Work Environment Of Physicians Research Articles

Physical work environment and burnout among primary care physicians in Israel: a cross-sectional study

BackgroundPhysician burnout remains a prevalent issue globally, negatively affecting work satisfaction and patient care. However, exploration of the physical work environments of physicians, a potential influencing factor for burnout, remains scarce. The physical work environment is everything that surrounds the physician, including the doctor’s office, the clinic, the clinic’s building, the waiting, and staff rooms. The aims of this study were to describe aspects of the physical work environment of primary care physicians (PCPs) and to explore the association between the physical work environment and burnout.MethodsIn this cross-sectional study, we emailed questionnaires to an online community of PCPs in Israel in October 2021. We asked physicians about their satisfaction with their physical work environment, evaluated elements of the work environment, and assessed burnout status (with the Shirom-Melamed Burnout Measure, SMBM). We used the Chi-square and Mann-Witney tests to compare categorical and continuous variables and used logistic regression for the final model.ResultsTwo hundred twenty-one PCPs answered the questionnaire (27.6% response rate). Over a third (35.7%) of respondents reported high burnout. PCPs who were satisfied with their general physical environment had lower burnout rates than those who were unsatisfied (28.1% vs. 47.8%, p-value < 0.001). We found positive correlations between general satisfaction with the physical work environment and the scores achieved for the doctor’s office, the clinic, the clinic’s building, and the waiting room. In the multivariate analysis, high satisfaction with the general physical work environment was associated with decreased odds for burnout (OR-0.50, 95% CI 0.25–0.99, p-value-0.048).ConclusionThe doctor’s office, the clinic, the clinic’s building, and the waiting room affected general satisfaction from the physical work environment. High satisfaction with the physical work environment reduced burnout rates. Future studies are needed to determine whether PCPs and managers should invest in the physical work environment to decrease burnout and increase satisfaction.

Musculoskeletal pain among medical residents: role of workplace safety climate and sexual harassment

BackgroundWorkplace factors are important predictors of occurrence of musculoskeletal pain among different occupational populations. In healthcare, a psychologically unsafe work environment can negatively affect the emotional, physical and psychological well-being of physicians. This study aimed to examine the relationship between workplace violence, sexual harassment and musculoskeletal pain among Egyptian physicians in their years of residency.MethodsWe distributed an online self-administered questionnaire to 101 residents working in various healthcare sectors in Egypt. It included sections on demographic data, working conditions, widespread pain index (WPI), pain interference short-form, workplace violence and harassment questionnaire, psychosocial safety climate questionnaire (PSC) and sexual harassment climate questionnaire.ResultsAll residents had at least one painful site on the WPI (range 1–11). The mean WPI was 3.5 ± 2.4, and 39.6% satisfied the criteria of having widespread pain by having at least 4 pain sites. Widespread pain index showed a weak statistically significant negative correlation with workplace PSC score (rho = − 0.272, p = 0.006), and a statistically significant weak positive correlation with the calculated total abuse index (rho = 0.305, p = 0.002). Workplace violence and abuse, as measured by a calculated abuse index was the only significant predictors of widespread pain among residents.ConclusionWPV was found to be a predictor of musculoskeletal pain among medical residents. Healthcare organizations need to address WPV by employing preventive strategies to minimize its hazardous effects and ensure a safe working environment for physicians.

Value co-creation in the health-care ecosystem for sustained excellence: realization of patient-centered medicine through task shifting of nurses

PurposeIn Japan, health-care systems have long been supported by physicians' long working hours. To solve this problem, there is an urgent need to improve the working environment for physicians while practicing patient-centered medicine and controlling health-care costs. This paper aims to examine the effect of task shifting to nurses and discuss its usefulness from the perspective of health-care value co-creation.Design/methodology/approachThis paper analyzes task shifting to nurses in acute care hospitals in Japan as a solution for the shortage of anesthesiologists. The authors discuss how the value was created from the perspective of the health-care ecosystem, with conceptual consideration of the value co-creation mechanism through patient-centered practices.FindingsThe study showed that task shifting initiatives in Japan can improve the motivation of nurses through human resource development while maintaining high quality. The study also suggested that task shifting from physicians to nurses may contribute to improving net income and maintaining the health-care system.Practical implicationsThe findings are highly reproducible and can be immediately applied to initiatives at other medical institutions in Japan. Furthermore, it is suggested that these findings might provide some perspective on the realignment of fragmented healthcare in the USA.Originality/valueIt was confirmed in practical terms that micro-level initiatives have an impact on the macro level as well. In addition, the academic presentation of the concept has contributed to the deepening of value research.

