Physician Work Research Articles

Machine Learning in Healthcare: A Review

Machine learning a new and very sophisticated technology has been developed as a large trend in the market nowadays. Machine learning is an everywhere phenomenon which is applied in different areas. It’s an irreplaceable factor in many sectors such as business, science and security and so on. Implementation of machine learning technology in healthcare is emerging as a crucial trend. The potential presented by the machine learning technologies for the healthcare field is simply stunning. Machine learning technologies are making a huge influence in healthcare. ML, a sort of technology which attempts to enhance the velocity and precision of physicians work. Machine learning algorithms are used to detect hidden patterns in medical data and provides great prediction skills. In this research, we have to examine various methods used to create effective decision assistance for medical applications. This work contributes to minimizing the gap of generating effective decision support systems for healthcare applications. Keywords: Healthcare, Machine Learning, ubiquitous, medical applications

Medical fitness for work in physicians with psychiatric disorders

IntroductionBeing a doctor is a profession with special medical requirements. Therefore, the assessment of medical fitness for work among physicians remains a complex decision, particularly for those with psychiatric disorders.ObjectivesTo assess the fitness for work decisions among physicians with psychiatric disorders.MethodsDescriptive and retrospective study including physicians with psychiatric disorders referred to the occupational department of the Charles Nicolle Hospital in Tunis for a medical fitness for work from January 1, 2018 to August 30, 2023.ResultsThe study included 28 patients with a female predominance (sex ratio M/F at 0.3) and a mean age of 44.1 ± 12 years. Participants were general practitioners (N=12), junior doctors (N=10), specialists (N=5) and one dentist. They worked in the public health sector in 93% of cases, and had a mean professional seniority of 12.4 ± 9.3 years. A psychiatric history was found in 20 patients. Current psychiatric disorders recorded were: depression (N=15), bipolar disorder (N=7), anxiety-depressive disorder (N=4), personality disorders (N=1) and addiction (N=1). Concerning the fitness for work, six patients were fit for work and 11 were temporarily unfit. Job adjustments were proposed for 11 physicians, mainly night shift exemption.ConclusionsPhysicians are exposed to several occupational hazards and require strict medical qualifications. The impact of psychiatric disorders on medical fitness for work is considerable, and could be avoided by appropriate prevention by occupational health practionnairers, starting from professional orientation.Disclosure of InterestNone Declared

Complications Rate and a Multidimensional Analysis of Their Causes of Tube Thoracostomy: A Mixed-Methods Study.

Tube thoracostomy (TT) complications are common in respiratory medicine. However, the prevalence of complications and risk factors is unknown, and data on countermeasures are lacking. This was a mixed-methods retrospective observational and qualitative study. This retrospective observational study included TT performed on patients admitted to the Department of Respiratory Medicine at our University Hospital between January 1, 2019, and August 31, 2022 (n=169). The primary endpoint was the incidence of TT-related complications. We reviewed the association between complications and patient- and medical-related factors as secondary endpoints. In this qualitative study, we theorized the background of physicians' susceptibility to TT-related complications based on the grounded theory approach. Complications were observed in 20 (11.8%) of the 169 procedures; however, they were unrelated to 30-day mortality. Poor activities of daily living (odds ratio 4.3, p=0.007) and regular administration of oral steroids (odds ratio 3.1, p=0.025) were identified as patient-related risk factors. Physicians undergoing training caused the most complications, and the absence of a senior physician at the procedure site (odds ratio 3.5, p=0.031) was identified as a medical risk factor. Based on this qualitative study, we developed a new model for TT complication rates consistent with the relationship between physicians' professional skills, professional identity, and work environments. Complications associated with TT are common. Therefore, it is necessary to implement measures similar to those identified in this study. Particularly, a supportive environment should be established for the training of physicians.

Exploring sleep duration and clinical reasoning process in resident physicians: a thematic analysis.

