Working Conditions Of Physicians Research Articles

Recurrent neural networks for generalization towards the vessel geometry in autonomous endovascular guidewire navigation in the aortic arch

PurposeEndovascular intervention is the state-of-the-art treatment for common cardiovascular diseases, such as heart attack and stroke. Automation of the procedure may improve the working conditions of physicians and provide high-quality care to patients in remote areas, posing a major impact on overall treatment quality. However, this requires the adaption to individual patient anatomies, which currently poses an unsolved challenge.MethodsThis work investigates an endovascular guidewire controller architecture based on recurrent neural networks. The controller is evaluated in-silico on its ability to adapt to new vessel geometries when navigating through the aortic arch. The controller’s generalization capabilities are examined by reducing the number of variations seen during training. For this purpose, an endovascular simulation environment is introduced, which allows guidewire navigation in a parametrizable aortic arch.ResultsThe recurrent controller achieves a higher navigation success rate of 75.0% after 29,200 interventions compared to 71.6% after 156,800 interventions for a feedforward controller. Furthermore, the recurrent controller generalizes to previously unseen aortic arches and is robust towards size changes of the aortic arch. Being trained on 2048 aortic arch geometries gives the same results as being trained with full variation when evaluated on 1000 different geometries. For interpolation a gap of 30% of the scaling range and for extrapolation additional 10% of the scaling range can be navigated successfully.ConclusionAdaption to new vessel geometries is essential in the navigation of endovascular instruments. Therefore, the intrinsic generalization to new vessel geometries poses an essential step towards autonomous endovascular robotics.

Evaluation of violence against emergency physicians

Aim: To identify the causes of violence in the emergency department and suggest ways to reduce the violence experienced.
 Material and Method: The population of this cross-sectional survey study consisted of all emergency medicine physicians who participated in the symposium on frequent emergencies held in Cyprus on May 6, 2022. The survey consisted of a total of 20 items comprising 16 multiple-choice and four fill-in-the-blank questions related to demographic characteristics and violence. It was administered to 230 physicians who volunteered to participate in the study.
 Results: A total of 230 physicians, 65.2% (n=150) male and 34.8% (n=80) female, participated in the study. It was determined that 28.7% of the participants had been exposed to physical violence, 89.2% to verbal violence, and 1.3% to sexual violence within the last year. The factors causing violence were identified as the low educational level of patients’ and their family members, patient requests for unnecessary medical practices, aggressive nature of family members, and patients’ desire to be examined before their turn. As the number of shifts worked by the physicians and number of treated patients increased, the frequency of exposure to violence also increased. Women were exposed to more violence. As the title and age of the physicians increased, the frequency of exposure to violence decreased.
 Conclusion: We consider that violence against physicians can be reduced by informing patients and patient’s relatives and improving the working conditions of physicians.

Doctor Clerk Implementation in Rural Community Hospitals for Effective Task Shifting of Doctors: A Grounded Theory Approach

With the diversification of medical care and work reform, doctor clerks play a major role today and are recruited to mitigate the burden of doctors worldwide. Their recruitment can improve the working conditions of physicians, facilitate task shifting in rural community hospitals, improve patient care, and help address the lack of healthcare resources. This study used a qualitative method to investigate difficulties in the implementation of doctor clerks and ascertain the features of effective implementation by collecting ethnographic data through field notes and semi-structured interviews with workers. We observed and interviewed 4 doctor clerks, 10 physicians, 14 nurses, 2 pharmacists, 1 nutritionist, and 2 therapists for our study. We clarified the doctor clerk process in rural hospitals through four themes: initial challenge, balance between education and expansion, vision for work progression, and drive for quality of care. We further clarified effectiveness, difficulties, and enhancing factors in implementation. Doctor clerk recruitment and bridging of discrepancies among medical professionals can mitigate professional workloads and improve staff motivation, leading to better interprofessional collaboration and patient care.

Working conditions in primary healthcare during the COVID-19 pandemic: an interview study with physicians in Sweden

ObjectiveThe aim of this study was to explore how the COVID-19 pandemic changed the working conditions of physicians in Swedish primary healthcare.DesignThis is a descriptive, qualitative study with individual semistructured...

