Older Physicians' Reporting of Psychological Distress, Alcohol Use, Burnout and Workplace Stressors

How do patients' perceptions and doctors' images impact patient decisions? Deconstructing online physician selection using multimodal data

In the post-pandemic era, medical resources are uneven, and access to healthcare is complicated. Online medical platforms have become a solution to bridge the information gap and reduce hospital pressure. This study uses the stereotype content model and signaling theory to explore the impact of patient perception of patient decision making (PDM) on online medical service platforms. Also, it tests the moderating effect of physician image. We collected information on 12,890 physicians and 746,981 patient reviews from online medical platforms in China. Unsupervised machine learning was used to construct a topic model to extract patients' perceptions of physicians' competence and warmth. Meanwhile, the facial features of physicians, such as age, smile, and glasses, are recognized by convolutional neural networks. Finally, the influence of PDM concern on decision-making and the moderating effect of physician image were analyzed by multiple linear regression. The results of the study showed that (1) patients' perceptions of physicians' competence and warmth had a positive effect on decision-making; (2) physicians' age and wearing glasses enhanced the positive effect of perception on decision-making; and (3) however, physicians' smiles weakened the positive effect of perception on decision-making. This study provides new insights into patients' online physician selection, guides the construction and promotion of medical service platforms, and provides an effective avenue of exploration to alleviate the problem of uneven distribution of offline medical resources.

Exploring antecedents and outcomes of burnout among emergency department staff using the job demands-resources model: A scoping review protocol

INTRODUCTION

High levels of burnout are prevalent among Emergency Department staff due to chronic exposure to job stress. There is a lack of knowledge about anteceding factors and outcomes of burnout in this population.

AIMS

To provide a comprehensive overview of burnout and identify its workplace antecedents and outcomes among Emergency Department staff.

METHODS

The scoping study will follow the methodology outlined by the Joanna Briggs Institute. PubMed, Scopus, Web of Science, APA PsycInfo, and CINAHL databases will be searched using predefined strategies. Two reviewers will screen the title, abstract and full text separately based on the eligibility criteria. Data will be charted, coded, and narratively synthesized based on the job demands-resources model.

CONCLUSION

The results will provide insights into the underlying work-related factors contributing to burnout and its implications for individuals, healthcare organizations, and patient care.

The association between workload, alcohol use, and alcohol misuse among psychiatrists in China

Aim

Survey alcohol use and workload among Chinese psychiatrists and explore their associations.

Methods

We conducted an online questionnaire among psychiatrists working in large psychiatric institutions across the country. We collected data including demographic factors, alcohol use, and workload. Alcohol use was assessed using the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C), and workload-related questions included working hours, night shifts, and caseloads.

Results

In total, 3,549 psychiatrists completed the survey. Nearly half (47.6%) reported alcohol use, and the percentage of alcohol use in males (74.1%) was significantly higher than in females. 8.1% exceeded the AUDIT-C cutoff scores for probable alcohol misuse (19.6%in males and 2.6%in females). AUDIT-C scores were significantly correlated with working hours per week (p = 0.017) and the number of outpatient visits per week (p = 0.006). Regressional analysis showed that alcohol use was significantly associated with the following factors: longer working hours (Working more than 44 h/week, OR = 1.315), having an administrative position (OR = 1.352), being male (OR = 6.856), being single (OR = 1.601), being divorced or widowed (OR = 1.888), smoking (OR = 2.219), working in the West (OR = 1.511) or the Northeast (OR = 2.440). Regressional analysis showed that alcohol misuse was significantly associated with the following factors: fewer night shifts (Three to four night shifts/month, OR = 1.460; No more than 2 night shifts/month, OR = 1.864), being male (OR = 4.007), working in the Northeast (OR = 1.683), smoking (OR = 2.219), frequent insomnia (OR = 1.678).

Conclusion

Nearly half of the psychiatrists in China reported alcohol use and 8.1% had probable AUD. Alcohol consumption is significantly associated with several workload-related factors, such as long working hours, heavy caseload, and administrative duties. Alcohol misuse was inversely associated with the number of night shifts per month. While the direction of causality is unclear, our findings may help identify vulnerable professional groups and develop more targeted interventions to improve healthcare professionals' well-being.

