Work week duration, work-family balance and difficulties encountered by female and male physicians: results from the French SESMAT study

Stress, burnout, and parenting: a qualitative study of general practice registrars

BACKGROUND

Early career medical professionals experience stress and burnout at higher levels than the wider community. Burnout can arise with competing demands of life and career, which is evident in early career development, where family planning can coincide with specialty training. General practice may be seen as a family friendly career option; however, few studies examine the experience of general practice trainees with stress and burnout and the impact that parenting has on their experience. This study aims to explore the experience of stress and burnout in general practice registrars and the exacerbating and protective factors, with a focus on the experiences of two groups of registrars, those that have children, and those that do not.

METHODS

A qualitative study was conducted with 14 participants, who were interviewed with questions exploring experiences of stress and burnout. Participants were grouped into those with children and those without children. The transcripts were thematically analysed.

RESULTS

Themes were identified as those that contributed to stress and burnout (such as time, financial concerns and isolation) and those factors that reduced stress and burnout (such as support from others and being respected and valued within the workplace). Parenting was identified as both a factor that could contribute to and reduce stress and burnout.

CONCLUSIONS

Stress and burnout are important foci for future research and policy to ensure the sustainability of general practice. System based and individual focused policies, including individualising training to support parenting, are required to ensure that registrars are supported through their training years and beyond.

"A cross-sectional study of burnout among Australian general practice registrars"

OBJECTIVE(S)

To identify if gender and parenting factors are associated with burnout in Australian general practice (GP) registrars.

DESIGN

Cross sectional study. The main outcome measure was the Maslach Burnout Inventory, included as part of the GPRA (General Practice Registrars Australia) biannual online survey.

PARTICIPANTS

GP registrars, 2019 cohort, undertaking fellowship training in Australia.

RESULTS

In 2019 a total of 366 GP registrars completed the online survey. Over 75% of registrars experienced moderate to high levels of burnout (emotional exhaustion scale). Several demographic factors were associated with an increased risk for reporting higher levels of burnout. Increasing age was associated with lower levels of personal accomplishment (P-value < 0.01), being female was associated with higher levels of emotional exhaustion (p-value < 0.001) and increasing numbers of children were associated with lower levels of burnout, independent of hours worked (p-value < 0.001).

CONCLUSION

This study suggests that being a parent is associated with a reduced risk of burnout, irrespective of hours worked. However, being female and increased age were associated with increased levels of burnout. With increasing numbers of females entering medical training, and the decreasing desirability of general practice training, this paper reviews the complexities around parenting during training and associations with burnout. There is a need to examine this interaction further to understand the causation for these findings, and to ensure appropriate policies, opportunities and workplace supports are developed to ensure GP training is optimised to attract and support the next generation.

The relationship between public service motivation and turnover intention: the mediating role of work stress and task performance

BACKGROUND

The shortage of health care workforce is a common problem all over the world and one of the main reasons for the shortage is the high turnover rate. Based on the characteristics of medical work, this study explored the relationship among public service motivation (PSM), work stress, task performance and turnover intention.

METHODS

Medical personnel in public hospitals were selected by stratified random sampling in Jilin province of China and validated scales from previous studies were applied to measure the variables. Besides, a structural equation model of turnover intention was constructed to demonstrate the relationship.

RESULTS

A total of 3191 valid questionnaires were collected. The results showed that the score of turnover intention was 2.02 ± 1.13. There are significant differences in turnover intention among medical staff of different genders and departments. At the same time, PSM had direct and negative effects on the turnover intention (β = -0.292, P < 0.001), work stress had direct and positive effects on the turnover intention (β = 0.479, P < 0.001), whereas task performance had no significant effect on turnover intention (β = 0.044, P < 0.142). The results showed an acceptable fit model.