Implementation of the new collective agreement in 2021 in urological clinics : Expectations and reality

The amendment to the collective agreement is intended to significantly improve the working conditions of physicians and includes longer-term duty scheduling, work on amaximum of two weekends per month, less overtime. Smaller hospitals often have problems implementing these requirements and have to make compromises. At least the overtime is now better paid-overall, an improvement in working conditions can only be achieved by increasing the number of staff, then better and more intensive training is also possible.

Regional disparity of certified teaching hospitals on physicians\u2019 workload and wages, and popularity among medical students in Japan

BackgroundRegional disparities in the working conditions of medical doctors have not been fully assessed in Japan. We aimed to clarify these differences in hospital characteristics: doctors’ workload, wages, and popularity among medical students by city population sizes.MethodsWe targeted 423 teaching hospitals certified by the Japanese Society of Internal Medicine and assessed the working conditions of physicians specializing in internal medicine. We calculated their workload (the annual number of discharged patients per physician) and retrieved data on junior residents’ monthly wages from the Resinavi Book which is popular among medical students in Japan to know the teaching hospital’s information and each hospital’s website. Furthermore, we explored the interim matching rate of each hospital as its popularity among medical students. Next, we classified cities in which all hospitals were located into eight groups based on their population size and compared the characteristics of these hospitals using a one-way analysis of variance.ResultsThe average workload was 110.3, while the average workload in hospitals located in most populated cities (≥ 2,000,000) was 88.4 (p < 0.05). The average monthly wage was 351,199 Japanese yen, while that in most populated cities was 305,635.1 Japanese yen. The average popularity (matching rate) was 101.9%, and the rate in most populated areas was 142.7%, which was significantly higher than in other areas.ConclusionsHospitals in most populated areas had significantly lower workloads and wages; however, they were more popular among medical students than those in other areas. This study was the first to quantify the regional disparities in physicians’ working conditions in Japan, and such disparities need to be corrected.

Work-family-conflict in the context of the working conditions of university employees – comparison of professions

IntroductionWorking conditions at universities are often considered precarious. Employees complain of fixed-term contracts and extensive unpaid overtime (Dorenkamp et al. 2016). Studies from various fields of work show that occupational groups with a high workload suffer particularly from a conflictual compatibility of work and family.ObjectivesThe aim of this study was to assess the WFC in the context of working conditions.MethodsN=844 university employees (55% women, 41% men) were asked about the burden of work/life balance using Work-family-conflict (WFC) - Family-work-conflict (FWC) -Scales (Netemeyer 1996). The dichotomously formulated question on overtime worked was supplemented by a five-step scaled item on the burden of overtime. The correlation analyses were calculated according to Spearman.ResultsOvertime performed by 83% of the total sample and 64% feel burdened by it. 95% of the scientists and physicians, 68% of the administrative staff, 63% of the service providers work overtime and 90% of the physicians and 72% of the scientists feel burdened by it. Significantly high correlations were found between the burden of overtime and the conflict of compatibility. The higher the burden of overtime, the higher the WFC and FWC. The highest correlation was found among physicians (r=.649), followed by scientists (r=.533), administration (r=.451), services (r= (total sample r=.562).ConclusionsThe additional work and strain caused by this, as well as the connections with the problem of compatibility, show need for action for employers regarding the working conditions of physicians and scientists. Especially with regard to reducing overtime and improving the compatibility of work and family.

Condiciones de trabajo en consultorios adyacentes a farmacias privadas en Ciudad de México: perspectiva del personal médico

ObjectiveTo analyse the working conditions of physicians in outpatient clinics adjacent to pharmacies (CAFs) and their organizational elements from their own perspective. MethodsWe carried out an exploratory qualitative study. Semi-structured interviews were conducted with 32 CAF physicians in Mexico City. A directed content analysis technique was used based on previously built and emerging codes which were related to the experience of the subjects in their work. ResultsRespondents perceive that work in CAFs does not meet professional expectations due to low pay, informality in the recruitment process and the absence of minimum labour guarantees. This prevents them from enjoying the benefits associated with formal employment, and sustains their desire to work in CAF only temporarily. They believe that economic incentives related to number of consultations, procedures and sales attained by the pharmacy allow them to increase their income without influencing their prescriptive behaviour. They express that the monitoring systems and pressure exerted on CAFs seek to affect their autonomy, pushing them to enhance the sales of medicines in the pharmacy. ConclusionsPhysicians working in CAFs face a difficult employment situation. The managerial elements used to induce prescription and enhance pharmacy sales create a work environment that generates challenges for regulation and underlines the need to monitor the services provided at these clinics and the possible risk for users.