Health and Well-Being of Intensive Care Unit Physicians: How to Ensure the Longevity of a Critical Specialty

A second epidemic of burnout, fatigue, anxiety, and moral distress has emerged concurrently with the coronavirus disease 2019 (COVID-19) pandemic, and critical care physicians are especially affected. This article reviews the history of burnout in health care workers, presents the signs and symptoms, discusses the specific impact of the COVID-19 pandemic on intensive care unit caregivers, and attempts to identify potential strategies to combat the Great Resignation disproportionately affecting health care workers. The article also focuses on how the specialty can amplify the voices and highlight the leadership potential of underrepresented minorities, physicians with disabilities, and the aging physician population.

LGBTQ+ Identity and Ophthalmologist Burnout

PURPOSE

To evaluate lesbian, gay, bisexual, transgender, questioning, and other sexual/gender minority (LGBTQ+) orientation as a burnout risk factor among an international ophthalmologist cohort.

METHODS

An anonymous, cross-sectional electronic survey was distributed via an Internet platform to characterize the relationship among demographic factors, including LGBTQ+ orientation, and burnout as measured by the Copenhagen Burnout Inventory (CBI). Univariable data analysis (linear) by sexual orientation was performed and variables with an association with a P value of <0.15 in univariable analysis were included in the multiple linear regression modeling.

RESULTS

A total of 403 ophthalmologists participated in the survey. The majority self-identified as "White" (69.2%), were from North America (72.0% United States, 18.6% Canada) and were evenly distributed between age of 30 and 65 years. Overall, 13.2% of participants identified as LGBTQ+ and 98.2% as cisgender. Approximately 12% had witnessed or experienced LGBTQ+-related workplace discrimination or harassment. The personal and work-related burnout scores and confidence limits of persons identified as LGBTQ+ were higher and nonoverlapping compared with those reported as non-LGBTQ+. Multivariable analysis identified significant risk factors for higher personal and work-related burnout scores: LGBTQ+ (11.8 and 11.1, P = .0005 and .0023), female gender (5.36 and 4.83, P = .0153 and .0434), older age (19.1 and 19.2, P = .0173 and .0273). and caretaker stress (6.42 and 5.97, P = .0085 and .0239).

CONCLUSIONS

LGBTQ+ orientation is a burnout risk factor among ophthalmologists, and LGBTQ+ workplace discrimination may be a contributing factor. Support from ophthalmology organizations to address LGBTQ+-, gender-, and age-related workplace discrimination may decrease burnout. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

Rates of perceived medical errors and its correlation with work-related factors and personal distress among emergency physicians in China: a national cross-sectional study

Purpose

Medical errors are a global concern, and specifically, EDs are at considerable risk for medical errors. Few studies focus on the healthcare provider’s self-perceived medical errors in hospitals, let alone the ED. Hence, this study explored perceived medical errors and their correlation with work-related factors and personal distress among physicians in EDs in China.

Methods

From July 2018 to August 2018, a national web-based cross-sectional study was conducted. The link to the web-based questionnaire was posted on the emergency physicians’ working platform, inviting Chinese licensed emergency physicians to participate anonymously in this survey. Our outcome of interest, medical errors, was investigated using self-reporting methods. Occupational stress was assessed using the Chinese version of the Effort-Reward Imbalance scale. The Patient Health Questionnaire, the subscale of the 10-item Positive and Negative Affect Schedule, the subscale of the validated Leiden Quality of Work Questionnaire and the 10-item Generalised Self-efficacy Scale were used to assess personal distress. Logistic regression analysis was used to determine factors significantly associated with perceived medical errors.

Results

A sample of 10 457 emergency physicians completed the survey. Almost half (43.63%) of physicians reported self-perceived medical errors during the previous 3 months. The rate of workplace verbal aggression, effort-reward imbalance and depressive symptoms were 81.81%, 78.39% and 35.71%, respectively. Medical errors were more likely to be reported among chief physicians, and those who reported the department was short-staffed for physicians, and who experienced workplace verbal aggression and intense work stress. Medical errors were significantly associated with negative affect and lower self-efficacy.

Conclusion

Self-perceived medical errors are prevalent among physicians working in EDs and are associated with their workplace environment and personal distress. Targeted interventions are required to reduce physicians’ workload and improve their working environment. Accounting for healthcare providers’ distress is imperative for reducing the incidence of medical errors and improving their health.

