1Department of Neurosurgery, University of Southern California Keck School of Medicine, Los Angeles, California.
2Department of Neurosurgery, Oregon Health & Science University, Portland, Oregon.
J Neurosurg. 2018 Nov 1;129(5):1349-1363. doi: 10.3171/2017.9.JNS17996. Epub 2018 Feb 9.
OBJECTIVEExcessive dissatisfaction and stress among physicians can precipitate burnout, which results in diminished productivity, quality of care, and patient satisfaction and treatment adherence. Given the multiplicity of its harms and detriments to workforce retention and in light of the growing physician shortage, burnout has garnered much attention in recent years. Using a national survey, the authors formally evaluated burnout among neurosurgery trainees.METHODSAn 86-item questionnaire was disseminated to residents in the American Association of Neurological Surgeons database between June and November 2015. Questions evaluated personal and workplace stressors, mentorship, career satisfaction, and burnout. Burnout was assessed using the previously validated Maslach Burnout Inventory. Factors associated with burnout were determined using univariate and multivariate logistic regression.RESULTSThe response rate with completed surveys was 21% (346/1643). The majority of residents were male (78%), 26-35 years old (92%), in a stable relationship (70%), and without children (73%). Respondents were equally distributed across all residency years. Eighty-one percent of residents were satisfied with their career choice, although 41% had at some point given serious thought to quitting. The overall burnout rate was 67%. In the multivariate analysis, notable factors associated with burnout included inadequate operating room exposure (OR 7.57, p = 0.011), hostile faculty (OR 4.07, p = 0.008), and social stressors outside of work (OR 4.52, p = 0.008). Meaningful mentorship was protective against burnout in the multivariate regression models (OR 0.338, p = 0.031).CONCLUSIONSRates of burnout and career satisfaction are paradoxically high among neurosurgery trainees. While several factors were predictive of burnout, including inadequate operative exposure and social stressors, meaningful mentorship proved to be protective against burnout. The documented negative effects of burnout on patient care and health care economics necessitate further studies for potential solutions to curb its rise.
目的
医生过度的不满和压力可能会导致倦怠,从而降低生产力、护理质量以及患者满意度和治疗依从性。鉴于倦怠对劳动力保留造成的多重危害和损害,以及考虑到医生短缺的日益严重,近年来它引起了广泛关注。本文作者使用一项全国性调查,正式评估了神经外科住院医师的倦怠情况。
方法
2015 年 6 月至 11 月,作者向美国神经外科学院数据库中的住院医师发放了一份包含 86 个问题的问卷。问题评估了个人和工作场所的压力源、指导关系、职业满意度和倦怠情况。使用先前验证的 Maslach 倦怠量表评估倦怠。使用单变量和多变量逻辑回归确定与倦怠相关的因素。
结果
完成调查的回复率为 21%(346/1643)。大多数住院医师为男性(78%),年龄在 26-35 岁(92%),处于稳定的关系(70%),没有孩子(73%)。受访者在所有住院年限中分布均匀。尽管 41%的住院医师曾一度认真考虑过辞职,但 81%的住院医师对自己的职业选择感到满意。总体倦怠率为 67%。在多变量分析中,与倦怠相关的显著因素包括手术操作暴露不足(OR 7.57,p = 0.011)、敌对的教职员工(OR 4.07,p = 0.008)和工作之外的社会压力源(OR 4.52,p = 0.008)。在多变量回归模型中,有意义的指导关系对倦怠具有保护作用(OR 0.338,p = 0.031)。
结论
神经外科住院医师的倦怠和职业满意度率出人意料地高。虽然有几个因素与倦怠相关,包括手术操作暴露不足和社会压力源,但有意义的指导关系证明可以预防倦怠。倦怠对患者护理和医疗保健经济学产生的负面影响需要进一步研究,以寻找可能的解决方案来遏制其上升趋势。