Organizational Citizenship Levels of Physicians in Public Hospitals

ABSTRACTThe aim of this study is to define organizational citizenship levels of physicians working in public hospitals. The population of the study consists of the physicians employed in the hospitals run by the Ministry of Health in Istanbul. The Organizational Citizenship Level Scale was used for the collection of data. It was found that the participants’ organizational citizenship levels were the highest in the “conscience” subsection and the lowest in the “praising the organization” subsection. Findings of this study provide clear information for the decision-makers and hospital managers in developing working conditions of physicians in public hospitals.

Power and trust in organizational relations: an empirical study in Turkish public hospitals.

Given the salience of the interplay between trust and power relations in organizational settings, this paper examines the perceptions of social power and its effects on trust in supervisors within the context of public hospitals. Following the theoretical background from which the study model is developed, the recent situation of hospitals within Turkish healthcare system is discussed to further elucidate the working conditions of physicians. Sample data were collected employing a structured questionnaire that was distributed to physicians working at seven different public hospitals. The statistical analyses indicate that perceptions of supervisors' social power affect subordinates' trust in supervisors. Although coercive power is found to have the greatest impact on trust in supervisors, the influence of the power base is weak. In addition, the results show that perceptions of social power differ between genders. However, the results do not support any of the hypotheses regarding the relations between trust in supervisors and the examined demographic variables.

Ärztlicher Disstress – eine Untersuchung baden-württembergischer Ärztinnen und Ärzte in Krankenhäusern

Current working conditions of physicians in hospitals display characteristics, which on the long term are harmful for the physicians mental and physical health (distress). There are problems concerning the work flow and the organization of working time which finally leads to gratification crises. How physicians perceive their stress-related working conditions is the issue this study wants to investigate. In this study 12 062 physicians in hospitals were invited to an anonymized online-survey. 2064 physicians took part. The basis of this investigation is built by 2 theoretical stress models: The effort-reward-imbalance models of Siegrist and the job-demand-control model of Karasek. Through these theoretical models distress is measured. The study revealed a high prevalence (55,5 %) of distress among physicians in hospitals. Furthermore there were significant differences between gender (59,7 % of female and 51,5 % of male physicians; OR 1,40; 95 %-CI 1,17‑1,66; p < 0,001), between age (61,9 % of under 35-year-old and 49,4 % of over 59-year-old; OR 1,67; 95 %-CI 1,06-2,62; p < 0,001) and between the functional position (24,6 % of chief physician and 63,8 % of junior doctors; OR 5,40; 95 %-CI 3,03-9,65; p < 0,001). An additional analysis of the psychosocial aspects of the working conditions showed that these aspects are rated positively by this sample. These results have to be considered as a cause for concern, because this high prevalence of distress will lead sooner or later to a migration of qualified physicians abroad or to other (less stressful) jobs. In order to prevent a future shortage of qualified physicians, the working conditions have to be adapted to current needs and expectations of the younger generation.