Connecting resident physician work hours and sleep deprivation to adverse outcomes has been difficult. Our study explores clinical reasoning rather than outcomes. Diagnostic errors are a leading cause of medical error and may result from deficits in clinical reasoning. We used simulated cases to explore relationships between sleep duration and diagnostic reasoning. Residents were recruited for a 2-month study (inpatient/outpatient). Each participant's sleep was tracked (sleep diary/actigraphy). At the end of each month, residents watched 2 brief simulated clinical encounters and performed "think alouds" of their clinical reasoning. In each session, 1 video was straightforward and the other video contained distracting contextual factors. Sessions were recorded, transcribed, and interpreted. We conducted a thematic analysis using a constant comparative approach. Themes were compared based on sleep duration and contextual factors. Residents (n = 17) slept more during outpatient compared with inpatient months (450.5 ± 7.13 vs 425.6 ± 10.78 hours, P = .02). We found the following diagnostic reasoning themes: uncertainty, disorganized knowledge, error, semantic incompetence, emotional content, and organized knowledge. Themes reflecting suboptimal clinical reasoning (disorganized knowledge, error, semantic incompetence, uncertainty) were observed more in cases with contextual factors (distractors). "Think alouds" from cases with contextual factors following sleep restriction had a greater number of themes concerning for problematic diagnostic reasoning. Residents obtained significantly more sleep during outpatient compared with inpatient months. Several negative clinical reasoning themes emerged with less sleep combined with cases containing contextual distractors. Our findings reinforce the importance of adequate sleep and supervision in house officers, particularly in cases with distracting elements. Collen J, Durning S, Berk J, Mang J, Alcover K, Jung E. Exploring sleep duration and clinical reasoning process in resident physicians: a thematic analysis. J Clin Sleep Med. 2024;20(8):1279-1289.

Position paper on working in the intensive care unit during pregnancy : DIVI recommendations for improving the situation of pregnant employees in the ICU

The Maternity Protection Act is intended to protect the mother and the child from hazards, excessive demands and damage to health in the workplace, and from financial disadvantages and loss of employment. However, the objectives defined by the Maternity Protection Act-the safety and health of the pregnant employee on the one hand and the prevention of disadvantages in working life on the other-are not yet adequately achieved in the intensive care unit (ICU). Implementation of the Maternity Protection Act to the benefit of all involved parties should also be promoted in the specialist areas represented by the DIVI, in particular the work of pregnant physicians and nursing staff and other working specialists (respiratory therapists, physiotherapists, speech therapists, psychotherapists, and social workers) in the ICU. The aim of this paper is to raise awareness of the need to consider each pregnant and breastfeeding staff member individually and to work together to find apersonal solution for continuing to work in the ICU. Possible ways and solutions to achieve this goal are outlined and practical examples are given for implementation in everyday clinical routine. These are also based on comprehensive presentation of activities according to atraffic light color-code system for all occupational groups. Arguments against pregnant employees working in the ICU are discussed and possible solutions are presented.

Position paper on working in the intensive care unit during pregnancy : DIVI recommendations for improving the situation of pregnant employees in the ICU

The Maternity Protection Act is intended to protect the mother and the child from hazards, excessive demands and damage to health in the workplace, and from financial disadvantages and loss of employment. However, the objectives defined by the Maternity Protection Act-the safety and health of the pregnant employee on the one hand and the prevention of disadvantages in working life on the other-are not yet adequately achieved in the intensive care unit (ICU). Implementation of the Maternity Protection Act to the benefit of all involved parties should also be promoted in the specialist areas represented by the DIVI, in particular the work of pregnant physicians and nursing staff and other working specialists (respiratory therapists, physiotherapists, speech therapists, psychotherapists, and social workers) in the ICU. The aim of this paper is to raise awareness of the need to consider each pregnant and breastfeeding staff member individually and to work together to find apersonal solution for continuing to work in the ICU. Possible ways and solutions to achieve this goal are outlined and practical examples are given for implementation in everyday clinical routine. These are also based on comprehensive presentation of activities according to atraffic light color-code system for all occupational groups. Arguments against pregnant employees working in the ICU are discussed and possible solutions are presented.

Long-term trends in the work hours of physicians in Canada.