The Interplay of Work, Digital Health Usage, and the Perceived Effects of Digitalization on Physicians' Work: Network Analysis Approach.

In health care, the benefits of digitalization need to outweigh the risks, but there is limited knowledge about the factors affecting this balance in the work environment of physicians. To achieve the benefits of digitalization, a more comprehensive understanding of this complex phenomenon related to the digitalization of physicians' work is needed. The aim of this study was to examine physicians' perceptions of the effects of health care digitalization on their work and to analyze how these perceptions are associated with multiple factors related to work and digital health usage. A representative sample of 4630 (response rate 24.46%) Finnish physicians (2960/4617, 64.11% women) was used. Statements measuring the perceived effects of digitalization on work included the patients' active role, preventive work, interprofessional cooperation, decision support, access to patient information, and faster consultations. Network analysis of the perceived effects of digitalization and factors related to work and digital health usage was conducted using mixed graphical modeling. Adjusted and standardized regression coefficients are denoted by b. Centrality statistics were examined to evaluate the relative influence of each variable in terms of node strength. Nearly half of physicians considered that digitalization has promoted an active role for patients in their own care (2104/4537, 46.37%) and easier access to patient information (1986/4551, 43.64%), but only 1 in 10 (445/4529, 9.82%) felt that the impact has been positive on consultation times with patients. Almost half of the respondents estimated that digitalization has neither increased nor decreased the possibilities for preventive work (2036/4506, 45.18%) and supportiveness of clinical decision support systems (1941/4458, 43.54%). When all variables were integrated into the network, the most influential variables were purpose of using health information systems, employment sector, and specialization status. However, the grade given to the electronic health record (EHR) system that was primarily used had the strongest direct links to faster consultations (b=0.32) and facilitated access to patient information (b=0.28). At least 6 months of use of the main EHR was associated with facilitated access to patient information (b=0.18). The results highlight the complex interdependence of multiple factors associated with the perceived effects of digitalization on physicians' work. It seems that a high-quality EHR system is critical for promoting smooth clinical practice. In addition, work-related factors may influence other factors that affect digital health success. These factors should be considered when developing and implementing new digital health technologies or services for physicians' work. The adoption of digital health is not just a technological project but a project that changes existing work practices.

Physician Flow at Work: Examining Work Absorption, Clinical Flow, Work Fulfillment, and Flow Thieves.

The experience of "flow" at work correlates with positive job outputs and work-related attitudes. Very little current literature describes flow at work in physicians, who experience significant barriers to optimal work outputs, also known as flow thieves (e.g., case interruptions, documenting care). This study aimed to develop a measurement for physician flow (P-Flow) at work and examine the association of P-Flow with physician burnout, job satisfaction, and well-being. A pilot instrument was tested with items measuring P-Flow at work. After the pilot administration, a 14-item physician flow (P-Flow-14) scale was administered to physicians. In addition to the P-Flow-14 scale, physician respondents completed items measuring burnout, job satisfaction, and well-being. This study specifies initial psychometric evidence of P-Flow-14 and 7-item P-Flow instruments for researchers interested in studying flow at work in physicians. For each P-Flow instrument, higher levels of the flow experience correlated with superior levels of well-being (p < .01) and job satisfaction (p < .01), and less burnout (p < .001). Results showed initial psychometric evidence of derived subscales (work absorption, clinical flow, flow thieves, work fulfillment) for application in future research. Results showed associations between flow experience by age group and physician specialty. To enhance well-being and job satisfaction, physicians should aim for concentration and immersion in clinical duties while reducing unnecessary distractions. These findings can be applied by employers and can guide further research on work interruptions and patient safety. Future research can validate the P-Flow scales and subscales to assess interventions aimed to improve the physician work environment.