Psychological distress among outpatient physicians in private practice linked to COVID-19 and related mental health during the second lockdown

BACKGROUND

Outpatient physicians in private practice, as inpatient physicians, are on the frontline of the COVID-19 pandemic. Mental-health consequences of the pandemic on hospital staff have been published, but the psychological distress among outpatient physicians in private practice due to COVID-19 has never been specifically assessed.

METHODS

A French national online cross-sectional survey assessed declared psychological distress among outpatient physicians in private practice linked to COVID-19, sociodemographic and work conditions, mental health (Copenhagen Burn-out Inventory, Hospital Anxiety and Depression Scale, and the Insomnia severity Index), consequences on alcohol, tobacco, and illegal substance misuse, and sick leave during the 2nd COVID-19 wave.

FINDINGS

Among the 1,992 physicians who answered the survey, 1,529 (76.8%) declared psychological distress linked to COVID-19. Outpatient physicians who declared psychological distress linked to COVID-19 had higher rates of insomnia (OR = 1.4; CI95 [1.1-1.7], p = 0.003), burnout (OR = 2.7; CI95 [2.1; 3.2], p < 0.001), anxiety and depressive symptoms (OR = 2.4; CI95 [1.9-3.0], p < 0.001 and OR = 1.7; CI95 [1.3-2.3], p < 0.001) as compared to physicians who did not. They also had higher psychotropic drug use in the last twelve months, or increased alcohol or tobacco consumption due to work-related stress and were more frequently general practitioners.

INTERPRETATION

The feeling of being in psychological distress due to COVID-19 is highly frequent among outpatient physicians in private practice and is associated with mental health impairment. There is a need to assess specific interventions dedicated to outpatient physicians working in private practice.

Effectiveness of a multi-modal hospital-wide doctor mental health and wellness intervention

BACKGROUND

Doctors report high rates of workplace stress and are at increased risk of mental health disorders. However, there are few real-world studies evaluating the effectiveness of interventions aimed at addressing workplace risk factors and improving doctors' mental health in a hospital setting. This study was conducted over two years (2017-2019) to assess the effects of a multi-modal intervention on working conditions doctors' mental health and help-seeking for mental health problems in two Australian teaching hospitals.

METHODS

The multimodal intervention consisted of organisational changes, such as reducing unrostered overtime, as well as strategies for individual doctors, such as mental health training programs. Hospital-based doctors at all career stages were eligible to participate in two cross-sectional surveys. 279 doctors completed the baseline survey (19.2% response rate) and 344 doctors completed the follow-up survey (31.3% response rate). A range of workplace risk and protective factors, mental health (psychological distress and suicidal ideation) and help-seeking outcomes were assessed.

RESULTS

There were significant improvements in key workplace protective factors, with small effects found for doctors' job satisfaction, stress, work-life balance and perceived workplace support and a significant reduction in workplace risk factors including a moderate reduction in reported bullying behaviour between baseline to follow-up (job satisfaction p < 0.05, all other outcomes p < 0.01). However, no significant changes in doctors' mental health or help-seeking outcomes were found over the intervention period.

CONCLUSION

Following the implementation of individual and organisational-level strategies in two Australian tertiary hospitals, doctors reported a reduction in some key workplace stressors, but no significant changes to their mental health or help-seeking for mental health problems. Further research is warranted, particularly to determine if these workplace changes will lead to improved mental health outcomes for doctors once maintained for a longer period.

Canadian emergency medicine physician burnout: a survey of Canadian emergency physicians during the second wave of the COVID-19 pandemic

Objectives

A previous survey of Canadian emergency medicine (EM) physicians during the first wave of the COVID-19 pandemic documented less than 20% experienced high levels of burnout. This study examined the experience of a similar group of physicians during the second pandemic wave. We reported the associations between burnout and physician age, gender, having children at home and training route.

Methods

This study utilized a national survey of Canadian emergency physicians. We collected data on demographics and measured burnout using the Maslach Burnout Inventory (MBI). Multiple logistic regression models identified associations between the emotional exhaustion and depersonalization domains of the MBI and EM physician demographics (age, gender, children living at home, and training route).