Less work: more burnout? A comparison of working conditions and the risk of burnout by German physicians before and after the implementation of the EU Working Time Directive

The present study is a 10-year comparison (1997 vs. 2007) of occupational and health aspects before and after the implementation of the European Working Time Directive on German hospital physicians. A major focus is whether the changes in working conditions are accompanied by a lower risk for burnout. Three hundred and twenty-eight physicians from the Medical Register of the city of Hamburg completed the survey in 1997 and 994 physicians in 2007. The response rates were 55.4 and 46.5 %, respectively. All participants filled in a 22-item version of the German translation of the Maslach Burnout Inventory. Results of multivariate covariance analyses are reported. The work of physicians has changed significantly within the 10-year period, for example, work time decreased by 4.5 h on average to 55.8 h per week in 2007. Junior physicians profited more from this development, but on-call duties increased for senior physicians in particular. The reduced hours were at the expense of fewer rests. Junior, as well as senior, physicians reported significantly higher rates on the burnout scale for emotional exhaustion (mean 21.8, SD 10.7) in the latter survey and senior physicians also on the depersonalization scale (mean 9.7, SD 6.3). Changes in working conditions in accordance with the European Working Time Directive are not accompanied by reduced strain and risk of burnout for physicians. Rather, our data argue for greater intensification in work, especially for senior physicians. Further studies are suggested in order to explore interventions for a sustainable improvement in the working conditions of physicians.

“Better Work, Working Better.” Are Professional-Related Problems Discussed at the Argentine Congress of Cardiology? Are Physicians Concerned with this Problem?

Background The big changes produced during the last two decades have produced a reality that requires physicians to reconsider the role they play in their new working scenario. These changes include regulations in health care working, work styles, health organization, use and importance of technology and how the physician is socially considered. The causes are complex and multifactorial, yet they share common elements as worse payment to physicians, an absolute and relative reduction in professional fees and physicians’ perception about their own profession. Objectives A “medical problem” is defined as any problematic experience or situation felt by a physician during his/her practice. In the last years, there are plenty of information and several opinions about this matter, in reference to the working conditions of physicians and to their negative self-perception about medical practice. The goal of the present study was to explore if the Argentine Congress of Cardiology dealt with the medical problem. Material and Methods Observational and descriptive study about open-topic sessions and roundtable sessions dealing with the medical problem –and under which field the medical problem was considered– during the past/latest three Argentine Congresses of Cardiology. The following key words were used: working reality, medical practice, burnout, bioethics, ethics and working conditions, among others. Results Of 2254 open topics presented in the three years, 8 (0.35%) dealt with the medical problem. The open topics were considered under “miscellany”, psychosocial, medical education or public health fields. Thirteen roundtable sessions were identified and organized by the Committee on Bioethics, the Research Area of the Argentine Society of Cardiology, the CONAREC and the Argentine Cardiology Foundation. Conclusions We found very few roundtable sessions and opened-topic sessions –and without an adequate preestablished conceptual framework– focused on the medical problem. Thus, the medical problem is not considered an important topic of study. Discussion and investigation are convenient to search for arguments and solutions at multiple levels, otherwise it will not be possible to make a diagnosis and treatment of the topic, with the eventual and important future implications.

A comparison of the workload of rural and urban primary care physicians in Germany: analysis of a questionnaire survey

BackgroundMany western countries are facing an existing or imminent shortage of primary care physicians especially in rural areas. In Germany, working in rural areas is often thought to be associated with more working hours, a higher number of patients and a lower income than working in urban areas. These perceptions might be key reasons for the shortage. The aim of this analysis was to explore if working time, number of treated patients per week or proportion of privately insured patients vary between rural and urban areas in Germany using two different definitions of rurality within a sample of primary care physicians including general practitioners, general internists and paediatricians.MethodsThis is a secondary analysis of pre-collected data raised by a questionnaire that was sent to a representative random sample of 1500 primary care physicians chosen by data of the National Association of Statutory Health Insurance Physicians from all federal states in Germany. We employed two different methods of defining rurality; firstly, level of rurality as rated by physicians themselves (urban area, small town, rural area); secondly, rurality defined according to the Organisation for Economic Co-operation and Development.ResultsThis analysis was based upon questionnaire data from 715 physicians. Primary care physicians in single-handed practices in rural areas worked on average four hours more per week than their urban counterparts (p < 0.05). Physicians' gender, the number of patients treated per week and the type of practice (single/group handed) were significantly related to the number of working hours. Neither the proportion of privately insured patients nor the number of patients seen per week differed significantly between rural and urban areas when applying the self-rated classification of rurality.ConclusionOverall this analysis identified few differences between urban and rural primary care physician working conditions. To counter future misdistribution of primary care, students should receive practical experience in rural areas to get more practical knowledge on working conditions.