Acquaintance-Based Medical Treatment Lowered Physician-Patient Trust When the Medical Outcome Was Negative: A Vignette Experiment

Background: The Chinese medical environment has seen a long history of physician-patient distrust, which often leads to conflict and violence, creating a stressful and unsafe working environment for physicians, and further deteriorating physician-patient relationships. Therefore, it is important to understand the factors that influence physician-patient trust in order to inform interventions. The current study investigated the effect of media reports regarding medical treatment outcomes and acquaintance-based medical Treatment on physician-patient trust. Acquaintance-based medical treatment refers to people using their connections to obtain better medical resources. Methods: A vignette experiment was conducted that investigated attitudes toward physicians under positive and negative treatment outcomes among 230 cancer patients and their families (Sample 1) and a cross-validated sample consisting of 280 employees from different industries (Sample 2). Findings: The results from both samples showed that negative media reports were associated with lower perceived trust from the patients toward physicians. Additionally, the results demonstrated that when the medical outcome was positive, the participants generally did not perceive physicians they were familiar with as being more competent and trustworthy than those they were not acquainted with; however, physicians who were acquaintances were perceived as less competent when the medical outcome was negative. Interpretation: The implications include advertising positive media images of physicians to facilitate trust and reduce acquaintance-based medical treatment to make medical resources more available in China. Funding: Preparation of this work was funded by The National Social Science Fund of China (20BSH139). Declaration of Interest: The authors declare that they have no conflicts of interests. Ethical Approval: This study was approved by the IRB at Peking University.

Research on the influence of physician-work environment fitting on turnover intention-mediating role of job burnout

From the perspective of Person-environment fit (PEF), this paper tooks job burnout as a mediating variable to study the influence of physician-work environment fitting on turnover intention. The mediating model of physician-work environment fitting, job burnout and turnover intention was fitted through the questionnaire survey results of 250 physicians in class3-A hospitals in Hubei province. The mediating effect accounts for 47.4% of the total effect between the two. The fitting degree between physicians-work environment in the class3-A hospitals in Hubei province was general (5.62+0.75), and the burnout situation and turnover tendency were not obvious (3.46+0.91, 3.67+1.34). The fitting degree between physicians and hospitals, as well as colleagues were important factors affecting the turnover of physician. In order to alleviate physicians burnout and reduce the turnover rate, the hospital should promote the cooperation and communication between physicians, face up to and meet the economic and psychological needs of physicians, and improve the fitting degree between physician-work environment. Finally, the paper puts forward some suggestions on the intervention of the hospital environment.

Associations between work satisfaction, engagement and 7-day patient mortality: a cross-sectional survey

ObjectiveThis study examines the association between profession-specific work environments and the 7-day mortality of patients admitted to these units with acute myocardial infarction (AMI), stroke and hip fracture.DesignA cross-sectional study...

Impact of training in Advanced Cardiac Life Support (ACLS) in the professional career and work environment.

We sought to evaluate the impact of Advanced Cardiac Life Support (ACLS) training in the professional career and work environment of physicians who took the course in a single center certified by the American Heart Association (AHA). Of the 4631 students (since 1999 to 2009), 2776 were located, 657 letters were returned, with 388 excluded from the analysis for being returned lacking addressees. The final study population was composed of 269 participants allocated in 3 groups (< 3 years, 3-5 and > 5years). Longer training was associated with older age, male gender, having undergone residency training, private office, greater earnings and longer time since graduation and a lower chance to participate in providing care for a cardiac arrest. Regarding personal change, no modification was detected according to time since taking the course. The only change in the work environment was the purchase of an automated external defibrillator (AED) by those who had taken the course more than 5 years ago. In multivariable analysis, however, the implementation of an AED was not independently associated with this group, which showed a lower chance to take a new ACLS course. ACLS courses should emphasize also how physicians could reinforce the survival chain through environmental changes.