CONCLUSION

The greater the PSM, the lower the turnover intention, and the higher the work stress, the higher the turnover intention. In addition, work stress and task performance play a mediating role between PSM and turnover intention. This paper provides theoretical support for the measures to reduce the turnover intention of medical staff.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Relation between Burnout and Sleep Problems in Nurses: A Systematic Review with Meta-Analysis

Burnout can affect nurses’ sleep quality. The aim of this study was to analyze the relationship between burnout syndrome and sleep problems in nurses. A systematic review with meta-analysis was performed. PubMed, CINAHL and Scopus databases were used. Some of the inclusion criteria were quantitative studies, in which the levels of burnout and sleep disorders were investigated in a sample of nurses using validated scales. A total of 12 studies were included. Sociodemographic variables did not influence the relation between burnout and sleep problems, except for being female. The environment and workplace violence, together with psychological traits and shifts, affect the probability of developing burnout and insomnia. The meta-analysis sample was n = 1127 nurses. The effect size of the correlation between burnout and sleep disorders was r = 0.39 (95% CI 0.29−0.48) with p < 0.001, indicating that the higher the level of burnout in nurses, the greater the presence of sleep disorders. The positive correlation between burnout and sleep disorders is a problem that must be addressed to improve the health of nurses. Developing turnicity strategies, using warmer lights in hospital units during night shifts and eliminating the fixed night shift could improve nurses’ working conditions.

Influence of sleep fragmentation and fatigue on turnover of female nurses working rotating shifts

AIMS AND OBJECTIVES

To investigate whether the sleep quality and fatigue of female nurses working rotating shifts could be used to predict future turnover status.

BACKGROUND

Female nurses working rotating shifts often suffer from sleep problems and fatigue, and the turnover rates of nurses are generally higher than those of other hospital personnel.

DESIGN

A prospective study.

METHODS

We recruited a total of 198 female nurses working rotating shifts from December 2017 to March 2019. The nurses completed the Checklist Individual Strength (CIS) scale and wore an actigraph for seven consecutive days in order to collect their sleep parameters. Their turnover status was tracked until 31 May 2021 at which time 55 participants (27.8%) had resigned. The Cox proportional hazard model was used to analyse the factors influencing turnover. In addition, the study adhered to the STROBE checklist.

RESULTS

The results revealed significant differences between the nurses in the still-working group and the resigned group in terms of the sleep quality parameters sleep efficiency (SE) and wake after sleep onset (WASO) as well as CIS scores. WASO was significantly correlated with intensity of fatigue, and fatigue was common among all of the nurses working rotating shifts. As time progressed, the sleep quality parameter WASO and CIS scores could be used to predict turnover status after 2.4 years.

CONCLUSION

The results of this study indicated more sleep fragmentation and poor sleep efficiency in the resigned group. Sleep fragmentation was highly correlated with fatigue, and sleep fragmentation and fatigue could be used to predict turnover status.

RELEVANCE TO CLINICAL PRACTICE

We suggest that relevant hospital management pay more attention to the sleep conditions and fatigue of female nurses working rotating shifts when arranging personnel and schedules and offer them more understanding.

Neuro-enhancement among German junior physicians: Prevalence, reasons and associations to mental health outcomes and quality of life

BACKGROUND

Previous research studies have demonstrated that neuro-enhancement, the use of legal or illegal drugs by healthy individuals to improve their job performance, is practiced among employees. Researchers discussed possible reasons for employees to consider the use of substances for neuro-enhancement.

OBJECTIVE

The aim of this study was to identify the prevalence of usage and motives for practicing neuro-enhancement among a sample of German junior physicians. The secondary objective was to determine associations between neuro-enhancement, mental health outcomes and quality of life.

METHODS

This cross-sectional study included an online survey to analyze junior physicians' neuro-enhancement stimulant use and their motives for usage (n = 873). Second, mental health outcomes and quality of life were assessed. Descriptive and analytic (Kruskal Wallis test, logistic regression) statistics were obtained.

RESULTS

Of the 873 junior physicians, 18% reported having used stimulants for neuro- enhancement. 8% of the physicians have taken prescription stimulants (e.g. modafinil) or illicit drugs (e.g. cannabis) at least once in their lifetime. The most common reasons for taking stimulants were to enhance concentration, to relax and to increase alertness. Neuro-enhancement was associated with emotional exhaustion (p < 0.01), lower quality of life (p < 0.05) and work-related stress (p < 0.01).

