Clin Proc 2016; 91:422-31. [PMID: 27046522 DOI: 10.1016/j.mayocp.2016.02.001] [Citation(s) in RCA: 377] [Impact Index Per Article: 47.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/13/2016] [Accepted: 02/02/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To longitudinally evaluate the relationship between burnout and professional satisfaction with changes in physicians' professional effort. PARTICIPANTS AND METHODS Administrative/payroll records were used to longitudinally evaluate the professional work effort of faculty physicians working for Mayo Clinic from October 1, 2008, to October 1, 2014. Professional effort was measured in full-time equivalent (FTE) units. Physicians were longitudinally surveyed in October 2011 and October 2013 with standardized tools to assess burnout and satisfaction. RESULTS Between 2008 and 2014, the proportion of physicians working less than full-time at our organization increased from 13.5% to 16.0% (P=.05). Of the 2663 physicians surveyed in 2011 and 2776 physicians surveyed in 2013, 1856 (69.7%) and 2132 (76.9%), respectively, returned surveys. Burnout and satisfaction scores in 2011 correlated with actual reductions in FTE over the following 24 months as independently measured by administrative/payroll records. After controlling for age, sex, site, and specialty, each 1-point increase in the 7-point emotional exhaustion scale was associated with a greater likelihood of reducing FTE (odds ratio [OR], 1.43; 95% CI, 1.23-1.67; P<.001) over the following 24 months, and each 1-point decrease in the 5-point satisfaction score was associated with greater likelihood of reducing FTE (OR, 1.34; 95% CI, 1.03-1.74; P=.03). On longitudinal analysis at the individual physician level, each 1-point increase in emotional exhaustion (OR, 1.28; 95% CI, 1.05-1.55; P=.01) or 1-point decrease in satisfaction (OR, 1.67; 95% CI, 1.19-2.35; P=.003) between 2011 and 2013 was associated with a greater likelihood of reducing FTE over the following 12 months. CONCLUSION Among physicians in a large health care organization, burnout and declining satisfaction were strongly associated with actual reductions in professional work effort over the following 24 months.
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Affiliation(s)
| | | | | | | | | | | | - Jeff A Sloan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Stephen J Swensen
- Department of Radiology, Mayo Clinic, Rochester, MN; Office of Organization and Leadership Development, Mayo Clinic, Rochester, MN
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Levine RB. The Secret of the Care of the Doctor Is in Caring for the Doctor. Mayo Clin Proc 2016; 91:408-10. [PMID: 27046521 DOI: 10.1016/j.mayocp.2016.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 02/10/2016] [Indexed: 11/20/2022]
Affiliation(s)
- Rachel B Levine
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD.
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Freed GL, Moran LM, Van KD, Leslie LK. Current Workforce of General Pediatricians in the United States. Pediatrics 2016; 137:peds.2015-4242. [PMID: 27006475 DOI: 10.1542/peds.2015-4242] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES A near vacuum exists for credible information regarding specialty-specific demography, including gender, years since training completion, current employer, academic affiliation, and hours worked in specific tasks. Understanding the current status and changes to the medical workforce and its work patterns is essential to assessing whether the supply and distribution meets the needs of patients, institutions, society, and educational programs. METHODS A self-administered electronic survey sent to all pediatricians at the time of their enrollment in the Maintenance of Certification program in 2013-2014. The survey focused on exploring trends associated with career choice, career paths, time spent in professional activities, and current practice characteristics. Logistic regression and χ(2) analyses were conducted. RESULTS The response rate was 87.2% (N = 15 351). Of those who completed the survey, 9253 (64%) self-identified as general pediatricians. An increased likelihood of working part-time was seen among women (odds ratio [OR]: 12.21), those without an academic appointment (OR: 1.32), and those not working in a private/independent practice (OR: 1.15). Overall, 89% (n = 8214) of respondents stated that their current allocation of professional time was approximately what they wanted. Those more likely to be involved in quality improvement in the past year did not work in independent/private practices (OR: 1.78) and worked full-time (OR: 1.16). CONCLUSIONS Understanding the current nature of the pediatric workforce is a first step in providing data to guide future workforce planning and the training experiences required to maintain and shape the workforce to meet the current and future needs of children.