Promoting and Preserving Careers in Women’s Health through Wellness: A Shared Responsibility

Background: Physician burnout is increasing in prevalence across all medical and surgical specialties and is associated with significant decline in the physical and mental health of providers as well as early retirement from the practice of medicine. There are factors unique to women’s health that put its providers at significantly increased risk for burnout including the preponderance of female providers and the practice settings, compensation, and call responsibilities inherent in our specialty. Keywords: Burnout, physician wellness, physician work environment, early retirement, self care, work-life balance.

Physician Work Environment and Well-being

Physician Work Environment and Well-being

The effects of dialogue groups on physicians' work environment: A matter of gender?

Over the past decades, the work environment of physicians has been deteriorating, particularly for female physicians. In this study, we evaluated the effects of dialogue groups on the work environment of physicians in relation to gender. Sixty physicians (38 women) at Sachs' Children's Hospital in Stockholm, Sweden, participated in dialogue groups once a month during a period of one year. Assessments of their psychosocial work environment were performed before and after the intervention. At baseline, female physicians experienced their work environment as less satisfactory compared to male physicians. After the intervention, the female physicians perceived improvements in more areas than their male colleagues. Our study shows that female physicians at this clinic were disadvantaged in relation to the work environment, but, more importantly, the findings suggest that several of the disadvantages can be reduced. Dialogue groups appear to improve the physicians' work environment and promote gender equality.

From Therapy and Enhancement to Assistive Technologies: An Attempt to Clarify the Role of the Sports Physician

Sports physicians are continuously confronted with new biotechnological innovations. This applies not only to doping in sports, but to all kinds of so-called enhancement methods. One fundamental problem regarding the sports physician's self-image consists in a blurred distinction between therapeutic treatment and non-therapeutic performance enhancement. After a brief inventory of the sports physician's work environment I reject as insufficient the attempts to resolve the conflict of the sports physician by making it a classificatory problem. Followed by a critical assessment of some ideas from the US President's Council on Bioethics, the formulation of ethical codes and attempts regarding a moral topography, it is argued that the sports physician's conflict cannot be resolved by the distinction between therapy and enhancement. Instead, we also have to consider the possibility that the therapy-based paradigm of medicine cannot do justice to the challenges of the continuously increasing technical manipulability of the human body and even our cognitive functions as well. At the same time we should not adhere to transhumanist ideas, because non-therapeutic interventions require clear criteria. Based on assistive technologies an alternative framework can be sketched that allows for the integration of therapeutic and non-therapeutic purposes. After a thorough definition of standards and criteria, the role of the sports physician might be defined as that of an assistant for enhancement. Yet the process of defining such an alternative framework is a societal and political task that cannot be accomplished by the sports physicians themselves. Until these questions are answered sports physicians continue to find themselves in a structural dilemma that they partially can come to terms with through personal integrity.

Communication practices of physicians with high patient-satisfaction ratings.

How do primary care physicians with outstanding patient-satisfaction ratings communicate with their patients? Which specific practices distinguish them from less effective communicators on the basis of measured performance? To answer this question, we videotaped 92 adult primary care visits in Southern California and Hawaii and interviewed both physicians and patients separately. Each participating physician and patient viewed the tapes of the visit and shared their perceptions of the communication aspects of the visit. We also audiotaped these debriefing sessions. To identify successful physician communication practices, exam room visit behaviors and comments from the postvisit debriefs were coded and compared with each physician's panel-level patient satisfaction. In the final section, we describe communication strategies reported by physicians with high patient-satisfaction ratings. The quality of physician-patient communication in primary care visits is related to patient satisfaction,1 adherence,2,3 litigation,4 quality of data collection,5 utilization patterns, and clinical outcomes.6 There is evidence that communications between physicians and patients are sometimes inadequate.7–9 In addition, disruptive communications reduce the quality of worklife for physicians. Thus, improvement in physician communication skills has great potential for both the quality of medical care and for the physician work environment.