CONCLUSIONS

Our study results give an overview on the actual situation regarding frequency and motives for taking performance-enhancing substances. The prevalence rate was low in comparison to current public debates. Decreasing the prevalence of neuro-enhancement among physicians requires the implementation of strategies targeting stress reduction and workload management.

Motherhood and medicine: systematic review of the experiences of mothers who are doctors

OBJECTIVE

To synthesise what is known about women combining motherhood and a career in medicine by examining the published research into their experiences and perspectives.

STUDY DESIGN

We reviewed peer-reviewed articles published or available in English reporting original research into motherhood and medicine and published during 2008-2019. Two researchers screened each abstract and independently reviewed full text articles. Study quality was assessed.

DATA SOURCES

CINAHL, MEDLINE, PsycINFO, Web of Science, and Scopus abstract databases.

DATA SYNTHESIS

The database search identified 4200 articles; after screening and full text assessment, we undertook an integrative review synthesis of the 35 articles that met our inclusion criteria.

CONCLUSIONS

Three core themes were identified: Motherhood: the impact of being a doctor on raising children; Medicine: the impact of being a mother on a medical career; and Combining motherhood and medicine: strategies and policies. Several structural and attitudinal barriers to women pursuing both medical careers and motherhood were identified. It was often reported that women prioritise career advancement by delaying starting a family, and that female doctors believed that career progression would be slowed by motherhood. Few evaluations of policies for supporting pregnant doctors, providing maternity leave, and assisting their return to work after giving birth have been published. We did not find any relevant studies undertaken in Australia or New Zealand, nor any studies with a focus on community-based medicine or intervention studies. Prospective investigations and rigorous evaluations of policies and support mechanisms in different medical specialties would be appropriate.

PROTOCOL REGISTRATION

PROSPERO CRD42019116228.

Job Satisfaction and Turnover Intention Among Anesthesiologists: An Iranian Study

Job satisfaction is shown to be the strongest predictor of turnover intention and actual leaving among healthcare personnel. The aim of this study was to identify job satisfaction and turnover intention among anesthesiologists in Iran. This cross-sectional survey was conducted among 177 anesthesiologists. A set of self-administered questionnaires were applied to evaluate job satisfaction and intention to quit anesthesiology. It was found 39.5% of the participants reported that they wanted to quit the anesthesiology profession in the next year. Multivariate logistic regression analysis revealed that job satisfaction was a significant predictor of intention to leave after controlling for other independent variables. A significant association was found between job satisfaction and anesthesiologists' intention to leave their current employment. Therefore, increasing anesthesiologists' job satisfaction can lead to a higher propensity to retention in the healthcare system.

Spotlight on Japanese physicians: An exploration of their professional experiences elicited by means of narrative facilitators

BACKGROUND

While investigation of physicians' work experience is often limited to issues of satisfaction or burnout, a broader view of their experiences is lacking.

OBJECTIVE

To explore professional experiences, we asked Japanese physicians (N = 18, 12 men and 6 women) of a general hospital to react to so-called "narrative facilitators".

METHODS

The narrative facilitators - inspired by clinical psychology, visual sociology and purpose-designed techniques - oriented physicians' narratives towards clinical practise, relationship with peers and context. Transcribed interviews were subject to thematic analysis.

RESULTS

The thematic analysis of participants' narratives revealed a lonely physician with a tough job, torn between the ideal of patient-centred care and a clinical reality, which limits these aspirations. Patients emerged as anxious and burdensome consumers of medicine. Feeling neither supported by peers nor the institution, physicians also perceived the society as somewhat negligent, delegating its problem to medicine. Communication difficulties, with patients and peers, and the absence of joyful aspects of the profession constituted fundamental elements of their narratives.

CONCLUSIONS

Comprehensive investigation of physicians' lived professional experience could become a key to conceive ways to support them.

