Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.
PLoS One. 2021 Jun 9;16(6):e0252778. doi: 10.1371/journal.pone.0252778. eCollection 2021.
Physician wellness is vital to career satisfaction, provision of high quality patient care, and the successful education of the next generation of physicians. Despite this, the number of physicians experience symptoms of burnout is rising. To assess the impact of organizational culture on physicians' professional fulfillment and burnout, we surveyed full-time Department of Medicine members at the University of Toronto. A cross-sectional survey assessed: physician factors (age, gender, minority status, disability, desire to reduce clinical workload); workplace culture (efforts to create a collegial environment, respectful/civil interactions, confidence to address unprofessionalism without reprisal, witnessed and/or personally experienced unprofessionalism); professional fulfillment and burnout using the Stanford Professional Fulfillment Index. We used multivariable linear regression to examine the relationship of measures of workplace culture on professional fulfillment and burnout (scores 0-10), controlling for physician factors. Of 419 respondents (52.0% response rate), we included 400 with complete professional fulfillment and burnout data in analyses (60% ≤ age 50, 45% female). Mean scores for professional fulfillment and burnout were 6.7±1.9 and 2.8±1.9, respectively. Controlling for physician factors, professional fulfillment was associated with satisfaction with efforts to create a collegial environment (adjusted beta 0.45, 95% CI 0.21 to 0.70) and agreement that colleagues were respectful/civil (adjusted beta 0.85, 95% CI 0.53 to 1.17). Lower professional fulfillment was associated with higher burnout scores. Controlling for professional fulfillment and physician factors, lower confidence in taking action to address unprofessionalism (adjusted beta -0.22, 95% CI -0.40 to -0.03) was associated with burnout. Organizational culture and physician factors had an impact on professional fulfillment and burnout. Professional fulfillment partially mediated the relationship between organizational culture and burnout. Strategies that promote inclusion, respect and civility, and safe ways to report workplace unprofessionalism are needed in academic medicine.
医生的健康对于职业满意度、提供高质量的患者护理以及成功培养下一代医生至关重要。尽管如此，越来越多的医生出现了职业倦怠的症状。为了评估组织文化对医生职业满足感和职业倦怠的影响，我们对多伦多大学医学系的全职成员进行了调查。一项横断面调查评估了：医生因素（年龄、性别、少数族裔地位、残疾、减少临床工作量的意愿）；工作场所文化（营造协作环境的努力、尊重/文明的互动、有信心在不受报复的情况下处理不专业行为、目睹和/或亲身经历不专业行为）；使用斯坦福职业满足度指数评估职业满足感和职业倦怠。我们使用多变量线性回归来研究工作场所文化对职业满足感和职业倦怠（0-10 分）的影响，同时控制医生因素。在 419 名应答者（52.0%的应答率）中，我们将 400 名有完整职业满足感和职业倦怠数据的应答者纳入分析（60%≤50 岁，45%为女性）。职业满足感和职业倦怠的平均得分分别为 6.7±1.9 和 2.8±1.9。在控制医生因素的情况下，职业满足感与对营造协作环境的努力的满意度相关（调整后的β值 0.45，95%置信区间 0.21 至 0.70），与同事尊重/文明的共识相关（调整后的β值 0.85，95%置信区间 0.53 至 1.17）。较低的职业满足感与较高的职业倦怠得分相关。在控制职业满足感和医生因素的情况下，对采取行动处理不专业行为的信心较低（调整后的β值-0.22，95%置信区间-0.40 至-0.03）与倦怠相关。组织文化和医生因素对职业满足感和职业倦怠有影响。职业满足感部分中介了组织文化和倦怠之间的关系。学术医学中需要促进包容、尊重和文明以及安全报告工作场所不专业行为的策略。
