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      The impact of gender and working hours on pulmonary physician burnout

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          Abstract

          Background

          Physician burnout has attracted an increasing amount of attention as a global public health problem. It is associated with negative clinical and organizational outcomes, including lower patient satisfaction, patient safety, and quality of care. The work of pulmonary physicians involves high levels of stress, putting them at higher risk of burnout. This study aimed to evaluate the personal and professional characteristics associated with burnout among pulmonary physicians.

          Methods

          Between March 2020 and May 2020, a survey to evaluate burnout and career satisfaction among pulmonary physicians was conducted in Shanghai Pulmonary Hospital. The survey collected information on physician characteristics, career satisfaction, and burnout. The Maslach Burnout Inventory (MBI), the gold standard tool for measuring burnout, was used to measure burnout symptoms. Self-reported professional satisfaction in relation to career, specialty, and work–life balance was recorded.

          Results

          Of 130 pulmonary physicians contacted, 125 (96.1%) completed full-length surveys. Ninety-one (72.8%) of these 125 physicians were female. The survey participants had a median age of 40 years. Of the respondents, 48.8% had at least one symptom of burnout according to high emotional exhaustion (EE) score and/or high depersonalization (DP) score. Univariable analysis showed female gender, the number hours worked per week, the number of nights on call per month, and the number of calls per night shift to be factors associated with burnout. Gender and hours worked per week were independent factors associated with burnout in multivariate analysis.

          Conclusions

          The MBI was able to characterize burnout experienced by pulmonary physicians in our hospital. Gender and the number of hours worked per week were the significant factors independently associated with burnout among the physicians in our study.

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          Most cited references24

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          Burnout and self-reported patient care in an internal medicine residency program.

          Burnout is a syndrome of depersonalization, emotional exhaustion, and a sense of low personal accomplishment. Little is known about burnout in residents or its relationship to patient care. To determine the prevalence of burnout in medical residents and explore its relationship to self-reported patient care practices. Cross-sectional study using an anonymous, mailed survey. University-based residency program in Seattle, Washington. 115 internal medicine residents. Burnout was measured by using the Maslach Burnout Inventory and was defined as scores in the high range for medical professionals on the depersonalization or emotional exhaustion subscales. Five questions developed for this study assessed self-reported patient care practices that suggested suboptimal care (for example, "I did not fully discuss treatment options or answer a patient's questions" or "I made...errors that were not due to a lack of knowledge or inexperience"). Depression and at-risk alcohol use were assessed by using validated screening questionnaires. Of 115 (76%) responding residents, 87 (76%) met the criteria for burnout. Compared with non-burned-out residents, burned-out residents were significantly more likely to self-report providing at least one type of suboptimal patient care at least monthly (53% vs. 21%; P = 0.004). In multivariate analyses, burnout--but not sex, depression, or at-risk alcohol use--was strongly associated with self-report of one or more suboptimal patient care practices at least monthly (odds ratio, 8.3 [95% CI, 2.6 to 26.5]). When each domain of burnout was evaluated separately, only a high score for depersonalization was associated with self-reported suboptimal patient care practices (in a dose-response relationship). Burnout was common among resident physicians and was associated with self-reported suboptimal patient care practices.
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            Burnout and satisfaction with work-life balance among US physicians relative to the general US population.

