Saint Sanjay, Zemencuk Judith K, Hayward Rodney A, Golin Carol E, Konrad Thomas R, Linzer Mark
Health Services Research and Development Field Program, Ann Arbor VA Center for Practice Management and Outcomes Research, Ann Arbor, MI, USA.
J Gen Intern Med. 2003 Sep;18(9):725-9. doi: 10.1046/j.1525-1497.2003.20637.x.
Because career satisfaction among general internists is relatively low, we sought to understand the impact on satisfaction of general internists managing patients both in and outside of the hospital. Using data from a national survey, we asked, "Among outpatient-oriented general internists (i.e., internists who spend less than 50% of their clinical time caring for inpatients), what effect does time spent in the hospital have on physician satisfaction, stress, and burnout?"
DESIGN/PARTICIPANTS: The Physician Worklife Study, in which 5,704 physicians in primary and specialty nonsurgical care selected from the American Medical Association's Masterfile were surveyed (adjusted response rate = 52%), was used. Our analyses focused on clinically active outpatient-oriented general internists (N = 339).
We constructed multivariate linear models to test for statistically significant associations between the amount of time spent seeing inpatients and physician satisfaction as measured by several satisfaction scales. Even after controlling for total hours worked and other possible confounding variables, we found that increased time working in the hospital was significantly associated with decreases in satisfaction with administration, specialty, autonomy, and personal time, and significantly associated with an increase in life stress. There was also a significant association between increased time spent in the hospital and burnout.
Our findings imply that there may be a tension between the practice of inpatient and outpatient medicine by general internists, and suggest that fewer hospital duties may increase career satisfaction for outpatient-oriented internists. Although additional studies are warranted in order to better understand why these relationships exist, our data suggest that the hospitalist model of inpatient care might be one approach to alleviate stress and improve satisfaction for many general internists.
由于普通内科医生的职业满意度相对较低，我们试图了解管理住院和门诊患者对普通内科医生满意度的影响。利用一项全国性调查的数据，我们提出问题：“在以门诊为主的普通内科医生（即临床时间少于50%用于照顾住院患者的内科医生）中，在医院花费的时间对医生满意度、压力和职业倦怠有何影响？”
设计/参与者：采用医生工作生活研究，该研究对从美国医学协会主文件中选取的5704名从事初级和非手术专科护理的医生进行了调查（调整后的回复率 = 52%）。我们的分析重点是临床活跃的以门诊为主的普通内科医生（N = 339）。
我们构建了多元线性模型，以检验看住院患者的时间与通过几种满意度量表衡量的医生满意度之间是否存在统计学上的显著关联。即使在控制了总工作时长和其他可能的混杂变量之后，我们发现，在医院工作时间的增加与对管理、专业、自主性和个人时间的满意度下降显著相关，与生活压力的增加显著相关。在医院花费的时间增加与职业倦怠之间也存在显著关联。
我们的研究结果表明，普通内科医生在住院和门诊医疗实践之间可能存在矛盾，并表明减少医院职责可能会提高以门诊为主的内科医生的职业满意度。尽管有必要进行更多研究以更好地理解这些关系存在的原因，但我们的数据表明，住院医师模式的住院护理可能是减轻许多普通内科医生压力并提高满意度的一种方法。