Estimating institutional physician turnover attributable to self-reported burnout and associated financial burden: a case study

Background

Awareness of the economic cost of physician attrition due to burnout in academic medical centers may help motivate organizational level efforts to improve physician wellbeing and reduce turnover. Our objectives are: 1) to use a recent longitudinal data as a case example to examine the associations between physician self-reported burnout, intent to leave (ITL) and actual turnover within two years, and 2) to estimate the cost of physician turnover attributable to burnout.

Methods

We used de-identified data from 472 physicians who completed a quality improvement survey conducted in 2013 at two Stanford University affiliated hospitals to assess physician wellness. To maintain the confidentially of survey responders, potentially identifiable demographic variables were not used in this analysis. A third party custodian of the data compiled turnover data in 2015 using medical staff roster. We used logistic regression to adjust for potentially confounding factors.

Results

At baseline, 26% of physicians reported experiencing burnout and 28% reported ITL within the next 2 years. Two years later, 13% of surveyed physicians had actually left. Those who reported ITL were more than three times as likely to have left. Physicians who reported experiencing burnout were more than twice as likely to have left the institution within the two-year period (Relative Risk (RR) = 2.1; 95% CI = 1.3–3.3). After adjusting for surgical specialty, work hour categories, sleep-related impairment, anxiety, and depression in a logistic regression model, physicians who experienced burnout in 2013 had 168% higher odds (Odds Ratio = 2.68, 95% CI: 1.34–5.38) of leaving Stanford by 2015 compared to those who did not experience burnout. The estimated two-year recruitment cost incurred due to departure attributable to burnout was between $15,544,000 and $55,506,000. Risk of ITL attributable to burnout was 3.7 times risk of actual turnover attributable to burnout.

Conclusions

Institutions interested in the economic cost of turnover attributable to burnout can readily calculate this parameter using survey data linked to a subsequent indicator of departure from the institution. ITL data in cross-sectional studies can also be used with an adjustment factor to correct for overestimation of risk of intent to leave attributable to burnout.

Mental health promotion for junior physicians working in emergency medicine: evaluation of a pilot study

OBJECTIVES

Work-related stress is highly prevalent among physicians working in emergency medicine. Mental health promotion interventions offer the chance to strengthen physicians' health, work ability, and performance. The aim of this study was to implement and evaluate a mental health promotion program for junior physicians working in emergency medicine.

METHODS

In total, 70 junior physicians working in emergency medicine were randomized to either the mental health promotion program (n=35) or a waitlist control arm (n=35). The training involved 90-min sessions over a time period of 3 months. The primary outcome was perceived stress. The secondary outcomes included emotional exhaustion, emotion regulation, work engagement, and job satisfaction. Self-report assessments for both groups were scheduled at baseline, after the training, after 12 weeks, and 6 months.

RESULTS

The intervention group showed a highly significant reduction in perceived stress and emotional exhaustion from baseline to all follow-up time points, with no similar effects found in the comparison group. The benefit of the mental health promotion program was also evident in terms of improved emotion regulation skills, job satisfaction, and work engagement. Participating physicians evaluated the training with high scores for design, content, received outcome, and overall satisfaction.

CONCLUSION

The results suggest that this health promotion program is a promising intervention to strengthen mental health and reduce perceived work stress. It is suitable for implementation as a group training program for junior physicians working in emergency medicine. Comparable interventions should be pursued further as a valuable supportive offer by hospital management.

A systematic review of effort-reward imbalance among health workers

The purpose of this article is to systematically collate effort-reward imbalance (ERI) rates among health workers internationally and to assess gender differences. The effort-reward (ER) ratio ranges quite widely from 0.47 up to 1.32 and the ERI rate from 3.5% to 80.7%. Many studies suggested that health workers contribute more than they are rewarded, especially in Japan, Vietnam, Greece, and Germany-with ERI rates of 57.1%, 32.3%, 80.7%, and 22.8% to 27.6%, respectively. Institutions can utilize systems such as the new appraisal and reward system, which is based on performance rather than the traditional system, seniority, which creates a more competitive working climate and generates insecurity. Additionally, an increased workload and short stay patients are realities for workers in a health care environment, while the structure of human resources for health care remains inadequate. Gender differences within the ER ratio can be explained by the continued impact of traditional gender roles on attitudes and motivations that place more pressure to succeed for men rather than for women. This systematic review provides some valued evidence for public health strategies to improve the ER balance among health workers in general as well as between genders in particular. An innovative approach for managing human resources for health care is necessary to motivate and value contributions made by health workers.

