Resilience and Burnout Among Physicians and the General US Working Population
Resilience and Burnout Among Physicians and the General US Working Population
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DOI：
10.1001/jamanetworkopen.2020.9385
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发表时间：
2020-07-02
影响因子：
13.8
通讯作者：
Shanafelt, Tait D.
中科院分区：
文献类型：
--
作者：
West, Colin P.;Dyrbye, Liselotte N.;Shanafelt, Tait D.
医生职业倦怠的流行是有据可查的，弹性培训已被提出作为一种选择，以支持医生的福祉。然而，与美国工作人口相比，医生的弹性并没有建立，弹性和医生倦怠之间的关联还没有得到很好的理解。目的评估医生和美国工作人员的复原力，并确定美国医生的复原力与倦怠之间的关联。设计、设置和参与者在2017年10月12日至2018年3月15日期间对5445名美国医生和5198名美国工作人群进行了一项基于概率的全国调查研究。主要结果和测量方法使用Connor-Davidson复原力量表测量复原力（总分为0-8分;分数越高，说明复原力越强）;倦怠是用完整的Maslach倦怠量表测量的，总体倦怠由0到54情绪耗竭子量表上至少27分和/或人格解体子量表上至少10分来表示（分数越高，表明倦怠感越强）。结果30 & x202 f;456名医生谁收到邀请参加，5445（17.9%）完成调查（2995名男性[62.1%];中位数[IQR]年龄为53 [42-62]岁）。在多变量分析中，医生的平均（SD）恢复力得分高于一般就业人群（6.49 [1.30] vs 6.25 [1.37];调整后的平均差异为0.25分; 95%CI为0.19-0.32; P <0.001）。在医生中，韧性与倦怠有关。没有总体倦怠的医生比有倦怠的医生有更高的平均（SD）弹性评分（6.82 [1.15] vs 6.13 [1.36];校正平均差异，0.68分，95% CI，0.61-0.76; P <0.001）。心理弹性得分每增加1分，总体倦怠的几率降低36%（比值比，0.64; 95%CI，0.60-0.67; P <0.001）。然而，1350名医生中有392名（29%）具有最高的弹性得分。结论和相关性这项全国性调查研究的结果表明，在美国，医生表现出比一般工作人口更高的弹性水平。复原力与倦怠症状呈负相关，但即使在最有复原力的医生中，倦怠率也很高。另外的解决方案，包括努力解决临床护理环境中的系统问题，需要减少倦怠和促进医生的福祉。这个横断面调查研究评估的弹性之间的医生和美国工人和评估之间的关联弹性和倦怠美国医生。问题如何弹性的医生相比，美国工人，和什么是弹性之间的关联和倦怠的医生？结果在这个横断面调查研究的5445名受访者从30 &x202f;456名医生，医生有显着较高的弹性得分比一般就业的美国人口。较高的复原力得分与较低的倦怠率相关，但即使是最有复原力的医生也有相当高的倦怠率。研究结果表明，虽然保持和加强弹性是重要的，医生总体上没有弹性赤字;需要额外的解决方案，包括努力解决临床护理环境中的系统问题，以减少倦怠和促进医生的福祉。
Importance The prevalence of physician burnout is well documented, and resilience training has been proposed as an option to support physician well-being. However, the resilience of physicians compared with that of the US working population is not established, and the association between resilience and physician burnout is not well understood. Objectives To evaluate resilience among physicians and US workers, and to determine the association between resilience and burnout among US physicians. Design, Setting, and Participants A cross-sectional national survey study of 5445 US physicians and a probability-based sample of 5198 individuals in the US working population was conducted between October 12, 2017, and March 15, 2018. Main Outcomes and Measures Resilience was measured using the 2-item Connor-Davidson Resilience Scale (total scores range from 0-8; higher scores indicate greater resilience); burnout was measured using the full Maslach Burnout Inventory with overall burnout indicated by a score of at least 27 on the 0 to 54 emotional exhaustion subscale and/or at least 10 on the depersonalization subscale (higher scores indicate greater burnout). Results Of 30 & x202f;456 physicians who received an invitation to participate, 5445 (17.9%) completed surveys (2995 men [62.1%]; median [IQR] age of 53 [42-62] years). In multivariable analysis, mean (SD) resilience scores were higher among physicians than the general employed population (6.49 [1.30] vs 6.25 [1.37]; adjusted mean difference, 0.25 points; 95% CI, 0.19-0.32; P < .001). Among physicians, resilience was associated with burnout. Physicians without overall burnout had higher mean (SD) resilience scores than physicians with burnout (6.82 [1.15] vs 6.13 [1.36]; adjusted mean difference, 0.68 points, 95% CI, 0.61-0.76; P < .001). Each 1-point increase in resilience score was associated with 36% lower odds of overall burnout (odds ratio, 0.64; 95% CI, 0.60-0.67; P < .001). However, 392 of 1350 physicians (29%) with the highest possible resilience score had burnout. Conclusions and Relevance The findings of this national survey study suggest that physicians exhibited higher levels of resilience than the general working population in the US. Resilience was inversely associated with burnout symptoms, but burnout rates were substantial even among the most resilient physicians. Additional solutions, including efforts to address system issues in the clinical care environment, are needed to reduce burnout and promote physician well-being.This cross-sectional survey study evaluates resilience among physicians and US workers and assesses the association between resilience and burnout among US physicians.Question How resilient are physicians compared with US workers, and what is the association between resilience and burnout among physicians? Findings In this cross-sectional survey study of 5445 respondents from among 30 & x202f;456 physicians, the physicians had significantly higher resilience scores than the general employed US population. Higher resilience scores were associated with lower burnout rates, but even the most resilient physicians had substantial rates of burnout. Meaning The findings suggest that, although maintaining and strengthening resilience is important, physicians overall do not have a deficit in resilience; additional solutions, including efforts to address system issues in the clinical care environment, are needed to reduce burnout and promote physician well-being.