Results

Between November 25, 2020, and February 4, 2021, 416 emergency physicians completed the survey, representing all Provinces or Territories in Canada (except Nunavut). The mean participant age was 44, 53% were male, 64% had children living at home and 41% were FRCPC and 41% CCFP-EM trained. Sixty percent reported high burnout (either high emotional exhaustion and/or high depersonalization). Increasing age was associated with lower emotional exhaustion and depersonalization; female or nonbinary gender was associated with an increase in emotional exhaustion; and having children living at home was associated with lower depersonalization.

Conclusions

Most Canadian emergency physicians participating in our study during the COVID-19 pandemic reported high burnout levels. Younger physicians and female physicians were more likely than their coworkers to report high burnout levels. Hospitals should address emergency physician burnout during the pandemic because it is a threat to quality of patient care and retention of the workforce for the future.

Supplementary Information

The online version contains supplementary material available at 10.1007/s43678-021-00259-9.

Social support and subjective well-being among postgraduate medical students: the mediating role of anxiety and the moderating role of alcohol and tobacco use

Medical students often face pressures from various sources in the course of postgraduate studies, and these factors have a negative impact on their subjective well-being. Previous researches have revealed that social support is a vital factor influencing subjective well-being, but unfortunately the underlying mechanism for this is unclear, especially for postgraduate medical students. The current study has inspected the effects of social support on subjective well-being of postgraduate medical students, the mediating role of anxiety and the moderating role of alcohol and tobacco use in the association between social support and subjective well-being of postgraduate medical students. A sample of 900 postgraduate medical students (Mage = 27.01 years, SD = 3.33) from The Second Affiliated Hospital of Nanchang University completed the Social Support Rating Scale, the Generalized Anxiety Disorder-7, the Tobacco and Alcohol Use Questionnaire and the Subjective Well-Being Scale. Analysis of the structural equation model revealed that anxiety partially mediated the relationship between social support and subjective well-being of postgraduate medical students, while alcohol and tobacco use moderated the relationship between anxiety and subjective well-being of postgraduate medical students. This study revealed how social support act upon subjective well-being of postgraduate medical students. This study provides a theoretical basis for promoting and enhancing the subjective well-being of postgraduate medical students.

Doctors' reporting of mental health stigma and barriers to help-seeking

BACKGROUND

Medical practitioners experience high levels of mental disorders but may be reluctant to seek care.

AIMS

To determine medical practitioner attitudes towards other doctors with anxiety/depression, barriers to seeking mental healthcare, treatments received for depression and the effects of age.

METHODS

Data from the National Mental Health Survey of Doctors and Medical Students, conducted in Australia, were analysed (N = 10 038 medical practitioners). Attitudes to anxiety/depression were assessed with 12 statements (total stigma score, range 12-60). Barriers to seeking professional help, and coping strategies used, for anxiety/depression were measured. Practitioners with a history of depression were asked what personal supports and treatments were received. Practitioners were compared by age-younger (40 years and younger), middle-aged (41-60) and older (61+).

RESULTS

Attitudes and help-seeking behaviours varied with age. Older doctors had a more positive outlook and less total stigma, with the exception that they believed a doctor with anxiety/depression was less reliable. Younger practitioners were most likely to report barriers, such as confidentiality, impact on career progression and registration, to seeking help. For practitioners with depression, counselling and counselling plus medication were most likely to be received by the younger and middle-aged groups, whereas medication alone was most likely to be received by the middle-aged and older groups.

CONCLUSIONS

Stigmatizing attitudes towards mental disorder and barriers to help-seeking remain prevalent within the medical profession. Our results suggest doctors' health programs should address mental health stigma in younger practitioners and facilitate education about psychological treatments in older practitioners.

Job Demands and Resources, Burnout, and Psychological Distress of Employees in the Chinese Non-profit Sector

The non-profit sector in China has expanded significantly in the past few decades. However, employees in non-profits experience high burnout rates, indicating a need to study non-profit work conditions and their effect on employees. This study applies the job demands and resources (JD-R) model and examines the effects of job demands (JD) and job resources (JR) on burnout and psychological distress experienced by non-profit employees, recruited via quota sampling, across China (n = 233). The findings from path analysis showed that JR had strong and negative effects on burnout and on psychological distress, while JD had strong and positive effects on burnout and on psychological distress. Burnout partially mediated the relations between JD-R and psychological distress. These results highlight the importance of JD-R in reducing burnout and psychological distress in non-profit employees in China. Research and practice implications are discussed.