Who Cares for Those Who Take Care? Risks and Resources of Work in Care Homes

Over the years – due to the aging population, the process of corporatisation and a demand for a higher quality of services – professionals who work in Care Homes have been exposed to an increasing risk of physical and emotional malaise because of the number of challenges they’ve been asked to manage. Given these factors, there is a growing interest in the study and understanding of professions in geriatric care settings. In the literature there is a prevalence of quantitative studies offering an overview in terms of indicators – at the individual or group or organizational level – concerning the potential development of situations of professional malaise. Conversely, there is a lack of qualitative studies exploring the risk and protection factors. For this reason, in this study we decided to use a qualitative approach to explore “more up close” this kind of organizational context and to keep together the different levels in systemic terms in order to identify – according to professionals’ perceptions – resource factors (in order to leverage these aspects) and fatigue factors (to identify them and treat them). Three Italian Care Homes were involved and the interview’s sample was composed of 45 professionals – 15 nurses, 30 total Patient Care Assistants (PCAs) and Auxiliary Care Assistants (ACAs), of these, 17 males and 28 females, with an average age of 43 years (SD = 0.78) – selected using a sampling of maximum variability. From the analysis of the materials there seem to be four profiles of the professionals involved. Implications to ensure a functional human resource management are discussed for the purpose of promote the well-being of the various professionals, and, as a result, an increasing quality of service.

Burnout and depression among medical residents in the United Arab Emirates: A Multicenter study

Introduction:

Persistent imbalance between work demands and resources seems to be a crucial contributor to the development of burnout among medical professionals. Yet, it seems that Middle East is lacking studies analyzing psychological well-being's of medical residents. Hence, we aimed to conduct a nationwide study to understand and address burnout and depression in medical residents in the UAE.

Methods:

A multicenter, cross-sectional study was designed to evaluate professional burnout and depression among medical residents to address the gap.

Results:

Our results indicate that 75.5% (216/286) of UAE medical residents had moderate-to-high emotional exhaustion (EE), 84% (249/298) had high depersonalization (DP), and 74% (216/291) had a low sense of personal accomplishment. In aggregate, 70% (212/302) of medical residents were considered to be experiencing at least one symptom of burnout based on a high EE score or a high DP score. Depression ranging from 6% to 22%, depending on the specialty was also noted. Noticeably, 83% (40/48) of medical residents who had high scores for depression also reported burnout.

Conclusions:

This study shows that burnout and depression are high among medical residents in UAE. There is a crucial need to address burnout through effective interventions at both the individual and institutional levels. Professional counseling services for residents will certainly be a step forward to manage resident burnout provided the social stigma associated with counseling can be eliminated with awareness. The work hour regulations suggested by the Accreditation Council for Graduate Medical Education partly provides a solution to improve patient safety and care quality. There is an urge to reconfigure the approach to medical training for the well-being of the next generation of physicians in the Arab world.

Work family conflict in its relations to perceived working situation and work engagement

BACKGROUND

These days physicians' work is characterized by an increase in economic demands, pressure and challenges in establishing a balance between work and family life. The current study investigates the relationship between physicians' job demands and resources, perceived job stress, work-family conflict, work engagement and job satisfaction.

METHODS

564 clinicians specialising in different medical fields participated in the cross-sectional study. Self-administered questionnaires, including the COPSOQ and the UWES- Scale were administered.

RESULTS

Our results illustrated significant relationships between physicians' work engagement and their job satisfaction as well as between job stress and work family conflict. Moreover, perceived job stress moderated the effect of high job demands on work family conflict. In addition, significant gender differences have been found in perceived stress levels, work family conflict and work engagement.

