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Abstract

Background Interest in the well-being of physicians has increased because of their contributions to the healthcare system quality. There is growing recognition that physicians are exposed to workplace factors that increase the risk of work stress. Long-term exposure to high work stress can result in burnout. Reports from around the world suggest that about one-third to one-half of physicians experience burnout. Understanding the outcomes associated with burnout is critical to understanding its affects on the healthcare system. Productivity outcomes are among those that could have the most immediate effects on the healthcare system. This systematic literature review is one of the first to explore the evidence for the types of physician productivity outcomes associated with physician burnout. It answers the question, “How does burnout affect physician productivity?” Methods A systematic search was performed of: Medline Current, Medline in process, PsycInfo, Embase and Web of Science. The search period covered 2002 to 2012. The searches identified articles about practicing physicians working in civilian settings. Articles that primarily looked only at residents or medical students were excluded. Productivity was captured by hours worked, patients seen, sick leave, leaving the profession, retirement, workload and presenteeism. Studies also were excluded if: (1) the study sample was not comprised of at least 50% physicians, (2) the study did not examine the relationship between burnout and productivity or (3) a validated measure of burnout was not used. Results The search identified 870 unique citations; 5 met the inclusion/exclusion criteria. This review indicates that globally there is recognition of the potential impact of physician burnout on productivity. Productivity was examined using: number of sick leave days, work ability, intent to either continue practicing or change jobs. The majority of the studies indicate there is a negative relationship between burnout and productivity. However, there is variation depending on the type of productivity outcome examined. Conclusions There is evidence that burnout is associated with decreased productivity. However, this line of inquiry is still developing. A number of gaps are yet to be filled including understanding how to quantify the changes in productivity related to burnout.

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The prevalence of common mental disorders among hospital physicians and their association with self-reported work ability: a cross-sectional study

Martijn M Ruitenburg, Monique HW Frings-Dresen, Judith K Sluiter (2012)

Background We studied the prevalence of common mental disorders among Dutch hospital physicians and investigated whether the presence of a mental disorder was associated with insufficient self-reported work ability. Methods A questionnaire was sent to all (n = 958) hospital physicians of one academic medical center, using validated scales to assess burnout, work-related fatigue, stress, posttraumatic stress disorder (PTSD), anxiety and depression. Furthermore, respondents were asked to rate their current work ability against the work ability in their own best period (adapted version of the first WAI item). The prevalence of each common mental disorder was calculated. In addition, odds ratios of reporting insufficient work ability for subjects with high complaint scores compared to physicians with low complaint scores were calculated for each mental disorder. Results The response rate was 51%, and 423 questionnaires were eligible for analysis. The mental disorder prevalence rates were as follows: work-related fatigue 42%, depression 29%, anxiety 24%, posttraumatic stress complaints 15%, stress complaints 15% and burnout 6%. The mean score for self-reported work ability was 8.1 (range 0–10), and 4% of respondents rated their own work ability as insufficient. Physicians with high mental health complaints were 3.5- for fatigue, 5.6- for PTSD, 7.1- for anxiety, 9.5- for burnout, 10.8- for depression and 13.6-fold for stress more likely to report their work ability as insufficient. Conclusions The prevalence of common mental disorders among hospital physicians varied from 6% for burnout to 42% for work-related fatigue. Those physicians with high complaints had significantly 4- to 14 times increased odds of reporting their own work ability as insufficient. This work suggests that to ensure future workers health and patients safety occupational health services should plan appropriate intervention strategies.

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Burnout and perceived quality of care among German clinicians in surgery.

Karl Blum, Olaf von dem Knesebeck, Jens Klein … (2010)

Burnout is highly prevalent among clinicians but there is not much known about the association between burnout and quality of care. In this paper, burnout, perceived quality of care and medical errors among German clinicians in surgery are explored. Data were collected during 2008 by a cross-sectional, standardized mail survey. and A total of 1311 clinicians in surgery in 489 German hospitals. Measure(s) Burnout was measured by using the Copenhagen Burnout Inventory (CBI). The measurement of self-rated patient care was based on a 13 item instrument (Chirurgisches Qualitätssiegel) and two questions assessing the frequency of medical errors. About 48.7% of the clinicians meet the criteria for burnout according to the CBI. Moreover, in multivariate logistic regression analyses, burnout is significantly associated with perceived quality of care among male (odds ratios vary from 1.5 to 2.6) but not among female surgeons (odds ratios vary from 1.3 to 1.5). The high prevalence of burnout in our study corresponds with former studies of burnout among physicians. Furthermore, the results of the study suggest a relationship between burnout and perceived quality of care among men. Thus, reducing burnout among surgeons could not only improve their health and well-being but also the quality of care.

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Stress and burnout in colorectal and vascular surgical consultants working in the UK National Health Service.

Ricky Sharma, Robert Walker, Z. D. Sharp … (2008)

It has been suggested that dealing with cancer is associated with increased stress and burnout in health-care professionals. The aim of this study is to examine the prevalence of psychiatric morbidity and burnout in surgeons working in the National Health Service (NHS), and the putative relationship between psychiatric morbidity, burnout and the amount of cancer-related work. All consultant colorectal and vascular surgeons identified from their professional societies were sent a booklet consisting of questions about cancer-related and specialty-specific work load, job satisfaction and socio-demographics. It also included the General Health Questionnaire (GHQ-12), the Maslach Burnout Inventory (MBI) and the Coping Questionnaire. Logistic regression analysis was used to identify independent predictors of psychiatric morbidity (GHQ), burnout (MBI) and retirement intentions. Five hundred and one questionnaire booklets were completed and returned (response rate 58.7%). The mean age of respondents was 47 years (range 31-65). The majority of the surgeons were male (460, 92%). One hundred and sixty-three (33%) surgeons scored in the positive range of the GHQ, and 154 (32%) had high burnout on at least one subscale of the MBI. Three hundred and eighty-three (77%) surgeons stated that they intended to retire before the statutory retirement age. Level of work satisfaction and perceived adequacy of training in communication and management skills were significantly negatively correlated with GHQ and MBI scores. Surgeons who planned to take early retirement or wished to retire as soon as they could afford to were more likely to have psychiatric morbidity and/or burnout. Surgeons who were married or cohabiting were less likely to have psychiatric morbidity, and younger surgeons were more likely to have higher levels of depersonalization (DP). Work satisfaction was negatively correlated with psychiatric morbidity and all three burnout scales. Colorectal surgeons had a greater cancer-related workload than vascular surgeons (48.6 vs 7.5%, respectively, U=2667, p<0.005). However, there were no significant differences between the two groups in psychiatric morbidity, personal accomplishment and emotional exhaustion. Vascular surgeons, however, had significantly higher levels of DP (p=0.04). Levels of psychiatric morbidity, burnout and work dissatisfaction are worryingly high in colorectal and vascular surgeons and are likely to impact adversely on patient satisfaction and service quality. The number of surgeons intending to retire early is also a cause for concern both in terms of the overall number of trained surgeons in the NHS and in the balance between senior and junior surgeons. Apart from DP, these indicators of stress, however, were unrelated to cancer workload.