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Affiliation(s)
- Gary L Freed
- Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, and Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan;
| | - Lauren M Moran
- Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, and
| | - Kenton D Van
- Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, and
| | - Laurel K Leslie
- American Board of Pediatrics Foundation, Chapel Hill, North Carolina; and Tufts University School of Medicine, Boston, Massachusetts
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Cull WL, Frintner MP, O'Connor KG, Olson LM. Pediatricians Working Part-Time Has Plateaued. J Pediatr 2016; 171:294-9. [PMID: 26795679 DOI: 10.1016/j.jpeds.2015.12.062] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 11/11/2015] [Accepted: 12/22/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine trends in pediatricians working part-time and residents seeking part-time work and to examine associated characteristics. STUDY DESIGN The American Academy of Pediatrics (AAP) Periodic Survey of Fellows and the AAP Annual Survey of Graduating Residents were used to examine part-time employment. Fourteen periodic surveys were combined with an overall response rate of 57%. Part-time percentages were compared for surveys conducted from 2006-2009 and 2010-2013. The AAP Annual Surveys of Graduating Residents (combined response rate = 60%) from 2006-2009 were compared with 2010-2013 surveys for residents seeking and obtaining part-time positions following training. Multivariable logistic regression models identified characteristics associated with part-time work. RESULTS Comparable percentages of pediatricians worked part-time in 2006-2009 (23%) and 2010-2013 (23%). There was similarly no statistically significant difference in residents seeking part-time work (30%-28%), and there was a slight decline in residents accepting part-time work (16%-13%, aOR .75, 95% CI .56-.96). Increases in working part-time were not found for any subgroups examined. Women consistently were more likely than men to work part-time (35% vs 9%), but they showed different patterns of part-time work across age. Women in their 40s (40%) were more likely than other women (33%) and men in their 60s (20%) were more likely than other men (5%) to work part-time. CONCLUSIONS There has been a levelling off in the number of pediatricians working part-time and residents seeking part-time work. Overall, women remain more likely to work part-time, although 1 in 5 men over 60 work part-time.
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Affiliation(s)
- William L Cull
- Department of Research, American Academy of Pediatrics, Elk Grove Village, IL.
| | - Mary Pat Frintner
- Department of Research, American Academy of Pediatrics, Elk Grove Village, IL
| | - Karen G O'Connor
- Department of Research, American Academy of Pediatrics, Elk Grove Village, IL
| | - Lynn M Olson
- Department of Research, American Academy of Pediatrics, Elk Grove Village, IL
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Frintner MP, Cull WL, Byrne BJ, Freed GL, Katakam SK, Leslie LK, Miller AA, Starmer AJ, Olson LM. A Longitudinal Study of Pediatricians Early in Their Careers: PLACES. Pediatrics 2015. [PMID: 26216329 DOI: 10.1542/peds.2014-3972] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The American Academy of Pediatrics (AAP) launched the Pediatrician Life and Career Experience Study (PLACES), a longitudinal study that tracks the personal and professional experiences of early career pediatricians, in 2012. We used a multipronged approach to develop the study methodology and survey domains and items, including review of existing literature and qualitative research with the target population. We chose to include 2 cohorts of US pediatricians on the basis of residency graduation dates, including 1 group who were several years out of residency (2002-2004 Residency Graduates Cohort) and a second group who recently graduated from residency at study launch (2009-2011 Residency Graduates Cohort). Recruitment into PLACES was a 2-stage process: (1) random sample recruitment from the target population and completion of an initial intake survey and (2) completion of the first Annual Survey by pediatricians who responded positively to stage 1. Overall, 41.2% of pediatricians randomly selected to participate in PLACES indicated positive interest in the study by completing intake surveys; of this group, 1804 (93.7%) completed the first Annual Survey and were considered enrolled in PLACES. Participants were more likely to be female, AAP members, and graduates of US medical schools compared with the target sample; weights were calculated to adjust for these differences. We will survey PLACES pediatricians 2 times per year. PLACES data will allow the AAP to examine career and life choices and transitions experienced by early-career pediatricians.