Physician work hours directly influence patient access to health care services and play a vital role in physician human resource planning. We sought to evaluate long-term trends in hours worked by physicians in Canada, overall and by subgroup. We used Statistics Canada's Labour Force Survey to identify physicians via occupation and industry coding information. We estimated descriptive statistics and performed graphical analysis of the average weekly hours worked by physicians over the 1987-2021 period. Overall, weekly physician work hours remained stable from 1987 until 1997, after which they declined. Average weekly hours decreased by 6.9 hours (p < 0.001), from 52.8 in 1987-1991 to 45.9 in 2017-2021. Among male physicians, work hours declined notably after 1997, while those of female physicians remained relatively stable at around 45 per week. Hours worked by married physicians declined significantly, amounting to 7.4 fewer hours per week (p = 0.001). In contrast, unmarried physicians displayed a statistically insignificant decline of 2.2 hours (p = 0.3). The COVID-19 pandemic was associated with a sharp but brief disruption in weekly hours; by the end of 2020, physicians' work hours had returned to prepandemic levels. These findings may indicate a long-term shift in work preferences among Canadian physicians; male physicians may be seeking a better work-life balance, which, in turn, has narrowed the gap in hours worked by sex, with potential implications for pay equity. Policymakers and planners should carefully consider changes in hours worked, rather than just the total number of physicians, to ensure an accurate evaluation of the physician workforce.

"We want to change the system": a qualitative study on emergency medicine physician leadership.

The significance of physician leadership to help transform the healthcare system has been increasingly discussed. This study looked at the qualities of emergency medicine (EM) physicians that support or inhibit their work as healthcare leaders. Through an iterative process of semi-structured interviews and then focus groups, we examined why EM physicians pursue leadership roles, the strengths they bring and the frustrations they encounter. Thematic analysis identified factors that facilitate and inhibit the work of EM physicians as they enter leadership roles. These findings can be summarized in four key themes. (1) A desire to improve the wider health system was often a prime motivator for entering a leadership role. (2) EM physicians' clinical skills such as confident decision-making, relationship building through communication, and comfort with uncertainty supported their successful transition to leadership. (3) EM physician leaders perceived shiftwork as both a potential benefit and a challenge in their leadership role and felt it needed to be carefully managed to ensure personal wellness and success. And (4) participants were not driven to take on leadership positions by financial remuneration but stated that the discrepancy between EM clinical and leadership compensation was a point of stress. As physician leadership is explored as a mechanism to support the healthcare system's success, this project provides insights into the realities experiences by EM physicians and considerations for healthcare professionals as they encourage physicians into leadership positions.

Artificial Intelligence–Generated Draft Replies to Patient Inbox Messages

The emergence and promise of generative artificial intelligence (AI) represent a turning point for health care. Rigorous evaluation of generative AI deployment in clinical practice is needed to inform strategic decision-making. To evaluate the implementation of a large language model used to draft responses to patient messages in the electronic inbox. A 5-week, prospective, single-group quality improvement study was conducted from July 10 through August 13, 2023, at a single academic medical center (Stanford Health Care). All attending physicians, advanced practice practitioners, clinic nurses, and clinical pharmacists from the Divisions of Primary Care and Gastroenterology and Hepatology were enrolled in the pilot. Draft replies to patient portal messages generated by a Health Insurance Portability and Accountability Act-compliant electronic health record-integrated large language model. The primary outcome was AI-generated draft reply utilization as a percentage of total patient message replies. Secondary outcomes included changes in time measures and clinician experience as assessed by survey. A total of 197 clinicians were enrolled in the pilot; 35 clinicians who were prepilot beta users, out of office, or not tied to a specific ambulatory clinic were excluded, leaving 162 clinicians included in the analysis. The survey analysis cohort consisted of 73 participants (45.1%) who completed both the presurvey and postsurvey. In gastroenterology and hepatology, there were 58 physicians and APPs and 10 nurses. In primary care, there were 83 physicians and APPs, 4 nurses, and 8 clinical pharmacists. The mean AI-generated draft response utilization rate across clinicians was 20%. There was no change in reply action time, write time, or read time between the prepilot and pilot periods. There were statistically significant reductions in the 4-item physician task load score derivative (mean [SD], 61.31 [17.23] presurvey vs 47.26 [17.11] postsurvey; paired difference, -13.87; 95% CI, -17.38 to -9.50; P < .001) and work exhaustion scores (mean [SD], 1.95 [0.79] presurvey vs 1.62 [0.68] postsurvey; paired difference, -0.33; 95% CI, -0.50 to -0.17; P < .001). In this quality improvement study of an early implementation of generative AI, there was notable adoption, usability, and improvement in assessments of burden and burnout. There was no improvement in time. Further code-to-bedside testing is needed to guide future development and organizational strategy.

