Physicians? Occupational Health During Covid-19: A Qualitative Analysis of Systems Factors

项目摘要 美国医生患抑郁症、滥用药物、自杀、过度工作、精疲力竭、 和精疲力竭。新冠肺炎大流行强加的新工作条件加剧了 这些职业健康负担对医生来说是在基线压力水平， 职业倦怠和心理健康状况差已经是压倒性的高水平。关于医生的研究 职业倦怠已经扩大，但大部分都集中在个人层面的原因和解决方案上 对于影响医生福祉的更广泛的结构性因素，几乎没有什么可识别和回应的。这 这项研究将应用职业健康透镜来检查医院医生在 纽约市(NYC)和西雅图，美国新冠肺炎爆发的两个中心。我们的社会- 生态模型承认卫生系统、工作和工作之间的协同关系 环境和个人幸福感，并解释了 影响医生职业健康的多层次因素。我们将进行定性的 采访了纽约市(n=40)和西雅图(n=40)在一线工作的医生 新冠肺炎护理(即以医院为基础的主治医生或在内部执业的研究员 医学、家庭医学、急诊医学、传染病和肺部/危重病 关爱)。通过对每个城市不同医院的医生进行抽样，我们将评估 州和地方公共卫生应对措施和体制因素的差异起到了中介作用 医生对这场危机做出了反应。我们的具体目标是：目标1：描述 在影响工作场所条件的制度、专业和机构层面的因素中 在新冠肺炎大流行期间，医生们对职业健康和 福祉；目标2：确定系统、专业、机构和个人级别 新冠肺炎期间保障医生职业健康福祉的特点 大流行病；目标3.制定和传播基于证据的建议，以保护 医生在正常和危急情况下的职业健康和福祉，专家 面板输入。这项研究解决了一个有充分记录的职业健康问题， 由于大流行而具有新的紧迫性，并通过对结构性疾病的新的关注来做到这一点 在一个独特的历史时刻塑造职业幸福感的因素。它的输出结果是 研究包括循证建议，以改善医生的职业健康和 福利和组织对大流行情况的反应。因此，这项研究回应了 符合NIOSH的全员健康™倡议和符合NIOSH研究的实践标准。

PROJECT ABSTRACT US physicians are at high risk for depression, substance abuse, suicide, overwork, exhaustion, and burnout. New working conditions imposed by the COVID-19 pandemic have exacerbated these occupational health burdens for physicians at a time when baseline levels of stress, burnout, and poor mental health were already overwhelmingly high. Research on physician burnout has expanded, yet much of it focuses on individual-level causes and solutions that do little to identify and respond to the broader structural factors shaping physicians' wellbeing. This study will apply an occupational health lens to examine the experiences of hospital physicians in New York City (NYC) and Seattle, the two epicenters of the US COVID-19 outbreak. Our socio- ecological model acknowledges the synergistic relationships between health systems, work environments, and individual wellbeing, and accounts for the complex interplay between the multi-level factors shaping physicians' occupational health. We will conduct qualitative interviews with physicians in NYC (n=40) and Seattle (n=40) who work at the front lines of COVID-19 care (i.e. hospital-based attending physicians or fellows practicing in internal medicine, family medicine, emergency medicine, infectious diseases, and pulmonary/critical care). By sampling physicians from diverse hospitals in each city, we will assess how differences in state and local public health responses and institutional factors mediate the way physicians respond to the crisis. Our specific aims are to: Aim 1: Describe the relationships among the systems-, professional-, and institutional-level factors shaping workplace conditions during the COVID-19 pandemic and physicians' perceptions of occupational health and wellbeing; Aim 2: Identify systems-, professional-, institutional-, and individual-level characteristics that protect physicians' occupational health and wellbeing during the COVID-19 pandemic; Aim 3. Develop and disseminate evidence-based recommendations to protect physicians' occupational health and wellbeing during normal and crisis conditions, with expert panel input. The study addresses a well-documented occupational health problem that has taken on new urgency due to the pandemic, and does so through novel attention to structural factors that shape occupational wellbeing during a unique historical moment. The outputs of this study include evidence-based recommendation to improve physicians' occupational health and wellbeing and organizational responses to pandemic conditions. Therefore, the study responds to NIOSH's Total Worker Health™ Initiative and meets NIOSH Research to Practice standards.