Quality of life, physical and mental health of physicians: a self-evaluation by graduates from the Botucatu Medical School--UNESP

Motivations of medical students and doctors leaving the NHS explored in a residency training application webinar series

BACKGROUND

Recent reports show that about 10% of UK-graduate doctors leave the country to pursue specialty training elsewhere. Our article aims to evaluate the motivating factors for UK graduates to leave the National Health Service (NHS), especially during the COVID-19 pandemic and Brexit.

STUDY DESIGN

Cross-sectional study.

METHOD

A novel 22-item questionnaire was disseminated at a webinar series regarding the application process to pursue residency training in six different countries/regions from 2 August 2020 to 13 September 2020. The data was analysed using Kruskal-Wallis rank-sum with post-hoc Wilcoxon test to compare the difference in significance among the motivating factors.

RESULTS

1118 responses from the UK medical students and doctors were collected; of which, 1001 (89.5%) were medical students, and 88 (7.9%) were junior doctors. There was a higher propensity for leaving after the Foundation Programme compared with other periods (p<0.0001 for all comparisons). There was no difference between desire for leaving after core surgical/medical training and specialty training (p=0.549). However, both were significantly higher than leaving the NHS after medical school (p<0.0001). Quality of life and financial prospects (both p<0.0001) were the most agreed reasons to leave the NHS, followed by clinical and academic opportunities and, subsequently, family reasons.

CONCLUSION

Future work on the quality of life for doctors in the UK should be explored, especially among those considering leaving the NHS. Policymakers should focus on assessing the difference in working hours, on-call hours and wages that may differ among healthcare systems.

Analysis of physicians work ability, in the city of Maringá, Brazil

Background

Occupational stress might impair the work ability of physicians, leading to medical errors and illness.

Objectives

To describe the sociodemographic and occupational profile of physicians, calculate the work ability index (WAI) and correlate it to sociodemographic factors, occupational characteristics and lifestyle.

Method

Cross-sectional study conducted with a random sample of 408 physicians from Maringa, Parana, Brazil, stratified per sex. We administered a self-report questionnaire with the following four sections: sociodemographic profile, occupational characteristics, lifestyle, and work ability.

Results

Most participants were male (61.27%), young (20 to 40 years old-57.35%) and married (61.76%). While participants had usually completed a medical residency program (50.74%) most had worked less than 10 years in the profession (47.06%). About 44.61% of the sample worked 50 to 120 hours / week, 41.18% had formal employment relationship registered in their work card, and 53.43% slept less than six hours/day. The mean WAI was 44, which characterizes excellent work ability. Reduced WAI was associated with older age, longer length in the profession, smoking, sedentary lifestyle, and poorer mental resources to cope with the job demands. Only 1.72% of the participants stated that, based on their current state of health, continuing in the job in two years' time would be unlikely.

Conclusion

Their excellent work ability notwithstanding, the occupational characteristics and lifestyle of physicians call for interventions to prevent impairments of their professionals performance.

Análise da qualidade de vida em médicos que trabalham em centro cirúrgico na cidade de Mossoró, Rio Grande do Norte, Brasil

Objetivo: avaliar a qualidade de vida (QV) em médicos que atuam em centro cirúrgico da cidade brasileira de Mossoró, RN. Métodos: foi realizado um estudo epidemiológico de corte transversal com aplicação de questionários nos profissionais, no período de novembro de 2018 a junho de 2019 em quatro hospitais. Para a caracterização da população estudada, o questionário foi constituído de dados biodemográficos com informações sobre o participante, o modo de trabalho e o questionário World Health Organization Quality of Life abreviado (escore de 0 a 100). Resultados: participaram do estudo 100 médicos de diversas especialidades. A média de idade foi de 39,6 ± 10,7 anos. Os médicos participantes da pesquisa possuíram uma boa QV para todos os todos domínios (escore geral = 75 ± 14,7). Maior idade, mais tempo de formado e maior  número de filhos para os domínios físico, psicológico e meio ambiente estiveram relacionados a maior QV. Melhores condições de trabalho estiveram associadas a maiores escores dos domínios social e meio ambiente. Maiores quantidade de horas semanais em plantões se correlacionaram a piores índices de QV para os domínios geral, psicológico, social e meio ambiente. A realização de prática de atividade física foi associada a melhores escores dos domínios geral, físico, social e meio ambiente. Conclusão: Apesar de a maioria dos profissionais apresentarem boa QV, algumas condições estiveram associadas à sua diminuição, como idade mais jovem, elevada carga horária de trabalho, piores condições de trabalho e a não realização de atividades físicas.

Prevalence of tobacco use in healthcare workers: A systematic review and meta-analysis

Objectives

To estimate tobacco use prevalence in healthcare workers (HCW) by country income level, occupation and sex, and compare the estimates with the prevalence in the general population.