Artificial-Intelligence-Based Clinical Decision Support Systems in Primary Care: A Scoping Review of Current Clinical Implementations.

Primary Care Physicians (PCPs) are the first point of contact in healthcare. Because PCPs face the challenge of managing diverse patient populations while maintaining up-to-date medical knowledge and updated health records, this study explores the current outcomes and effectiveness of implementing Artificial Intelligence-based Clinical Decision Support Systems (AI-CDSSs) in Primary Healthcare (PHC). Following the PRISMA-ScR guidelines, we systematically searched five databases, PubMed, Scopus, CINAHL, IEEE, and Google Scholar, and manually searched related articles. Only CDSSs powered by AI targeted to physicians and tested in real clinical PHC settings were included. From a total of 421 articles, 6 met our criteria. We found AI-CDSSs from the US, Netherlands, Spain, and China whose primary tasks included diagnosis support, management and treatment recommendations, and complication prediction. Secondary objectives included lessening physician work burden and reducing healthcare costs. While promising, the outcomes were hindered by physicians' perceptions and cultural settings. This study underscores the potential of AI-CDSSs in improving clinical management, patient satisfaction, and safety while reducing physician workload. However, further work is needed to explore the broad spectrum of applications that the new AI-CDSSs have in several PHC real clinical settings and measure their clinical outcomes.

Problems of nursing staff in the ophthalmology department

The nurse plays an integral and important role in the health care system, providing direct medical care and supporting the effective work of physicians. One of the most demanding and responsible departments where nurses work is the ophthalmology department. The importance of the work of a nurse in ophthalmology cannot be overemphasized. They help doctors in the diagnosis and treatment of eye diseases, monitor the condition of patients before and after surgical interventions, as well as carry out preventive measures to maintain the health of the organ of vision. Without their professional skills and hard work, it is impossible to provide effective and safe treatment of eye diseases. Despite the challenges, the nurse in the ophthalmology department plays an indispensable role in ensuring the health and well-being of patients.

(241) Optimizing Care - Economic Impact of Reduced Teaching Visits After IPP Implantation

Abstract Introduction The increasing shortage of urologists has resulted in longer wait times for appointments and surgeries, causing delays in receiving care that may negatively impact quality-of-life, especially for erectile dysfunction (ED) treatment. Urologists specializing in inflatable penile prosthesis (IPP) implantation are familiar with such challenges and utilize various approaches to improve practice efficiency, including optimizing IPP teaching visits and post-operative care. Objective This study assessed whether reducing the number of IPP teaching visits within the immediate 90-day post-operative period may improve efficiency and enhance patient care amongst urology practices. Methods Using American Medical Association (AMA) resource-based relative value scale (RBRVS) data for IPP implantation [Current Procedural Terminology (CPT) 54405], a scenario analysis was constructed that assessed the effects on patient care and physician reimbursement of eliminating one 30-minute post-operative teaching visit (CPT 99213) from the average of 2.5 visits accounted for within the immediate 90-day postoperative period for CPT 54405 in RBRVS data. The efficiency impact on practices which perform 25, 50, or 100 IPP implants, annually, was modeled. The effects on patient access to care, by reapplying the time recaptured from the reduction in teaching visits, were evaluated under three scenarios: 1) the most frequent in-office CPT codes used by IPP implanters [from Definitive Healthcare 2021 commercial and Medicare claims], 2) evaluation and management of new ED patients who pursue/receive an IPP [CPT 99204 + 3x CPT 99214], and, as a control measure, 3) vasectomy procedures [CPT 55250]. Physician work time and reimbursement were conservatively estimated using 2023 Medicare Physician Fee Schedule. Changes to reimbursement if Advanced Practice Providers (APPs) in the urology practice provided post-operative IPP teaching were also modeled (data not shown). Results The reduction of one 30-minute post-operative IPP teaching visit for practices performing 25/50 / 100 IPP implants resulted in recapturing 750 /1,500/3,000 minutes annually, respectively. Applying this recaptured time to 1) commonly performed in-office visit types or procedures (Table 1), 2) evaluation and management of new ED patients, or 3) vasectomy translated to significant additional Medicare reimbursement, as high as $18,325 annually. At 25 IPP implants yearly, a urologist could care for an additional 13-25 patients through office visits, reaching $2,049-$2,270 in additional annual Medicare reimbursement. At 50 IPP implants yearly, clinical workups for 7 ED patients who go on to IPP implantation can result in an additional $4,125 of reimbursement, excluding any reimbursement from additional diagnostic procedures and/or downstream surgical cases. At 100 IPP implants yearly, recaptured schedule capacity can enable 37 patients for vasectomy care, resulting in a $12,563 reimbursement. Conclusions Regardless of IPP implant volume, practices optimizing care and achieving fewer post-operative IPP teaching visits gain additional schedule capacity that may serve more patients in the office and, potentially, the ability to treat more men with ED, including IPP implantation. These time savings and gains in practice efficiency enable implanters to manage patient demand and workload more effectively amidst the scarcity of urologists and growing wait times for care, while also helping ensure practice viability in the era of decreasing reimbursement. Disclosure Yes, this is sponsored by industry/sponsor: Boston Scientific - Data Acquisition, Statistical Support. Clarification: Industry funding only - investigator initiated and executed study. Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.