Enabling Collaborative Medical Diagnosis Over the Internet via Peer-to-Peer Distribution of Electronic Health Records

Recent developments in networking and computing technologies and the expansion of the electronic health record system have enabled the possibility of online collaboration between geographically distributed medical personnel. In this context, the paper presents a Web-based application, which implements a collaborative working environment for physicians by enabling the peer-to-peer exchange of electronic health records. The paper treats technological issues such as Video, Audio and Message Communication, Workspace Management, Distributed Medical Data Management and exchange, while it emphasizes on the Security issues arisen, due to the sensitive and private nature of the medical information. In the paper, we present initial results from the system in practice and measurements regarding transmission times and bandwidth requirements. A wavelet based image compression scheme is also introduced for reducing network delays. A number of physicians were asked to use the platform for testing purposes and for measuring user acceptance. The system was considered by them to be very useful, as they found that the platform simulated very well the personal contact between them and their colleagues during medical meetings.

Alphanumeric paging in an academic hospital setting

Objective To determine whether implementation of an alphanumeric-paging system would improve physician work environment. Design Surveys were distributed to all general surgery residents, faculty, and nurses before and after implementation of an alphanumeric-paging system. Housestaff also kept a detailed log of paging activity before and after the intervention. Measurements User satisfaction with the paging system was measured using a Likert format survey. Interruptions to patient care and pages requiring a call back were tracked using paging logs. Results Physician perceptions of the capability of text paging before the intervention were high and did not differ significantly postintervention. For nursing staff, postintervention perceptions of the text-paging system were significantly more positive than preintervention, especially with regard to perceived improvements in patient care (54.1% versus 81.6%, P < .05). Residents’ paging logs reflected significantly decreased interruptions to patient care after the intervention (28.2% versus 46.9%, P < .05), with less pages requiring a call back (100% versus 73.6%, P < .05). Conclusions Study participants rated the alphanumeric-paging system highly. Text-paging technology has the potential to reduce interruptions in patient care and improve physician work efficiency and satisfaction.

Psychosocial challenges facing physicians of today

Fundamental changes in the organization, financing, and delivery of health care have added new stressors or opportunities to the medical profession. These new potential stressors are in addition to previously recognized external and internal ones. The work environment of physicians poses both psychosocial, ergonomic, and physico–chemical threats. The psychosocial work environment has, if anything, worsened. Demands at work increase at the same time as influence over one's work and intellectual stimulation from work decrease. In addition, violence and the threat of violence is another major occupational health problem physicians increasingly face. Financial constraint, managed care and consumerism in health care are other factors that fundamentally change the role of physicians. The rapid deployment of new information technologies will also change the role of the physician towards being more of an advisor and information provider. Many of the minor health problems will increasingly be managed by patients themselves and by non-physician professionals and practitioners of complementary medicine. Finally, the economic and social status of physicians are challenged which is reflected in a slower salary increase compared to many other professional groups. The picture painted above may be seen as uniformly gloomy. In reality, that is not the case. There is growing interest in and awareness of the importance of the psychosocial work environment for the delivery of high quality care. Physicians under stress are more likely to treat patients poorly, both medically and psychologically. They are also more prone to make errors of judgment. Studies where physicians’ work environment in entire hospitals has been assessed, results fed-back, and physicians and management have worked with focused improvement processes, have demonstrated measurable improvements in the ratings of the psychosocial work environment. However, it becomes clear from such studies that quality of the leadership and the physician team impact on the overall work atmosphere. Physicians unaware of the goals of the department as well as the hospital, that do not receive management performance feedback, and who do not get annual performance appraisals and career guidance, rate their psychosocial environment as more adverse than their colleagues. There is also a great need to offer personally targeted competence development plans. Heads of department and senior physicians rate their work environment as of higher quality than more junior and mid-career physicians. More specifically, less senior physicians perceive similar work demands as their senior colleagues but rate influence over work, skills utilization, and intellectual stimulation at work as significantly worse. In order to combat negative stressors in the physicians’ work environment, enhancement initiatives should be considered both at the individual, group, and structural level. Successful resources used by physicians to manage the stress of everyday medicine should be identified. Physicians are a key group to ensure a well-functioning health care system. In order to be able to change and adapt to the ongoing evolution of the Western health care system, more focus needs to be put on the psychosocial aspects of physicians’ work.