Employed Family Physician Satisfaction and Commitment to Their Practice, Work Group, and Health Care Organization

Test a model of family physician job satisfaction and commitment. Data were collected from 1,482 family physicians in a Midwest state during 2000-2001. The sampling frame came from the membership listing of the state's family physician association, and the analyzed dataset included family physicians employed by large multispecialty group practices. A cross-sectional survey was used to collect data about physician working conditions, job satisfaction, commitment, and demographic variables. The response rate was 47 percent. Different variables predicted the different measures of satisfaction and commitment. Satisfaction with one's health care organization (HCO) was most strongly predicted by the degree to which physicians perceived that management valued and recognized them and by the extent to which physicians perceived the organization's goals to be compatible with their own. Satisfaction with one's workgroup was most strongly predicted by the social relationship with members of the workgroup; satisfaction with one's practice was most strongly predicted by relationships with patients. Commitment to one's workgroup was predicted by relationships with one's workgroup. Commitment to one's HCO was predicted by relationships with management of the HCO. Social relationships are stronger predictors of employed family physician satisfaction and commitment than staff support, job control, income, or time pressure.

Pediatria no século 21: uma especialidade em perigo

OBJETIVO: Revisar a literatura sobre trabalho médico, formas de remuneração, avanço tecnológico e sua influência na Pediatria. FONTES DE DADOS: Artigos publicados em inglês e português nas bases de dados Medline, Lilacs e SciELO no período de 1990 a 2007. Foram utilizadas as palavras-chave"Puericultura","Pediatria","trabalho médico","honorários médicos","mercado de trabalho" e"desenvolvimento tecnológico". SÍNTESE DOS DADOS: Diante do estado atual de avanço tecnológico em todas as áreas do conhecimento, especialmente na Medicina, é necessário resgatar o papel do pediatra apesar das mudanças nas relações de trabalho, formas de remuneração, formação cada vez mais especializada e condições de trabalho aviltantes. Se, de um lado, as novas tecnologias são benéficas para a Medicina, para o médico e para o paciente, do outro o atendimento médico do clínico, principalmente do pediatra, não está sendo devidamente valorizado. CONCLUSÕES: É preciso que a classe pediátrica assuma a responsabilidade pela situação na qual essa especialidade se encontra, pois o pediatra se submete a condições de trabalho indignas do ponto de vista pessoal e social, obrigado à quantidade em detrimento da qualidade, tornando-se suscetível ao erro médico

Job Satisfaction Among Physicians In Al-Sabah Hospital, Kuwait

Background: The prevalence of dissatisfaction among doctors has been given considerable importance in recent years as it affects the quality of health care Objectives: The aim of the present study was to determine the level of job satisfaction among doctors working at AL-Sabah Hospital in Kuwait, identify aspects of dissatisfaction and factors that could be associated with. Methods: All sixty physicians currently working in the department of internal medicine were asked to participate. A self-administered close-ended questionnaire was used to obtain personal data and information from the physicians on various aspects of job satisfaction. It included 20 items divided into 5 aspects that are relevant to a number of job facets. A 5-point, Likert-scale was used. Analysis was carried out using Chi-square and Fisher Exact tests. Results: The response rate was 83.3%. Overall, 50% of participating physicians were generally satisfied with their job. Higher scores of satisfaction were reported among male, married, with longer experience, with higher qualification. Proportions of satisfaction with each item were presented. No significant difference could be detected according to personal factors and working conditions regarding these items except for nationality. Higher proportions of satisfied non Kuwaiti physicians were recorded regarding the freedom to use their own judgment (62.2% versus 14.4%, P = 0.004) and to do their own method to do the job (59.5 % versus 23.1%, P = 0.02), whereas only 18.9% of non-Kuwaiti physicians were satisfied with their payment as compared with 69.2% in Kuwaiti physicians (P= 0.002) Conclusion: It is urgent and necessary to improve physician working conditions and their working pattern to maintain job satisfaction. Physicians themselves, hospital administrators and the government should take the initiative to improve the working conditions in Kuwait hospitals. Larger multi-centric research about this issue is needed. Keywords: job satisfaction - physicians - working conditions