CONCLUSION

This study proves and verified associations between work engagement, work-family conflict, job demands and resources that may influence employees' satisfaction. Implications for both working physicians and hospital management are given.

[Compatibility of Work and Family Life of Employees in the Healthcare Sector: An Issue in Health Services Research]

Hintergrund/Ziele

Beschäftigte im Gesundheitswesen sind mit besonderen beruflichen Rahmenbedingungen und Anforderungen konfrontiert, die sich auf das Verhältnis von Familie und Arbeit/Beruf auswirken können und mittelbar auch die Qualität der Gesundheitsversorgung beeinflussen. Ziel des vorliegenden Beitrags ist es, einen Überblick über den Forschungsstand zu diesem Thema zu geben. Dieser ist für die Versorgungsforschung von Relevanz. Er kann als Ausgangspunkt dafür dienen, Strukturen im Gesundheitswesen (auch in ländlichen Regionen) dahingehend zu verändern, dass sie eine bessere Vereinbarkeit von Familie und Beruf ermöglichen.

Methode

Es wurde eine systematische nationale und internationale Literaturrecherche in Form eines Scoping Review durchgeführt, um den aktuellen Forschungsstand zur Vereinbarkeit von Familie und Gesundheitsberuf zu dokumentieren. Als inhaltliche Suchkriterien wurden definiert: Vereinbarkeit von Beruf und Familie (allgemein); Vereinbarkeitserleben und -konflikte bei Gesundheitsberufen; Vereinbarkeit von Familie und Gesundheitsberuf im ländlichen Raum; Interventionsansätze zur Förderung der Vereinbarkeit von Beruf und Familie. Im Ergebnis eines mehrstufigen Selektionsprozesses wurden 145 Publikationen in die inhaltliche Auswertung einbezogen.

Ergebnisse

Die dokumentierte Literatur bezieht sich schwerpunktmäßig auf die Berufsgruppen Ärzte und beruflich Pflegende, für andere Berufsgruppen liegen kaum Arbeiten vor. Die methodische Qualität der Studien ist meist niedrig, Metaanalysen liegen nicht vor. Mehrere Arbeiten dokumentieren eine Unzufriedenheit bei Ärzten und beruflich Pflegenden bzgl. Möglichkeiten der Vereinbarkeit von Familie und Beruf. Es konnten nur wenige Interventionsstudien zur Förderung der Vereinbarkeit von Familie und Beruf gefunden werden, diese sind wiederum nur teilweise spezifisch auf Gesundheitsberufe ausgerichtet. Defizite bestehen zudem hinsichtlich der Vernetzung mit Fragen der Verbesserung der Gesundheitsversorgung in ländlichen Gebieten.

Schlussfolgerung

Zur Thematik „Vereinbarkeit von Familie und Gesundheitsberuf“ existiert national wie international nur wenig systematische Forschung. Insbesondere zur Evaluation von Maßnahmen bestehen Defizite. Der Literaturüberblick ermöglicht die Ableitung von Ansatzpunkten, um eine Verbesserung der Vereinbarkeit von Familie und Beruf zu erreichen.

A pilot study evaluation of psychosocial competency training for junior physicians working in oncology and hematology

BACKGROUND

This pilot and feasibility study evaluated a work-related self-care competency training in oncology and hematology medicine for junior physicians working in oncology and hematology medicine.

METHODS

A pilot study was conducted with 80 physicians working in oncology and hematology hospital departments in Germany. Physicians were distributed to either the intervention group receiving competency training or a comparison group. The intervention took place in groups over a period of 12 weeks. Training content included work-related self-care strategies, problem-solving techniques solution-focused counselling. The outcomes studied were changes in work-related stress, emotional exhaustion, emotion regulation, and job satisfaction. Follow-up assessments were arranged after 12 weeks (T1), after 24 weeks (T2), and after 36 weeks (T3).

RESULTS

Intervention group reached a decrease in perceived job stress and emotional exhaustion. Self-perceived improvements were also obvious regarding enhanced emotion regulation skills. Future oncologists valued the intervention with high scores for training design, content, received outcome, and overall training satisfaction.