            Despite extensive data about physician burnout, to our knowledge, no national study has evaluated rates of burnout among US physicians, explored differences by specialty, or compared physicians with US workers in other fields. We conducted a national study of burnout in a large sample of US physicians from all specialty disciplines using the American Medical Association Physician Masterfile and surveyed a probability-based sample of the general US population for comparison. Burnout was measured using validated instruments. Satisfaction with work-life balance was explored. Of 27 276 physicians who received an invitation to participate, 7288 (26.7%) completed surveys. When assessed using the Maslach Burnout Inventory, 45.8% of physicians reported at least 1 symptom of burnout. Substantial differences in burnout were observed by specialty, with the highest rates among physicians at the front line of care access (family medicine, general internal medicine, and emergency medicine). Compared with a probability-based sample of 3442 working US adults, physicians were more likely to have symptoms of burnout (37.9% vs 27.8%) and to be dissatisfied with work-life balance (40.2% vs 23.2%) (P < .001 for both). Highest level of education completed also related to burnout in a pooled multivariate analysis adjusted for age, sex, relationship status, and hours worked per week. Compared with high school graduates, individuals with an MD or DO degree were at increased risk for burnout (odds ratio [OR], 1.36; P < .001), whereas individuals with a bachelor's degree (OR, 0.80; P = .048), master's degree (OR, 0.71; P = .01), or professional or doctoral degree other than an MD or DO degree (OR, 0.64; P = .04) were at lower risk for burnout. Burnout is more common among physicians than among other US workers. Physicians in specialties at the front line of care access seem to be at greatest risk.
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              Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population.

              To compare the prevalence of burnout and other forms of distress across career stages and the experiences of trainees and early career (EC) physicians versus those of similarly aged college graduates pursuing other careers. In 2011 and 2012, the authors conducted a national survey of medical students, residents/fellows, and EC physicians (≤ 5 years in practice) and of a probability-based sample of the general U.S. population. All surveys assessed burnout, symptoms of depression and suicidal ideation, quality of life, and fatigue. Response rates were 35.2% (4,402/12,500) for medical students, 22.5% (1,701/7,560) for residents/fellows, and 26.7% (7,288/27,276) for EC physicians. In multivariate models that controlled for relationship status, sex, age, and career stage, being a resident/fellow was associated with increased odds of burnout and being a medical student with increased odds of depressive symptoms, whereas EC physicians had the lowest odds of high fatigue. Compared with the population control samples, medical students, residents/fellows, and EC physicians were more likely to be burned out (all P < .0001). Medical students and residents/fellows were more likely to exhibit symptoms of depression than the population control samples (both P < .0001) but not more likely to have experienced recent suicidal ideation. Training appears to be the peak time for distress among physicians, but differences in the prevalence of burnout, depressive symptoms, and recent suicidal ideation are relatively small. At each stage, burnout is more prevalent among physicians than among their peers in the U.S. population.
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                Author and article information

                Journal
                Ann Transl Med
                Ann Transl Med
                ATM
                Annals of Translational Medicine
                AME Publishing Company
                2305-5839
                2305-5847
                September 2020
                September 2020
                : 8
                : 18
                : 1166
                Affiliations
                [1 ]Department of Respiratory Medicine and Clinical Research Center, Shanghai Pulmonary Hospital, Tongji University School of Medicine , Shanghai, China;
                [2 ]Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine , Shanghai, China;
                [3 ]Shanghai Pulmonary Hospital, Tongji University School of Medicine , Shanghai, China;
                [4 ]Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine , Shanghai, China
                Author notes

                Contributions: (I) Conception and design: C Chen, R Tao, Y Zhou; (II) Administrative support: C Chen, R Tao; (III) Provision of study materials or patients: Y Zhou, W Gu; (IV) Collection and assembly of data: Y Zhou, W Gu; (V) Data analysis and interpretation: Y Zhou, W Gu; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

                [#]

                These authors contributed equally to this work.

                Correspondence to: Chang Chen. Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, China. Email: Chenthoracic@ 123456163.com ; Rong Tao. Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, China. Email: 18930177100@ 123456126.com .
                Article
                PMC7576023 PMC7576023 7576023 atm-08-18-1166
                10.21037/atm-20-5827
                7576023
                33241015
                a5b2ccc3-6127-4e77-8f76-09300fc8aab8
                2020 Annals of Translational Medicine. All rights reserved.
                History
                : 13 July 2020
                : 04 September 2020
                Categories
                Original Article

                pulmonary physician,Burnout,career satisfaction
                pulmonary physician, Burnout, career satisfaction

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