Methods

We systematically searched five databases; Medline, EMBASE, CINHAL Plus, CAB Abstracts, and LILACS for original studies published between 2000 and March 2016 without language restriction. All primary studies that reported tobacco use in any category of HCW were included. Study extraction and quality assessment were conducted independently by three reviewers, using a standardised data extraction and quality appraisal form. We performed random effect meta-analyses to obtain prevalence estimates by World Bank (WB) country income level, sex, and occupation. Data on prevalence of tobacco use in the general population were obtained from the World Health Organisation (WHO) Global Health Observatory website. The review protocol registration number on PROSPERO is CRD42016041231.

Results

229 studies met our inclusion criteria, representing 457,415 HCW and 63 countries: 29 high-income countries (HIC), 21 upper-middle-income countries (UMIC), and 13 lower-middle-and-low-income countries (LMLIC). The overall pooled prevalence of tobacco use in HCW was 21%, 31% in males and 17% in females. Highest estimates were in male doctors in UMIC and LMLIC, 35% and 45%, and female nurses in HIC and UMIC, 21% and 25%. Heterogeneity was high (I² > 90%). Country level comparison suggest that in HIC male HCW tend to have lower prevalence compared with males in the general population while in females the estimates were similar. Male and female HCW in UMIC and LMLIC tend to have similar or higher prevalence rates relative to their counterparts in the general population.

Conclusions

HCW continue to use tobacco at high rates. Tackling HCW tobacco use requires urgent action as they are at the front line for tackling tobacco use in their patients.

Religiosity and Physician Lifestyle from a Family Health Strategy

This study examines the association between religiosity and physician lifestyle from a Family Health Strategy perspective. This is a cross-sectional study with 30 physicians, who completed the religiosity and lifestyle questionnaires. Among the participants, 70% (n = 21) had no "focus" on spirituality and health. The average total lifestyle score was 74.1 (SD = 8.1), but the "Physical Activity" subscale score was below average (3.4, SD = 2.37). We found eight significant correlations between religiosity and lifestyle subscales (p < 0.05). Greater religious involvement is associated with better overall and specific areas of physician lifestyle.

Quality of Life of the Plastic Surgeon in the Midwest of Brazil

BACKGROUND

The quality of life theme is much studied in the area of plastic surgery; however, there are few studies on the quality of life of plastic surgeons. The main aim of this study was to describe the quality of life of the plastic surgeon in Center-West of Brazil.

METHODS

A cross-sectional study was performed of plastic surgeons in the greater state of Goias, Center-West of Brazil, registered until January 2015. A sample with power of 80%, 115 surgeons from 163 WHOQOL-BREF, and a social-demographic and professional questionnaire were used as instruments. The data were compared between qualitative variables of the questionnaire and WHOQOL-BREF using the Mann-Whitney and Kruskal-Wallis tests.

RESULTS

One hundred sixteen surgeons answered; for WHOQOL-BREF, domain statistics were as follows: physical, 57.85; psychological, 62.9; social, 74.13; and environment, 68.56. The higher scores in each domain were related: physical: monthly income higher than US$ 11,200, more than 10 years of experience, weekly work hours lower than 40, being an associate or full member, and more than 4 surgeries/week; psychological: man, married, and having only private patients; social: man, monthly income higher than US$15,000, more than 20 years of experience, and weekly work hours lower than 40; and environment: monthly income higher than US$15,000, more than 10 years of experience, weekly work hours lower than 60, and more than 4 surgeries/week.

CONCLUSION

The study demonstrates that the youngest surgeon, with a duration of less than 10 years, has the worst quality of life.

Depressão em médicos da Estratégia de Saúde da Família no município de Itajaí/SC

Objetivo: Conhecer a prevalência de depressão em médicos da Estratégia de Saúde da Família (ESF) da cidade de Itajaí/SC. Métodos: Foram utilizados o Inventário de Depressão de Beck para rastreamento dos sintomas depressivos e um questionário elaborado pelos pesquisadores para coletar informações da vida pessoal e profissional. Os dados coletados foram armazenados em tabela de Microsoft Excel, estratificados conforme intensidade dos sintomas e as variáveis relacionáveis. Para apresentação, foram calculadas frequências absolutas e percentuais. Resultados: Em uma amostra de 45 médicos, apenas sintomas depressivos leves foram identificados, o que representou somente 13% dos participantes, porém nenhuma das variáveis analisadas neste estudo apresentou associação com depressão. A grande maioria dos resultados se mostrou satisfatoriamente positiva para prevenção e fatores estressores: horas de sono suficientes, número adequado de consultas, satisfação com o trabalho, prática de atividade física e não relatar antecedentes psiquiátricos. Conclusões: São percebidos, no presente estudo, poucos médicos na ESF de Itajaí/SC com sintomas depressivos, contudo, considera-se, ainda, fundamental a adoção de estratégias na melhoria da saúde mental destes profissionais.