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Affiliation(s)
- Mary Pat Frintner
- Department of Research, American Academy of Pediatrics, Elk Grove Village, Illinois;
| | - William L Cull
- Department of Research, American Academy of Pediatrics, Elk Grove Village, Illinois
| | - Bobbi J Byrne
- Section of Neonatal-Perinatal Medicine, Department of Pediatrics, Indiana University, Indianapolis, Indiana
| | - Gary L Freed
- Department of Pediatrics and Child Health Evaluation and Research Unit, University of Michigan, Ann Arbor, Michigan
| | - Shesha K Katakam
- Department of Pediatrics, Indiana University Health La Porte, La Porte, Indiana
| | - Laurel K Leslie
- Department of Pediatrics, Tufts Medical Center Floating Hospital for Children, Boston, Massachusetts
| | - Ashley A Miller
- Department of Pediatrics New London Hospital, New London, New Hampshire
| | - Amy J Starmer
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Lynn M Olson
- Department of Research, American Academy of Pediatrics, Elk Grove Village, Illinois
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Panattoni L, Stone A, Chung S, Tai-Seale M. Patients report better satisfaction with part-time primary care physicians, despite less continuity of care and access. J Gen Intern Med 2015; 30:327-33. [PMID: 25416600 PMCID: PMC4351271 DOI: 10.1007/s11606-014-3104-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 06/17/2014] [Accepted: 10/27/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND The growing number of primary care physicians (PCPs) reducing their clinical work hours has raised concerns about meeting the future demand for services and fulfilling the continuity and access mandates for patient-centered care. However, the patient's experience of care with part-time physicians is relatively unknown, and may be mediated by continuity and access to care outcomes. OBJECTIVE We aimed to examine the relationships between a physicians' clinical full-time equivalent (FTE), continuity of care, access to care, and patient satisfaction with the physician. DESIGN We used a multi-level structural equation estimation, with continuity and access modeled as mediators, for a cross-section in 2010. PARTICIPANTS The study included family medicine (n = 104) and internal medicine (n = 101) physicians in a multi-specialty group practice, along with their patient satisfaction survey responses (n = 12,688). MAIN MEASURES Physician level FTE, continuity of care received by patients, continuity of care provided by physician, and a Press Ganey patient satisfaction with the physician score, on a 0-100 % scale, were measured. Access to care was measured as days to the third next-available appointment. KEY RESULTS Physician FTE was directly associated with better continuity of care received (0.172% per FTE, p < 0.001), better continuity of care provided (0.108% per FTE, p < 0.001), and better access to care (-0.033 days per FTE, p < 0.01), but worse patient satisfaction scores (-0.080% per FTE, p = 0.03). The continuity of care provided was a significant mediator (0.016% per FTE, p < 0.01) of the relationship between FTE and patient satisfaction; but overall, reduced clinical work hours were associated with better patient satisfaction (-0.053 % per FTE, p = 0.03). CONCLUSIONS These results suggest that PCPs who choose to work fewer clinical hours may have worse continuity and access, but they may provide a better patient experience. Physician workforce planning should consider these care attributes when considering the role of part-time PCPs in practice redesign efforts and initiatives to meet the demand for primary care services.
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Affiliation(s)
- Laura Panattoni
- Palo Alto Medical Foundation Research Institute, 2350 W. El Camino Real, Mountain View, CA, 94040, USA,
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Pollart SM, Dandar V, Brubaker L, Chaudron L, Morrison LA, Fox S, Mylona E, Bunton SA. Characteristics, satisfaction, and engagement of part-time faculty at U.S. medical schools. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:355-364. [PMID: 25186817 DOI: 10.1097/acm.0000000000000470] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE To describe the demographics of part-time faculty at U.S. medical schools and to examine their satisfaction with and perceptions of their workplace. METHOD Faculty from 14 Liaison Committee on Medical Education-accredited U.S. medical schools participated in the 2011-2012 Faculty Forward Engagement Survey. The authors calculated descriptive statistics of part-time faculty respondents and used ANOVA and t test analyses to assess significant differences between and among demographic groups. RESULTS The survey yielded an overall response rate of 62% (9,600/15,490). Of the part-time faculty respondents, most had appointments in clinical departments (634/674; 94%) and were female (415/674; 62%). Just over 80% (384/474) reported a full-time equivalent of 0.5 or higher. The majority of part-time faculty respondents reported satisfaction with their department and medical school as a place to work (372/496 [75%] and 325/492 [66%]); approximately half agreed that their institution had clear expectations for part-time faculty (210/456; 46%) and provided the resources they needed (232/457; 51%). Significant differences existed between part- and full-time faculty respondents regarding perceptions of growth opportunities and compensation and benefits, with part-time faculty respondents feeling less satisfied in these areas. CONCLUSIONS As institutions work to improve the satisfaction of full-time faculty, they should do the same for part-time faculty. Understanding why faculty choose part-time work is important in encouraging the recruitment and retention of the most talented faculty. The findings of this study indicate multiple opportunities to improve the satisfaction and engagement of part-time faculty.