Patient complaining of cough in primary care

Cough is one of the most common symptoms when seeking primary medical care. Purpose. To increase the efficiency of diagnostic search for the cause of cough in the practice of a primary care doctor. Materials and methods. A comparative analysis of 2 different approaches to the tactics of primary admission of patients who complained of cough was carried out (n=1800): group 1 is the traditional approach in the work of a primary care physician; group 2 is the application before admission of the "Diagnostic search algorithm in the examination of a patient with cough complaints", developed on the basis of the generated database. Results. In the group 42,3% of patients were initially diagnosed with acute respiratory viral infection (ARVI), and 13,2% suspected pneumonia. Cough due to other causes was 44,5%. In the group 2, ARVI was diagnosed in 19% of cases, an exacerbation of COPD was detected in 11,8%, bronchial asthma in 8,9%, in 6,7% congestive heart failure, in 6,1% gastroesophageal reflux disease, in 2,1% focal pulmonary tuberculosis, in 23% pneumonia, in 6,7% COVID-19, in 15,7% chronic sinusitis. Conclusion. The use of the algorithm in the practice of a general practitioner to identify the cause of cough can significantly facilitate the diagnostic search and reduce the number of unjustified consultations of specialist doctors. Also, this approach in the world of digitalization allows us to develop an intelligent service to support medical decision-making.

A Serious Shortfall in Clinical Research in Doctoral Schools: A Detailed Analysis of Ten Doctoral Schools of Medicine

The amount and quality of clinical research are constantly increasing; however, the translation of results into daily practice is not keeping pace. University curricula provide minimal methodological background for understanding the latest scientific findings. In this project, we aimed to investigate the quality and amount of clinical research compared with basic research by analysing ten doctoral schools in Hungary. We found that 71% of PhD theses were submitted in basic sciences. The majority of physicians (53%) working in clinical institutions did their PhD projects in theoretical departments. Importantly, recent clinical methodologies such as pre-registered randomized clinical trials and meta-analysis are only rarely used (1% and 1%, respectively) compared with retrospective data analysis or cross-sectional studies (30% and 43%, respectively). Quality measures such as international registration, sample size calculation, and multicentricity of clinical sciences are generally absent from articles. Our results suggest that doctoral schools are seriously lagging behind in both teaching and scholarly activity in terms of recent clinical research methodology. Innovation and new educational platforms are essential to improve the proportion of science-oriented physicians.

Umbilical vein catheterisation for the family physician working in primary health care.

This is part of a series of articles on vascular access in emergencies. The other two articles were on intra osseous lines and central venous lines. These are critical lifesaving emergency skills for the primary care professional. In this article, we will provide an overview of umbilical vein catheterisation highlighting its importance, the indications, contraindications, techniques, complications and nursing considerations. By familiarising healthcare providers with this procedure, we hope to enhance their knowledge and skills, ultimately leading to improved outcomes in the neonatal population.

