Center for Healthcare Policy and Research, Department of Family and Community Medicine, University of California, Davis, USA.
, Sacramento, California, USA.
BMC Health Serv Res. 2022 Mar 19;22(1):365. doi: 10.1186/s12913-022-07728-6.
Physician burnout and wellbeing are an ongoing concern. Limited research has reported on the impact of the COVID 19 pandemic on burnout over time among U.S. physicians.
We surveyed U.S. frontline physicians at two time points (wave one in May-June 2020 and wave two in Dec 2020-Jan 2021) using a validated burnout measure. The survey was emailed to a national stratified random sample of family physicians, internists, hospitalists, intensivists, emergency medicine physicians, and infectious disease physicians. Burnout was assessed with the Professional Fulfillment Index Burnout Composite scale (PFI-BC). Responses were weighted to account for sample design and non-response bias. Random effects and quantile regression analyses were used to estimate change in conditional mean and median PFI-BC scores, adjusting for physician, geographic, and pandemic covariates.
In the random effects regression, conditional mean burnout scores increased in the second wave among all respondents (difference 0.15 (CI: 0.24, 0.57)) and among respondents to both waves (balanced panel) (difference 0.21 (CI: - 0.42, 0.84)). Conditional burnout scores increased in wave 2 among all specialties except for Emergency medicine, with the largest increases among Hospitalists, 0.28 points (CI: - 0.19,0.76) among all respondents and 0.36 (CI: - 0.39,1.11) in the balanced panel, and primary care physicians, 0.21 (CI: - 0.23,0.66) among all respondents and 0.31 (CI: - 0.38,1.00) in the balanced panel. The conditional mean PFI-BC score among hospitalists increased from 1.10 (CI: 0.73,1.46) to 1.38 (CI: 1.02,1.74) in wave 2 in all respondents and from 1.49 (CI: 0.69,2.29) to 1.85 (CI: 1.24,2.46) in the balanced panel, near or above the 1.4 threshold indicating burnout. Findings from quantile regression were consistent with those from random effects.
Rates of physician burnout during the first year of the pandemic increased over time among four of five frontline specialties, with greatest increases among hospitalist and primary care respondents. Our findings, while not statistically significant, were consistent with worsening burnout; both the random effects and quantile regressions produced similar point estimates. Impacts of the ongoing pandemic on physician burnout warrant further research.
医师倦怠和幸福感一直是人们关注的问题。有限的研究报告了随着时间的推移，美国医生的倦怠感在 COVID-19 大流行期间的变化。
我们在两个时间点（2020 年 5 月至 6 月的第 1 波和 2020 年 12 月至 2021 年 1 月的第 2 波）使用经过验证的倦怠测量方法对美国一线医生进行了调查。该调查通过电子邮件发送给全国分层随机抽样的家庭医生、内科医生、医院医生、重症监护医生、急诊医生和传染病医生。倦怠感使用专业满意度指数倦怠综合量表（PFI-BC）进行评估。通过考虑医生、地理和大流行方面的因素对响应进行加权，以消除样本设计和无响应偏差的影响。使用随机效应和分位数回归分析来估计条件均值和中位数 PFI-BC 分数的变化，同时调整医生、地理位置和大流行相关的协变量。
在随机效应回归中，所有受访者（差异 0.15（CI：0.24，0.57））和两个波次的受访者（平衡面板）（差异 0.21（CI：-0.42，0.84））的条件均值倦怠评分在第二波次中均有所增加。除了急诊医学外，所有专业的条件倦怠评分在第二波次中均有所增加，其中医院医生的倦怠评分增加最大，在所有受访者中增加了 0.28 分（CI：-0.19，0.76），在平衡面板中增加了 0.36 分（CI：-0.39，1.11），初级保健医生在所有受访者中增加了 0.21 分（CI：-0.23，0.66），在平衡面板中增加了 0.31 分（CI：-0.38，1.00）。在所有受访者中，医院医生的条件均值 PFI-BC 评分从第 1 波次的 1.10（CI：0.73，1.46）增加到第 2 波次的 1.38（CI：1.02，1.74），从第 1 波次的 1.49（CI：0.69，2.29）增加到平衡面板中的 1.85（CI：1.24，2.46），接近或高于表示倦怠的 1.4 阈值。分位数回归的结果与随机效应的结果一致。
在大流行的第一年，五分之四的一线专业医生的倦怠率随时间推移而增加，其中医院医生和初级保健医生的倦怠率增加幅度最大。虽然我们的发现没有统计学意义，但它们表明倦怠情况正在恶化；随机效应和分位数回归都产生了类似的点估计值。大流行对医生倦怠的影响值得进一步研究。