CONCLUSIONS

This study provided first indications that an innovative self-care competency training might be a supportive approach for junior physicians starting work in oncology and hematology. However, replication studies are needed to verify the results in the medical working context.

La conciliation travail-famille : le défi des mères médecins

Les médecins, compte tenu des exigences de leur profession, présentent d’importantes difficultés de conciliation travail-famille. Des mesures favorisant la conciliation travail-famille seraient bénéfiques pour tous les médecins (particulièrement pour les femmes), leurs enfants et leurs patients.

Burnout among young physicians and its association with physicians' wishes to leave: results of a survey in Saxony, Germany

Background

Concerns about burnout, and its consequences, among German physicians are rising. However, data on burnout among German physicians are scarce. Also, a suspected association between burnout and German physicians’ wishes to leave remains to be studied. Therefore, the extent of burnout, and the association between burnout and wishes to leave clinical practice or to go abroad for clinical work was studied in a sample of young physicians in Saxony.

Methods

In a cross-sectional survey, all physicians ≤40 years and registered with the State Chamber of Physicians of Saxony, Germany (n = 5956) received a paper-pencil questionnaire inquiring about socio-demographics, job satisfaction, and wishes to leave clinical practice or to go abroad for clinical work. Response rate was 40 % (n = 2357). Burnout was measured with the German version of the Maslach Burnout Inventory - Human Services Survey (MBI) consisting of the subscales emotional exhaustion (feeling emotionally drained), depersonalization (feelings of cynicsm) and personal accomplishment (feelings of personal achievement in job). Variables associated with burnout, and the association between burnout and wishes to leave were assessed in multivariate logistic regression analyses.

Results

For emotional exhaustion participants reached a mean of 21.3 [standard deviation = 9.74], for depersonalization a mean of 9.9 [5.92], and for personal accomplishment a mean of 36.3 [6.77]. Men exhibited significantly higher depersonalization than women (11.3 [6.11] versus 9 [5.62], p < 0.001). Eleven percent of participants showed a high degree of burnout on all subscales, while 35 % did not show a high degree of burnout on any subscale. Confirming that one would become a physician again, and higher satisfaction with the components “work environment” and “humaneness”, were associated with a lower chance for a high degree of burnout on all subscales. Higher emotional exhaustion and lower personal accomplishment were associated with an increased chance of wishing to leave clinical practice. Higher emotional exhaustion and higher depersonalization were associated with an increased chance of wishing to go abroad for clinical work.

Conclusions

Preventing physician burnout may not only benefit the affected individual. It may also benefit the health care system by potentially preventing physicians from leaving clinical practice or from going abroad for clinical work.

Habilitations as a bottleneck? A retrospective analysis of gender differences at the Medical University of Vienna

BACKGROUND

The share of female physicians who drop out of a university career increases disproportionately with every career step. In this project, we analysed careers at the Medical University of Vienna (formerly the Medical Faculty at the University of Vienna) in the time span from 1992 to 2012 to explore the particular role of habilitations as a potential obstacle for women striving to pursue a career in science.

METHODS

To gain both a macro- and micro-view of the phenomenon of habilitations, a descriptive analysis of the data found in the archive of the Medical University of Vienna was carried out as a first step. Building on these results, structured interviews with the female physicians who were involved in the habilitation procedures at that time were conducted.

RESULTS

While hardly any gender-based differences or discrimination can be reported for the habilitation procedures themselves, the research clearly reveals that the disparity in habilitations by men and women is a manifestation of unequal access to informal networks, differences regarding integration in the scientific community and available time resources. It is unlikely that the rising number of women completing doctoral studies in the field of medicine will automatically lead to a harmonisation of habilitation numbers.

CONCLUSION

The analysis of existing gender-based differences with regard to habilitations in the field of medicine shows that they result from multiple processes that are subtle and relatively resistant to change.

Physicians' intention to leave direct patient care: an integrative review

BACKGROUND

In light of the growing shortage of physicians worldwide, the problem of physicians who intend to leave direct patient care has become more acute, particularly in terms of quality of care and health-care costs.