Essays on Partial Derangement of the Mind in Supposed Connexion with Religion by John Cheyne

SUMMARY Essays on Partial Derangement of the Mind in Supposed Connection with Religion, written amidst the illness of its author almost two centuries ago, was the little-known work of a distinguished physician. Seeking to rebut the argument that religion is causative of ‘derangement of the mind’ it takes a surprisingly biological view of such conditions while, at the same time, affirming the importance of faith, hope and love in human well-being. Despite its limitations, it makes observations that remain relevant to debates about religion and psychiatry today.

The current landscape of emergency medicine resident scheduling.

The Accreditation Council for Graduate Medical Education (ACGME) and Residency Review Committee oversee resident physician work hours with additional specifics for U.S. emergency medicine (EM) residency programs. While there are maximum work hours, the regulatory bodies do not describe minimum work hours to achieve competency, leading to variable scheduling practices. This study aimed to understand the current landscape of U.S. EM residency scheduling given the expansion of programs, evolution of policies, and increased emphasis on wellness. We conducted a cross-sectional study to assess current strategies of U.S. EM residency scheduling. The RedCap survey was sent to all ACGME-accredited EM residency programs across the United States via individualized emails between January 10, 2023, and March 15, 2023. Data were combined using Microsoft Excel. A total of 138 of 278 (50%) programs responded to the survey. A total of 73.2% of programs were using thirteen 28-day blocks with the remainder using twelve 1-month blocks or reported "other" block scheduling. The number of blocks in the ED increases with each postgraduate year (PGY). For PGY-1 through PGY-3, the most commonly used shift duration was 9 h. The mean total shifts per ED block and hours worked per ED block are as follows: 19 shifts and 185.1 h (PGY-1), 18.2 shifts and 173.9 h (PGY-2), 17.3 shifts and 163.6 h (PGY-3), and 14.8 shifts and 157.2 h (PGY-4). Programs provide a median for 4 weeks of vacation per year of residency. Given the expansion of U.S. EM residency programs, we reevaluated the landscape of resident scheduling. We described scheduling patterns related to night shifts, vacations, requested time off, conference coverage, charting time, and circadian rhythms. Programs should utilize these data as a starting point for setting a clinical experience for their residents.

Working hours of full-time hospital physicians in Japan: a cross-sectional nationwide survey

BackgroundThe culture of excessively long overtime work in Japan has not been recently addressed. New legislation on working hours, including a limitation on maximum overtime work for physicians, will be enforced in 2024. This study was performed to elucidate the working conditions of full-time hospital physicians and discuss various policy implications.MethodsA facility survey and a physician survey regarding physicians’ working conditions were conducted in July 2022. The facility survey was sent to all hospitals in Japan, and the physician survey was sent to all physicians working at half of the hospitals. The physicians were asked to report their working hours from 11 to 17 July 2022. In addition to descriptive statistics, a multivariate logistic regression analysis on the factors that lead to long working hours was conducted.ResultsIn total, 11,466 full-time hospital physicians were included in the analysis. Full-time hospital physicians worked 50.1 h per week. They spent 45.6 h (90.9%) at the main hospital and 4.6 h (9.1%) performing side work. They spent 43.8 h (87.5%) on clinical work and 6.3 h (12.5%) on activities outside clinical work, such as research, teaching, and other activities. Neurosurgeons worked the longest hours, followed by surgeons and emergency medicine physicians. In total, 20.4% of physicians were estimated to exceed the annual overtime limit of 960 h, and 3.9% were estimated to exceed the limit of 1860 h. A total of 13.3% and 2.0% exceeded this level only at their primary hospital, after excluding hours performing side work. Logistic regression analysis showed that male, younger age, working at a university hospital, working in clinical areas of practice with long working hours, and undergoing specialty training were associated with long working hours after controlling for other factors.ConclusionsWith the approaching application of overtime regulations to physicians, a certain reduction in working hours has been observed. However, many physicians still work longer hours than the designated upper limit of overtime. Work reform must be further promoted by streamlining work and task-shifting while securing the functions of university hospitals such as research, education, and supporting healthcare in communities.

