Makowski Maryam S, Trockel Mickey, Paganoni Sabrina, Weinstein Stuart, Verduzco-Gutierrez Monica, Kinney Carolyn, Kennedy David J, Sliwa James, Wang Hanhan, Knowlton Tiffany, Stautzenbach Tom, Shanafelt Tait D
From the Stanford University, Stanford, California (MSM, MT, HW, TDS); Spaulding Rehabilitation Hospital, Boston, Massachusetts (SP); Association of Academic Physiatrists, Owing Mills, Maryland (SP, MV-G, TK); University of Washington, Seattle, Washington (SW); American Academy of Physical Medicine and Rehabilitation, Rosemont, Illinois (SW, DJK, TS); University of Texas Health Science Center at San Antonio, San Antonio, Texas (MV-G); Mayo Clinic, Minneapolis, Minnesota (CK); American Board of Physical Medicine and Rehabilitation, Rochester, Minnesota (CK, JS); Vanderbilt University, Nashville, Tennessee (DJK); and Northwestern University Feinberg School of Medicine: Shirley Ryan Ability Lab, Chicago, Illinois (JS).
Am J Phys Med Rehabil. 2023 May 1;102(5):379-388. doi: 10.1097/PHM.0000000000002216. Epub 2023 Feb 16.
Multiple national studies suggest that among physicians, physiatrists are at increased risk for occupational burnout.
The aim of the study is to identify characteristics of the work environment associated with professional fulfillment and burnout among US physiatrists.
Between May and December 2021, a mixed qualitative and quantitative approach was used to identify factors contributing to professional fulfillment and burnout in physiatrists.
Online interviews, focus groups, and survey were conducted.
The participants are physiatrists in the American Academy of Physical Medicine and Rehabilitation Membership Masterfile.
Burnout and professional fulfillment were assessed using the Stanford Professional Fulfillment Index.
Individual interviews with 21 physiatrists were conducted to identify domains that contributed to professional fulfillment followed by focus groups for further definition. Based on themes identified, scales were identified or developed to evaluate: control over schedule (6 items, Cronbach α = 0.86); integration of physiatry into patient care (3 items, Cronbach α = 0.71); personal-organizational values alignment (3 items, Cronbach α = 0.90); meaningfulness of physiatrist clinical work (6 items, Cronbach α = 0.90); teamwork and collaboration (3 items, Cronbach α = 0.89). Of 5760 physiatrists contacted in the subsequent national survey, 882 (15.4%) returned surveys (median age, 52 yrs; 46.1% women). Overall, 42.6% (336 of 788) experienced burnout and 30.6% (244 of 798) had high levels of professional fulfillment. In multivariable analysis, each one-point improvement in control over schedule (odds ratio = 1.96; 95% confidence interval = 1.45-2.69), integration of physiatry into patient care (odds ratio = 1.77; 95% confidence interval = 1.32-2.38), personal-organizational values alignment (odds ratio = 1.92; 95% confidence interval = 1.48-2.52), meaningfulness of physiatrist clinical work (odds ratio = 2.79; 95% confidence interval = 1.71-4.71), and teamwork and collaboration score (odds ratio = 2.11; 95% confidence interval = 1.48-3.03) was independently associated with higher likelihood of professional fulfillment.
Control over schedule, optimal integration of physiatry into clinical care, personal-organizational values alignment, teamwork, and meaningfulness of physiatrist clinical work are strong and independent drivers of occupational well-being in US physiatrists. Variation in these domains by practice setting and subspecialty suggests that tailored approaches are needed to promote professional fulfillment and reduce burnout among US physiatrists.
多项全国性研究表明，在医生群体中，物理医学与康复医师职业倦怠的风险有所增加。
本研究旨在确定与美国物理医学与康复医师职业成就感和职业倦怠相关的工作环境特征。
在2021年5月至12月期间，采用定性与定量相结合的方法来确定导致物理医学与康复医师职业成就感和职业倦怠的因素。
进行了在线访谈、焦点小组讨论和调查。
参与者为美国物理医学与康复学会会员主文件中的物理医学与康复医师。
使用斯坦福职业成就感指数评估职业倦怠和职业成就感。
对21名物理医学与康复医师进行了个人访谈，以确定有助于职业成就感的领域，随后进行焦点小组讨论以进一步明确。根据确定的主题，确定或开发了量表来评估：日程安排控制权（6项，克朗巴哈α系数=0.86）；物理医学与康复在患者护理中的整合（3项，克朗巴哈α系数=0.71）；个人与组织价值观的一致性（3项，克朗巴哈α系数=0.90）；物理医学与康复医师临床工作的意义（6项，克朗巴哈α系数=0.90）；团队合作与协作（3项，克朗巴哈α系数=0.89）。在随后的全国性调查中，联系了5760名物理医学与康复医师，其中882人（15.4%）回复了调查问卷（中位年龄52岁；46.1%为女性）。总体而言，42.6%（788人中的336人）经历了职业倦怠，30.6%（798人中的244人）有较高的职业成就感。在多变量分析中，日程安排控制权每提高1分（优势比=1.96；95%置信区间=1.45 - 2.69）、物理医学与康复在患者护理中的整合（优势比=1.77；95%置信区间=1.32 - 2.38）、个人与组织价值观的一致性（优势比=1.92；95%置信区间=1.48 - 2.52）、物理医学与康复医师临床工作的意义（优势比=2.79；95%置信区间=1.71 - 4.71）以及团队合作与协作得分（优势比=2.11；95%置信区间=1.48 - 3.03）均与更高的职业成就感可能性独立相关。
日程安排控制权、物理医学与康复在临床护理中的最佳整合、个人与组织价值观的一致性、团队合作以及物理医学与康复医师临床工作的意义是美国物理医学与康复医师职业幸福感的强大且独立的驱动因素。这些领域在实践环境和亚专业方面的差异表明，需要采取针对性方法来促进美国物理医学与康复医师的职业成就感并减少职业倦怠。
