Worklife and Wellness in Academic General Internal Medicine: Results from a National Survey
Worklife and Wellness in Academic General Internal Medicine: Results from a National Survey
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DOI：
10.1007/s11606-016-3720-4
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发表时间：
2016-09-01
影响因子：
5.7
通讯作者：
Ovington, Kay
中科院分区：
文献类型：
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作者：
Linzer, Mark;Poplau, Sara;Ovington, Kay
普通内科（GIM）职业越来越被视为具有挑战性和不可持续性。我们的目的是评估学术GIM的工作生活，并确定压力和倦怠的补救预测。我们进行了一项电子邮件调查。15个GIM部门的医生，护士执业者和医生助理参与。一项10项调查询问压力，倦怠和工作条件，如电子病历（EMR）挑战。一个开放式问题评估了压力源和解决方案。结果分为倦怠，高压力，高控制，混乱，良好的团队合作，高值对齐，文档时间压力，和过度的家庭电子病历使用。确定了国家数据、退伍军人事务部（VA）与平民人群以及住院医师与门诊角色的频率。一般线性混合模型（GLMM）评估与倦怠的关联。对开放式问题的回答进行了正式的内容分析，在1235名临床医生中，有579人（47%）回答了问题。67%的人存在高度压力，38%的人倦怠（按部门划分，倦怠范围为10- 56%）。一半的受访者工作控制力低，60%的人报告文件时间压力大，一半的人描述了太多的家庭电子病历时间，大多数人报告工作场所非常忙碌或混乱。三分之二的人认为与部门领导的价值观一致，四分之三的人对团队合作感到满意。职业倦怠与高压力、低工作控制力和与领导者的低价值观一致性有关（所有p < 0.001）。退伍军人管理局的45名教师比文职人员的倦怠程度要低（17%比40%，p < 0.05）。住院医师描述了比门诊临床医师更好的团队合作，更少的住院医师注意到记录时间压力（均p < 0.001）。从定性分析的关键主题是短期访问，支持人员不足，相对价值单位的心态，文件的时间压力，和低估的education.While GIM部门整体表现出高压力和倦怠，司率差异很大。GIM内部的可持续性工作可以集中在访问长度，工作人员支持，时间表控制，诊所混乱和EMR压力。
General internal medicine (GIM) careers are increasingly viewed as challenging and unsustainable.We aimed to assess academic GIM worklife and determine remediable predictors of stress and burnout.We conducted an email survey.Physicians, nurse practitioners, and physician assistants in 15 GIM divisions participated.A ten-item survey queried stress, burnout, and work conditions such as electronic medical record (EMR) challenges. An open-ended question assessed stressors and solutions. Results were categorized into burnout, high stress, high control, chaos, good teamwork, high values alignment, documentation time pressure, and excessive home EMR use. Frequencies were determined for national data, Veterans Affairs (VA) versus civilian populations, and hospitalist versus ambulatory roles. A General Linear Mixed Model (GLMM) evaluated associations with burnout. A formal content analysis was performed for open-ended question responses.Of 1235 clinicians sampled, 579 responded (47 %). High stress was present in 67 %, with 38 % burned out (burnout range 10-56 % by division). Half of respondents had low work control, 60 % reported high documentation time pressure, half described too much home EMR time, and most reported very busy or chaotic workplaces. Two-thirds felt aligned with departmental leaders' values, and three-quarters were satisfied with teamwork. Burnout was associated with high stress, low work control, and low values alignment with leaders (all p < 0.001). The 45 VA faculty had less burnout than civilian counterparts (17 % vs. 40 %, p < 0.05). Hospitalists described better teamwork than ambulatory clinicians and fewer hospitalists noted documentation time pressure (both p < 0.001). Key themes from the qualitative analysis were short visits, insufficient support staff, a Relative Value Unit mentality, documentation time pressure, and undervaluing education.While GIM divisions overall demonstrate high stress and burnout, division rates vary widely. Sustainability efforts within GIM could focus on visit length, staff support, schedule control, clinic chaos, and EMR stress.