National Burnout Trends Among Physicians Working in the Department of Veterans Affairs
National Burnout Trends Among Physicians Working in the Department of Veterans Affairs
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DOI：
10.1007/s11606-019-05582-7
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发表时间：
2020-02-24
影响因子：
5.7
通讯作者：
Charns, Martin P.
中科院分区：
文献类型：
--
作者：
Rinne, Seppo T.;Mohr, David C.;Charns, Martin P.
背景现有医生职业倦怠研究的异质性影响了对影响医生职业倦怠的纵向趋势、地理分布和组织因素的分析。退伍军人事务部(VA)是美国最大的综合医疗系统之一，为研究退伍军人事务部不同地点和时间的倦怠提供了独特的机会。目的了解退伍军人的纵向职业倦怠趋势，评估组织特征和地域分布与职业倦怠的关系。设计2013-2017年退伍军人管理局全体员工调查的纵向研究。参与者在全国140个退伍军人事务部的九个临床服务区之一自认执业医生。主要测量我们使用了来自Maslach职业倦怠量表的有效定义来确定职业倦怠，并描述了不同临床服务领域的医生的职业倦怠趋势。我们使用聚类分析根据网站随着时间推移的倦怠率对网站进行分类，并比较了高、中、低倦怠类别的组织特征和地理分布。主要结果我们从140个退伍军人管理局站点确定了40,382名医生的回复。所有医生的平均职业倦怠率从2013年的34.3%到2014年的39.0%不等。初级保健医生的职业倦怠程度最高。职业倦怠程度高的地点更有可能是农村和非教学场所，具有较低的复杂性(即，提供较少的高级临床服务)，并且每个地点有较少的独特患者。结论在许多非退伍军人研究中，退伍军人内科医生的职业倦怠程度低于以前的描述，并且随着时间的推移相对稳定。这些发现可能是由于退伍军人管理局执业环境的独特特点造成的。尽管如此，超过三分之一的退伍军人事务部医生报告了职业倦怠，组织干预是必要的。初级保健医生和那些在小的农村地点执业的人有更高的倦怠率，可能需要更有针对性的关注。我们的结果可以指导有针对性的干预措施，以促进退伍军人管理局医生的幸福感，并为在不同的临床环境中解决职业倦怠的努力提供信息。
Background Heterogeneity of existing physician burnout studies impairs analyses of longitudinal trends, geographic distribution, and organizational factors impacting physician burnout. The Department of Veterans Affairs (VA) is one of the largest integrated healthcare systems in the USA, offering a unique opportunity to study burnout across VA sites and time. Objective To characterize longitudinal burnout trends of VA physicians and assess organizational characteristics and geographic distribution associated with physician burnout. Design Longitudinal study of the VA All Employee Survey during 2013-2017. Participants Self-identified physicians practicing in one of nine clinical service areas at 140 VA sites nationwide. Main Measures We identified burnout using a validated definition adapted from the Maslach Burnout Inventory and characterized burnout trends for physicians in different clinical service areas. We used clustering analysis to categorize sites based on their burnout rates over time, and compared organizational characteristics and geographic distribution of high, medium, and low burnout categories. Key Results We identified 40,382 physician responses from 140 VA sites. Mean burnout rates across all physicians ranged from 34.3% in 2013 to a high of 39.0% in 2014. Primary care physicians had the highest burnout. High burnout sites were more likely to be rural and non-teaching, have lower complexity (i.e., offer fewer advanced clinical services), and have fewer unique patients per site. Conclusions VA physician burnout was lower than previously described in many non-VA studies and was relatively stable over time. These findings may be due to unique characteristics of the VA practice environment. Nonetheless, with over a third of VA physicians reporting burnout, organizational interventions are needed. Primary care physicians and those practicing at small, rural sites have higher rates of burnout and may warrant more focused attention. Our results can guide targeted interventions to promote VA physician well-being and inform efforts to address burnout in diverse clinical settings.