METHODS

A literature search was carried out following Cooper's five-stage model for conducting an integrative literature review. Database searches were made in MEDLINE, PsycINFO and Web of Science in May 2014.

RESULTS

A total of 17 studies from five countries were identified and the study results synthesized. Measures and percentages of physicians' intention to leave varied between the studies. Variables associated with intention to leave were demographics, with age- and gender-specific findings, family or personal domain, working time and psychosocial working conditions, job-related well-being and other career-related aspects. Gender differences were identified in several risk clusters. Factors such as long working hours and work-family conflict were particularly relevant for female physicians' intention to leave.

CONCLUSIONS

Health-care managers and policy-makers should take action to improve physicians' working hours and psychosocial working conditions in order to prevent a high rate of intention to leave and limit the number of physicians actually leaving direct patient care. Further research is needed on gender-specific needs in the workplace, the connection between intention to leave and actually leaving and measures of intention to leave as well as using qualitative methods to gain a deeper understanding and developing validated questionnaires.

Managing work-family conflict in the medical profession: working conditions and individual resources as related factors

OBJECTIVES

This study developed and tested a research model that examined the effects of working conditions and individual resources on work-family conflict (WFC) using data collected from physicians working at German clinics.

MATERIAL AND METHODS

This is a cross-sectional study of 727 physicians working in German hospitals. The work environment, WFC and individual resources were measured by the Copenhagen Psychosocial Questionnaire, the WFC Scale, the Brief Resilient Coping Scale and the Questionnaire for Self-efficacy, Optimism and Pessimism. Descriptive, correlation and linear regression analyses were applied.

RESULTS

Clinical doctors working in German hospitals perceived high levels of WFC (mean=76). Sociodemographic differences were found for age, marital status and presence of children with regard to WFC. No significant gender differences were found. WFCs were positively related to high workloads and quantitative job demands. Job resources (eg, influence at work, social support) and personal resources (eg, resilient coping behaviour and self-efficacy) were negatively associated with physicians' WFCs. Interaction terms suggest that job and personal resources buffer the effects of job demands on WFC.

CONCLUSIONS

In this study, WFC was prevalent among German clinicians. Factors of work organisation as well as factors of interpersonal relations at work were identified as significant predictors for WFC. Our results give a strong indication that both individual and organisational factors are related to WFC. Results may play an important role in optimising clinical care. Practical implications for physicians' career planning and recommendations for future research are discussed.

The impact of training and working conditions on junior doctors' intention to leave clinical practice

BACKGROUND

The shortage of physicians is an evolving problem throughout the world. In this study we aimed to identify to what extent junior doctors' training and working conditions determine their intention to leave clinical practice after residency training.

METHODS

A prospective cohort study was conducted in 557 junior doctors undergoing residency training in German hospitals. Self-reported specialty training conditions, working conditions and intention to leave clinical practice were measured over three time points. Scales covering training conditions were assessed by structured residency training, professional support, and dealing with lack of knowledge; working conditions were evaluated by work overload, job autonomy and social support, based on the Demand-Control-Support model. Multivariate ordinal logistic regression analyses with random intercept for longitudinal data were applied to determine the odds ratio of having a higher level of intention to leave clinical practice.

RESULTS

In the models that considered training and working conditions separately to predict intention to leave clinical practice we found significant baseline effects and change effects. After modelling training and working conditions simultaneously, we found evidence that the change effect of job autonomy (OR 0.77, p = .005) was associated with intention to leave clinical practice, whereas for the training conditions, only the baseline effects of structured residency training (OR 0.74, p = .017) and dealing with lack of knowledge (OR 0.74, p = .026) predicted intention to leave clinical practice.

CONCLUSIONS

Junior doctors undergoing specialty training experience high workload in hospital practice and intense requirements in terms of specialty training. Our study indicates that simultaneously improving working conditions over time and establishing a high standard of specialty training conditions may prevent junior doctors from considering leaving clinical practice after residency training.