American Medical Association, Chicago, Illinois.
Stanford University School of Medicine, Palo Alto, California.
J Healthc Manag. 2024;69(5):368-386. doi: 10.1097/JHM-D-23-00124. Epub 2024 Sep 6.
This research aimed to evaluate variations in perceived organizational support among physicians during the first year of the COVID-19 pandemic and the associations between perceived organizational support, physician burnout, and professional fulfillment.
Between November 20, 2020, and March 23, 2021, 1,162 of 3,671 physicians (31.7%) responded to the study survey by mail, and 6,348 of 90,000 (7.1%) responded to an online version. Burnout was assessed using the Maslach Burnout Inventory, and perceived organizational support was assessed by questions developed and previously tested by the Stanford Medicine WellMD Center. Professional fulfillment was measured using the Stanford Professional Fulfillment Index.
Responses to organizational support questions were received from 5,933 physicians. The mean organizational support score (OSS) for male physicians was higher than the mean OSS for female physicians (5.99 vs. 5.41, respectively, on a 0-10 scale, higher score favorable; p < .001). On multivariable analysis controlling for demographic and professional factors, female physicians (odds ratio [OR] 0.66; 95% CI: 0.55-0.78) and physicians with children under 18 years of age (OR 0.72; 95% CI: 0.56-0.91) had lower odds of an OSS in the top quartile (i.e., a high OSS score). Specialty was also associated with perceived OSS in mean-variance analysis, with some specialties (e.g., pathology and dermatology) more likely to perceive significant organizational support relative to the reference specialty (i.e., internal medicine subspecialty) and others (e.g., anesthesiology and emergency medicine) less likely to perceive support. Physicians who worked more hours per week (OR for each additional hour/week 0.99; 95% CI: 0.99-1.00) were less likely to have an OSS in the top quartile. On multivariable analysis, adjusting for personal and professional factors, each one-point increase in OSS was associated with 21% lower odds of burnout (OR 0.79; 95% CI: 0.77-0.81) and 32% higher odds of professional fulfillment (OR 1.32; 95% CI: 1.28-1.36).
Perceived organizational support of physicians during the COVID-19 pandemic was associated with a lower risk of burnout and a higher likelihood of professional fulfillment. Women physicians, physicians with children under 18 years of age, physicians in certain specialties, and physicians working more hours reported lower perceived organizational support. These gaps must be addressed in conjunction with broad efforts to improve organizational support.
本研究旨在评估 COVID-19 大流行第一年期间医生感知到的组织支持的变化，以及感知到的组织支持、医生倦怠和专业满足感之间的关联。
2020 年 11 月 20 日至 2021 年 3 月 23 日，3671 名医生中有 1162 名（31.7%）通过邮件对研究调查做出了回应，90000 名医生中有 6348 名（7.1%）对在线版本做出了回应。倦怠使用 Maslach 倦怠量表进行评估，感知到的组织支持通过斯坦福医学 WellMD 中心开发和先前测试的问题进行评估。专业满足感使用斯坦福专业满足感指数进行衡量。
共收到 5933 名医生对组织支持问题的回答。男性医生的平均组织支持得分（OSS）高于女性医生（分别为 0-10 分制中的 5.99 分和 5.41 分，得分越高越好；<0.001）。在控制人口统计学和专业因素的多变量分析中，女性医生（比值比[OR]0.66；95%CI：0.55-0.78）和有 18 岁以下子女的医生（OR0.72；95%CI：0.56-0.91）获得 OSS 高分（即高 OSS 得分）的可能性较低。专业也与感知到的 OSS 相关，在均值方差分析中，一些专业（例如病理学和皮肤病学）比参考专业（即内科亚专业）更有可能感知到显著的组织支持，而其他专业（例如麻醉学和急诊医学）则不太可能感知到支持。每周工作时间每增加一小时（每增加一小时/周的 OR 为 0.99；95%CI：0.99-1.00），获得 OSS 高分的可能性就越低。在多变量分析中，调整个人和专业因素后，OSS 每增加 1 分，倦怠的可能性就降低 21%（OR0.79；95%CI：0.77-0.81），专业满足感的可能性就增加 32%（OR1.32；95%CI：1.28-1.36）。
COVID-19 大流行期间医生感知到的组织支持与倦怠风险降低和专业满足感提高相关。女性医生、有 18 岁以下子女的医生、某些专业的医生和工作时间较长的医生报告感知到的组织支持较低。这些差距必须与改善组织支持的广泛努力相结合加以解决。
