多专科学术教职员工实践组织中医师职业倦怠的趋势和相关因素。
Trends and Factors Associated With Physician Burnout at a Multispecialty Academic Faculty Practice Organization.
机构信息
Massachusetts General Physicians Organization, Boston.
Department of Obstetrics, Gynecology and Reproductive Biology, Massachusetts General Hospital, Harvard Medical School, Boston.
出版信息
JAMA Netw Open. 2019 Mar 1;2(3):e190554. doi: 10.1001/jamanetworkopen.2019.0554.
IMPORTANCE
Physician burnout is common, and prevalence may differ throughout a clinician's career. Burnout has negative consequences for physician wellness, patient care, and the health care system. Identifying factors associated with burnout is critical in designing and implementing initiatives to reduce burnout.
OBJECTIVE
To measure trends and identify factors associated with physician burnout.
DESIGN, SETTING, AND PARTICIPANTS: Survey study conducted from May 16 to June 15, 2014, and again from May 16 to June 15, 2017, measuring rates of physician burnout in a large academic medical practice. Factors associated with burnout out were evaluated. In 2014, 1774 of 1850 eligible physicians (95.9%) completed the survey. In 2017, 1882 of 2031 (92.7%) completed the survey.
EXPOSURES
Medical specialty, demographic characteristics, years in practice, and reported rates of burnout.
MAIN OUTCOMES AND MEASURES
Burnout rates measured at 2 points and risk factors associated with burnout.
RESULTS
Respondents included 1027 men (57.9%) and 747 women (42.1%) in 2014 and 962 men (51.1%) and 759 women (40.3%) in 2017. The mean (SD) number of years since training completion was 15.3 (11.3) in the 2014 survey data and 15.1 (11.3) in the 2017 data. Burnout increased from 40.6% to 45.6% between the 2 points. The increased rate was associated with an increase in exhaustion (from 52.9% in 2014 to 57.7% in 2017; difference, 4.8%; 95% CI, 1.6%-8.0%; P = .004) and cynicism (from 44.8% in 2014 to 51.1% in 2017; difference, 6.3%; 95% CI, 3.1%-9.6%; P < .001). Compared with midcareer physicians (11-20 years since training), early-career physicians (≤10 years since training) were more susceptible to burnout (odds ratio, 1.36; 95% CI, 1.05-1.77), while physicians in their late career (>30 years since training) were less vulnerable (odds ratio, 0.59; 95% CI, 0.40-0.88).
CONCLUSIONS AND RELEVANCE
Efforts to alleviate physician burnout and administrative burden require a combination of a shared commitment from physicians and organizations and central and locally implemented programs. Continued research is necessary to establish the most effective initiatives to decrease physician burnout at the individual and organizational level.
重要性
医生倦怠是常见的，而且在医生职业生涯的不同阶段，其流行程度可能有所不同。倦怠会对医生的健康、患者的护理和医疗保健系统产生负面影响。确定与倦怠相关的因素对于设计和实施减少倦怠的计划至关重要。
目的
衡量趋势并确定与医生倦怠相关的因素。
设计、设置和参与者：这项调查研究于 2014 年 5 月 16 日至 6 月 15 日以及 2017 年 5 月 16 日至 6 月 15 日进行，旨在测量一家大型学术医疗实践中医生倦怠的发生率。评估了与倦怠相关的因素。2014 年，1850 名符合条件的医生中有 1774 名（95.9%）完成了调查。2017 年，2031 名符合条件的医生中有 1882 名（92.7%）完成了调查。
暴露因素
医学专业、人口统计学特征、从业年限以及报告的倦怠率。
主要结果和测量指标
两次测量的倦怠率和与倦怠相关的风险因素。
结果
2014 年的调查数据中包括 1027 名男性（57.9%）和 747 名女性（42.1%），2017 年的调查数据中包括 962 名男性（51.1%）和 759 名女性（40.3%）。2014 年调查数据中，从培训结束到现在的平均（SD）年限为 15.3（11.3）年，2017 年数据中为 15.1（11.3）年。倦怠率从 40.6%增加到 45.6%。这一增长率与疲劳感的增加（从 2014 年的 52.9%增加到 2017 年的 57.7%；差异，4.8%；95%置信区间，1.6%-8.0%；P = .004）和犬儒主义（从 2014 年的 44.8%增加到 2017 年的 51.1%；差异，6.3%；95%置信区间，3.1%-9.6%；P < .001）有关。与处于职业中期的医生（培训后 11-20 年）相比，处于职业早期的医生（培训后 1-10 年）更容易出现倦怠（优势比，1.36；95%置信区间，1.05-1.77），而处于职业后期的医生（培训后>30 年）则不易出现倦怠（优势比，0.59；95%置信区间，0.40-0.88）。
结论和相关性
缓解医生倦怠和行政负担的努力需要医生和组织的共同承诺以及中央和地方实施的计划。需要进一步研究以确定在个人和组织层面减少医生倦怠最有效的计划。
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