Health services research in dermatology – current update and perspectives

An in-depth knowledge of the demands on health care resources and the quality of health care provision is of major importance for the future care of skin and allergy patients. We present a comprehensive summary of all available health care data and research activities in dermatology in Germany. A standardized electronic literature search was performed using PUBMED as well as a manual search to identify activities in the field of health services research in dermatology. Furthermore, questionnaires were sent to 114 dermatology hospitals and to 52 health service research institutions in Germany. The overall return rate of the survey was 81%. Hints on projects were given by 30 hospitals and 5 institutions. Most of these projects were in the field of epidemiology, quality of life, economy and prevention. Finally, the search identified 101 health services research projects in Germany. In addition, material gathered from internet and secondary citations from scientific journals produced a total of 216 publications. Only few projects were found on the working conditions of physicians and other health care professionals, on the implementation of guidelines, on needs and use of dermatological services and on the quality of care. The findings demonstrate that there are substantial deficiencies in some important areas of health services research in dermatology. To provide efficient and qualified dermatological health care in Germany in the future, more research projects on the needs, demands and quality of health care are needed.

Scheduling emergency room physicians.

This paper introduces the problem of scheduling emergency room physicians. We interviewed physicians from six hospitals in the greater Montreal, Canada area, in order to understand the emergency room scheduling problem. Extracting the real scheduling problem is difficult because physician working conditions are based on informal mutual cooperation which is usually not documented. We present the characteristics of the scheduling problem and the scheduling techniques currently used in the six emergency rooms we analyzed. Using the scheduling problems of Charles-Lemoyne Hospital and the Jewish General Hospital, we show how to modify a hospital's existing scheduling rules to develop techniques which produce better schedules and reduce the time needed to build them.

勤務医の労働条件 少数例の労働時問，余暇，及び収入の面接調査から

The government of Japan is now implementing a policy aimed at reducing the occupational working hours, for all types of labor in Japan, to 40 hrs/week and 1, 800 hrs/year. The implementation of this policy began in 1988 and is scheduled to be completed in 1997. In fact, average working hours have decreased, reaching 1, 904hrs/year in 1995, a level comparable to those of the USA and the United Kingdom. Physicians have, however, been dealt with differently from other hospital workers. Even physicians employed in large hospitals seem to work harder for a longer time than ever. The authors attempted to ascertain the working conditions of physicians employed in large hospitals in Gunma Prefecture, Japan. Twenty-four male physicians in their 30s of age, working in national university hospitals and relatively large private and public hospitals, were randomly selected from the membership list of the alumni association of a national medical school in the same prefecture. A questionnaire was prepared to include the following items: working hours, number of holidays, annual income, actual time budget on seven successive days. The questionnaire was distributed by an interviewer after obtaining each subject's consent to participate in the survey. After a week or more the interviewer retrieved the filled-in forms. Intotal, 19 physicians responded. Average working hours for 11 university hospital physicians (UP) and 8 other hospital physicians (HP) were 2, 781 and 2, 346 hrs/year, or 66.3 and 57.7 hrs/week, respectively. Average weekly working hours of approximately 5, 000 general and non-general physicians sampled in the USA were 51 hrs in 1980, based on a periodic survey conducted by the American Medical Association.Numbers of holidays per year for UP and HP were 57.8 and 69.6 days, respectively, though the number for workers employed in Gunma Prefecture was 107.5 days. Incomes per year for UP were 3.79 million yen from the university hospital and 4.86 from hospitals employed as part timers, a total of 8.65 million yen, while that of HP was 12.56 million yen. The UP time budgets for primary (sleep, etc.), secondary (work, etc .) and tertiary (learning, etc.) activities were 70.4, 71.2 and 24.4 hrs/week, respectively; these figures were almost the same as those of HP. The longer the secondary activity time the shorter the primary and tertiary activity times. The shift system and the team approach for physicians employed in hospitals are so inadequate that they cannot take enough holidays and have little time to study or to refresh the knowledge essential to their professional lives.