Vacation Days Taken, Work During Vacation, and Burnout Among US Physicians

Vacation has been shown to be an important restorative activity in the general population; less is known about physicians' vacation behaviors and their association with burnout and professional fulfillment. To examine the number of vacation days taken per year and the magnitude of physician work while on vacation and their association with physician burnout and professional fulfillment, by individual and organizational characteristics. This cross-sectional survey of US physicians was conducted between November 20, 2020, and March 23, 2021. Data analysis was performed from March to July 2023. Burnout was measured using the Maslach Burnout Index, and professional fulfillment was measured using the Stanford Professional Fulfillment Index. Number of vacation days taken in the last year, time spent working on patient care and other professional tasks per typical vacation day (ie, work on vacation), electronic health record (EHR) inbox coverage while on vacation, barriers to taking vacation, and standard demographics were collected. Among 3024 respondents, 1790 of 3004 (59.6%), took 15 or fewer days of vacation in the last year, with 597 of 3004 (19.9%) taking 5 or fewer days. The majority, 2104 respondents (70.4%), performed patient care-related tasks on vacation, with 988 of 2988 (33.1%) working 30 minutes or more on a typical vacation day. Less than one-half of physicians (1468 of 2991 physicians [49.1%]) reported having full EHR inbox coverage while on vacation. On multivariable analysis adjusting for personal and professional factors, concern about finding someone to cover clinical responsibilities (odds ratio [OR], 0.48 [95% CI, 0.35-0.65] for quite a bit; OR, 0.30 [95% CI, 0.21-0.43] for very much) and financial concerns (OR, 0.49 [95% CI, 0.36-0.66] for quite a bit; OR, 0.38 [95% CI, 0.27-0.54] for very much) were associated with decreased likelihood of taking more than 3 weeks of vacation per year. Taking more than 3 weeks of vacation per year (OR, 0.66 [95% CI, 0.45-0.98] for 16-20 days; OR, 0.59 [95% CI, 0.40-0.86] for >20 days vs none) and having full EHR inbox coverage while on vacation (OR, 0.74; 95% CI, 0.63-0.88) were associated with lower rates of burnout on multivariable analysis, whereas spending 30 minutes or longer per vacation day on patient-related work (OR, 1.58; 95% CI, 1.22-2.04 for 30-60 minutes; OR, 1.97; 95% CI, 1.41-2.77 for 60-90 minutes; OR, 1.92; 95% CI, 1.36-2.73 for >90 minutes) was associated with higher rates of burnout. In this cross-sectional study of 3024 physicians, the number of vacation days taken and performing patient-related work while on vacation were associated with physician burnout. System-level efforts to ensure physicians take adequate vacation and have coverage for clinical responsibilities, including EHR inbox, may reduce physician burnout.

Job stressors in relation to burnout and compromised sleep among academic physicians in India.

Burnout among physicians, especially in the academic setting, is an urgent concern, with adequate sleep one of the key focal points. To identify job stressors contributing to burnout and compromised sleep among academic physicians, using a comprehensive, theory-based instrument, the Occupational Stressor Index (OSI), whose specific form was created 'for physicians by physicians'. This parallel mixed-methods cross-sectional investigation was conducted among 109 physicians employed in a public teaching hospital, Jodhpur, India. Work conditions were evaluated by the physician-specific OSI (part I). The Copenhagen Burnout Index and Pittsburgh Sleep Quality Index (PSQI) were the outcome instruments (part II). Seventy-six physicians completed parts I and II. The physicians were from wide-ranging specialties, and 82% of the cohort were residents. Mean total OSI scores were 87.4±8.1, with unit-change yielding adjusted odds-ratios (95% confidence-intervals) for personal (1.10 (1.02-1.18)) and work-related burnout (1.12 (1.04-1.22)), and PSQI (1.09 (1.01-1.17)). Significant multivariable associations with burnout and/or sleep indices included: working 7 days/week, lacking work-free vacation, insufficient rest breaks, interruptions, many patients in intensive-care, no separate time for non-clinical duties, pressure to publish, injury/suicide attempts of colleagues/staff, performing pointless tasks. The latter were described as administrative/clerical. Lacking genuine rest breaks was mainly patient-related, further compromised by emergency work and lacking separate time for non-clinical duties. Long workhours and exhausting schedule were cited as most difficult parts of work, while reducing workhours, improving work schedule, and hiring more staff most frequently recommended. Specific working conditions potentially contributory to burnout and compromised sleep among physicians working in academic medicine are identified using a methodologically-rigorous, in-depth approach. These findings inform evidence-based interventions aimed at preserving physician mental health and work capacity.