Profile of the newly graduated physicians in southern Brazil and their professional insertion

Knowledge of the profile and professional integration of new graduates enables adjustments in medical education. This study evaluated 107 graduates from a private institution in the Brazilian South region, using a self-administered electronic questionnaire. There were similar participation of young physicians of both genders and higher male concentration in general surgery. Graduates are inserted in the public and private labor market. Most do extra shifts in emergency services and trauma surgery, where there is greater need for clinical and surgical skills. These findings suggest that adequate surgical training during graduation is critical to employability. RESUMO O conhecimento do perfil e inserção profissional dos recém-formados possibilita ajustes na educação médica. Este estudo avaliou 107 egressos de instituição privada no sul do país, utilizando questionário eletrônico autoaplicável. Houve participação similar de jovens de ambos os sexos e maior concentração masculina na área de cirurgia geral. Os egressos estão inseridos no mercado de trabalho público e privado. A maioria faz plantões extras em serviços de emergência e cirurgia do trauma, onde há maior necessidade de habilidades clinicas e cirúrgica. Esses achados apontam que a formação cirúrgica adequada durante a graduação é fundamental para a empregabilidade.

Factors associated with job and personal satisfaction in adult Brazilian intensivists

Objective

To evaluate job and personal satisfaction rates in physicians who work in adult intensive care units and to identify the factors associated with satisfaction.

Methods

A cross-sectional study performed with physicians who participated in two intensive medicine online discussion groups. A questionnaire designed to assess the physician's sociodemographic profile and job was available for both groups for 3 months. At the end of the questionnaire, the participants addressed their degrees of job and personal satisfaction using a Likert scale in which 1 represented "very dissatisfied" and 5 represented "very satisfied". The association between sociodemographic and job characteristics with job and personal satisfaction was evaluated. Variables independently associated with satisfaction were identified using a logistic regression model.

Results

The questionnaire was answered by 250 physicians, of which 137 (54.8%) declared they were satisfied with their jobs and 34 (13.5%) were very satisfied. None of the evaluated characteristics were independently associated with job satisfaction. Regarding personal satisfaction, 136 (54.4%) physicians reported being satisfied, and 48 (19.9%) reported being very satisfied. Job satisfaction (OR = 7.21; 95%CI 3.21 - 16.20) and working in a university hospital (OR = 3.24; 95%CI 1.29 - 8.15) were factors independently associated with the personal satisfaction of the participants.

Conclusion

The participant physicians reported job and personal satisfaction with their work in intensive care. Job satisfaction and working in a university hospital were independently associated with greater personal satisfaction.

A saúde física e mental do profissional médico: uma revisão sistemática

RESUMO O objetivo desta revisão sistemática da literatura foi de identificar as principais doenças que acometem os médicos em todo o mundo, mediante uma pesquisa eletrônica na base de dados Biblioteca Virtual em Saúde (BVS) baseada na metodologia Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Prisma). Foram analisados 57 dos 374 artigos científicos encontrados sobre o tema em inglês, português e espanhol, publicados entre 2005 e 2015. Os resultados encontrados apontaram que os acometimentos mentais prevaleceram, destacando-se o esgotamento profissional (síndrome de burnout). Entre as doenças físicas, predominaram os acometimentos musculoesqueléticos.

The physician's quality of life: Relationship with ego defense mechanisms and object relations

OBJECTIVE

To assess whether ego defense mechanisms and object relations (the way an individual subjectively experiences his/her relationships with others) are related to quality of life among physicians.

METHODS

In this cross-sectional mail survey, 602 physicians from Botucatu, SP, Brazil, were sent a socio-demographic questionnaire, the Bell Object Relations and Reality Testing Inventory-Form O (BORRTI-O), the Defense Style Questionnaire-40 (DSQ-40), and the World Health Organization Abbreviated Instrument for Quality of Life Assessment (WHOQOL-BREF).

RESULTS

198 questionnaires (33%) with valid responses were obtained. High BORRTI-O scores (indicative of pathology) on the alienation, egocentricity and insecure attachment subscales were associated with reduced WHOQOL-BREF scores for the psychological health and social relationship domains. Immature ego defense mechanisms were associated with lower WHOQOL-BREF scores for all domains. No significant associations of WHOQOL-BREF scores with working hours, workplace or monthly income were observed in the study population

CONCLUSIONS

WHOQOL-BREF scores correlated with mature defense mechanisms and normal object relations, suggesting an association between psychological maturity and quality of life among physicians.