Physician Humor Thyself: An Analysis of Doctor Jokes

Physician Humor Thyself- An Analysis of Doctor Jokes. By Che Prasad. (WinstonSalem, North Carolina: Harbinger Medical Press, 1998. 119 pp., Foreword by Alan Dundes, $12.95, paper) In Physician Humor Thyself, Che Prasad offers an analysis of medical humor that focuses strictly on the jokes that circulate within the medical community. Currently a resident in clinical pathology at the University of California, San Francisco, Prasad uses his experience and insight as a physician to clarify and analyze jokes frequently told within various areas of medicine including primary care, surgery, and several sub-specialties. Following the introduction, each concise chapter of this extended essay highlights a specific area of medicine and provides numerous examples of related jokes, explanations of terms, and brief analyses. Prasad's functionalist approach describes how medical jokes and humor help physicians deal with the aspects of medicine the general population may be completely unaware of. For example, in chapter four, Prasad focuses on the humor surrounding surgery and surgeons. While surgeons are often equated with God by individuals outside of medicine, according to Prasad's analysis, this is not necessarily the case among doctors. A particular rivalry exists between surgeons and internists with surgeons often portrayed as being intellectually inferior (37): Internists know everything, but do nothing. Surgeons know nothing, but do everything. Psychiatrists know nothing and do nothing. Pathologists know everything and do everything, but too damn late (36). Although Prasad has viewed each area of medicine separately, in the Postscript, he connects each chapter with three general themes. First, each specialty has jokes that attack other specialties. One particular reason that Prasad offers for these attacks is an underlying need to protect one's own fear of inadequacy. Second, within the medical establishment there exists an understood code of silence that makes it difficult for physicians to openly criticize one another. Working on a daily basis with sickness and death, often under pressure with long hours, a physician's work environment can be quite stressful. jokes allow doctors to express their criticisms without singling out one particular physician, while still addressing some of these tensions. Finally, jokes allow patients to confront the imperfections, mistakes, and contradictions in medicine in a constructive manner. …

The Psychosocial Work Environment of Physicians

This study examines the relationship between the psychosocial work environment and cross-sectional job dissatisfaction and prospective psychiatric distress in a cohort of Hopkins Medical School graduates in midcareer. An instrument was constructed consisting of five scales: psychological job demands, patient demands, work control, physician resources, and coworker support. The results of scale reliability and factor analysis are presented. Higher job demands were found to be associated with increases in job dissatisfaction and psychiatric distress and greater resources were associated with decreased levels of dissatisfaction and distress. In multiple-regression analysis, only work control and social support were found to be independently associated with dissatisfaction and distress. These results suggest that the presence of control and social support at work protects physicians from developing job dissatisfaction and psychiatric distress.

The Responsive Workbench: A virtual working environment for physicians

The paper describes the concept of the Responsive Workbench (RW). This virtual environment was designed to support end users working on desks, workbenches, and tables as physicians, architects and scientists with an adequate human-machine interface. We attempt to construct a task-driven interface for this class of users by working in an interdisciplinary team from the beginning. The system is explained and evaluated along three medical applications: medical education, a cardiological tutorial with a simulation system for ultrasonographic examinations of the heart and surgery planning. Virtual objects are located on a real “workbench”. The objects, displayed as computer generated stereoscopic images are projected onto the surface of a table. The participants operate within a non-immersive virtual environment. A “guide” uses the virtual environment while several observers can also watch events by using shutter glasses. Depending on the application, various input and output modules can be integrated, such as motion, gesture and speech recognition systems which characterize the general trend away from the classical multimedia desktop interface. The RW is compared with other common virtual reality systems as head mounted displays. First experiences of the collaborators are drawn and future enhancements are proposed.