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Affiliation(s)
- Susan M Pollart
- Dr. Pollart is Ruth E. Murdaugh Professor of Family Medicine and senior associate dean for faculty affairs and faculty development, University of Virginia School of Medicine, Charlottesville, Virginia. Ms. Dandar is senior research and member services specialist, Faculty Forward, Association of American Medical Colleges, Washington, DC. Dr. Brubaker is professor of obstetrics and gynecology and dean, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois. Dr. Chaudron is senior associate dean for diversity and professor in psychiatry, pediatrics, and obstetrics and gynecology, University of Rochester Medical Center, Rochester, New York. Dr. Morrison is vice chancellor for academic affairs and professor of neurology and pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Dr. Fox is senior director of research, American Academy of Physician Assistants, Alexandria, Virginia. Dr. Mylona is vice dean for faculty affairs and professional development and professor of medicine, Eastern Virginia Medical School, Norfolk, Virginia. Dr. Bunton is research director, Organization and Management Studies, Association of American Medical Colleges, Washington, DC
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Dwan KM, Douglas KA, Forrest LE. Are "part-time" general practitioners workforce idlers or committed professionals? BMC FAMILY PRACTICE 2014; 15:154. [PMID: 25233955 PMCID: PMC4262981 DOI: 10.1186/1471-2296-15-154] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 09/05/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND The traditional view of general practice holds that only general practitioners (GPs) in full-time clinical practice can provide quality patient care. Nevertheless, increasing numbers of GPs are choosing to work sessionally, that is, ostensibly "part-time". There are concerns about the health workforce's ability to meet demand and also fears that patient care may be compromised. We sought answers to a) what activities do GPs undertake when not consulting patients, b) why do they choose to work sessionally, and c) does sessional general practice reflect a lack of commitment to patients and the profession? METHODS Semi-structured interviews were conducted with GPs who worked sessionally, (i.e. six or fewer sessions a week in clinical general practice, where a session comprises four consecutive hours of patient care). These data were analysed qualitatively and saturation was reached. RESULTS The majority of participants were in full-time paid employment, while part-time in clinical general practice. They reported that consultations increasingly required the management of patients with complex, chronic conditions who also required psychological management. Coupled with unrealistic patient expectations, these factors led GPs to be concerned about maintaining the quality patient care they considered professionally desirable. Many diversified their work activities to ensure that they retained their professional standards. CONCLUSION "Part-time" general practice is a misnomer that masks the contribution these GPs make as part of the health workforce. Sessional practice more accurately describes the nature of our participants' clinical work. Their choice of sessional work is a professional response to the increasing demands within the consultation. It enables GPs to maintain their commitment to quality patient care and their profession, while attenuating the challenges of demanding consultations. Sessional general practitioners demonstrate strong commitment to their patients and the profession.
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Huber TS. Professionalism and the work-life balance. J Vasc Surg 2014; 60:1072-82. [PMID: 25135876 DOI: 10.1016/j.jvs.2014.04.077] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 04/07/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Thomas S Huber
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida College of Medicine, Gainesville, Fla.
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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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Brown JB, Fluit M, Lent B, Herbert C. Surgical culture in transition: gender matters and generation counts. Can J Surg 2013; 56:153-8. [PMID: 23484466 DOI: 10.1503/cjs.024011] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND We sought to study the impact of the change in gender balance and the shift in generational beliefs on the practice of surgery. METHODS We used in-depth, individual, semistructured interviews to explore the ideas, perceptions and experiences of recently recruited academic surgeons regarding the role of gender and the influence of the changing attitudes of this generation on the work environment. All the interviews were audiotaped and transcribed verbatim. The data analysis was both iterative and interpretative. RESULTS Nine women and 8 men participated in the study. All participants stated that departmental expectations regarding their performance as clinicians and as academics were not influenced by gender. However, further exploration revealed how gender did influence the way they sought to balance their personal and professional lives. Women in particular struggled with attaining this balance. While maternity leave was endorsed by both men and women, the challenging logistics associated with such leave were noted. Our data also revealed a generational shift among men and women in terms of the importance of the balance between their personal and professional lives. Participants saw this priority as radically different from that of their senior colleagues. CONCLUSION Gender and the shift in generational attitudes are changing the culture of academic surgery, often described as the prototypical male-dominated medical environment. These changes may reflect the changing face of medicine.
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Affiliation(s)
- Judith Belle Brown
- The Centre for Studies in Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont., Canada.
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