Research Progress on Job Burnout of Family Doctors

HU,Yangyang

Hengshu medical research center, Hengshui Hebei 053000China

【Abstract】Job burnout is an important factor affecting the work attitude and profes-sional behavior of family doctors.This paper reviews the measurement tools,influencing factors and intervention strategies of job burnout,it is suggested that improving job burnout can improve job satisfaction,work efficiency and reduce turnover intention of family doctors,and it is of great significance to the construction of family doctor team and the improvement of work quality.

【Keywords】Family doctor;Influencing factors;Job burnout;Measuring tools;Intervention strategies

1.Introduction

Burnout,also known as“job burnout”,refers to the state of physical and mental fatigue and energy exhaustion in the face of continuous workload[1].The term“job burnout”was first put forward by American psychological expert Freudenberger and then summarized by Maslach.[2]The psychological syndrome caused by continuous emo-tions and interpersonal stressors at work is called job burnout.As an important support of community health management,family doctors undertake the management of chronic diseases,infectious diseases and population health management tasks,with heavy workload and heavy medical tasks.They are the potential high inci-dence group of job burnout.Job burnout will affect the family doctor in work.[3-4]

2.Job Burnout of Family Doctors

The research on family doctors’job burnout was car-ried out earlier abroad.The United States,the United Kingdom,Germany and other countries,which are the first European countries to implement the family doctor service model,have carried out relevant research and achieved a series of results.[5]According to a study on the job burnout of 27276 doctors carried out by US research-ers,the incidence of job burnout of general practitioners in family medicine field is higher,ranking in the top five.[6]conducted a job burnout analysis of 232 family doctors in the UK from March 2016 to August 2017,and the results showed that 22.7%and 72.7%of general practitioners in the field of family medicine were in the top five the degree of job burnout is related to family doctors’job well-being.In Germany,researchers selected 214 general practitioners for analysis and found that female doctors had a higher risk of emotional exhaustion and a lower de-gree of job satisfaction.[7]A survey of 683 general practi-tioners in Ireland shows that age and gender are related to the degree of job burnout of family doctors.[8-9]conducted a cross-sectional survey of 196 general practitioners and found that the incidence of moderate and high emotion-al exhaustion,depersonalization and personal accom-plishment were 34.7%,33.5%and 67.8%respectively.Researchers analyzed 183 general practitioners in Israeli community medical centers,and found that job burnout of general practitioners in the community was affected by job stress and job satisfaction.[10]In Japan,researchers found that the level ofjob burnout of middle-aged general practitioners is higher than that of young family doctors.[11]In contrast,the domestic research on family doctors’job burnout is less than that abroad.Researchers investigated the job burnout of 85 general practitioners working in Shanghai suburban community health service centers,and found that the incidence of moderate and severe job burn-out was 40.0%,and the job burnout was serious among the selected general practitioners;Others investigated 135 general practitioners nationwide,and the results showed that job burnout had an impact on their turnover intention People with high level of burnout are more willing to leave.Combined with the research and analysis at home and abroad,the degree of job burnout affects the work of family doctors,relates to the work efficiency and quality of staff,and becomes a key topic in the psychological as-pect of community family doctors.

3.Influencing Factors of Family Doctors’Job

Burnout

The influencing factors of family doctors’job burnout include many aspects,including inpidual,social,organi-zational and other factors.Job burnout brings pressure to family doctors,and a higher degree of burnout may even affect their physical and mental health.

3.1 Inpidual Factors

Through research concluded that there is a positive correlation between age and the level of job burnout,and the level ofjob burnout of the elderly is higher than that of the young.[12]At the same time,the degree of job burnout is also affected by the inpidual’s own personality traits.Compared with extroverts,introverts have higher degree of job burnout.Researchers conducted a survey on family doctors in Hungary,and found that the incidence of female job burnout is higher than that of male,which may be relat-ed to female family doctors’need to bear the dual pressure of occupation and family.Therefore,they are more likely to have job burnout than male family doctors.[13]

3.2 Social Factors

The family doctor model originated in foreign coun-tries and began to be carried out in China in 2012,which was gradually promoted by Shanghai,Beijing,Hangzhou and other cities.[14]The social factors influencing family doctors’job burnout are related to the local government’s investment in community health care and the trust rela-tionship between doctors and patients.Due to the differ-ence between the development time of family doctors in China and the amount of funds invested by the gov-ernment in the community health system,in cities with earlier development time and more developed economy,the government has invested more in the medical service of family doctors.The survey shows that the degree ofjob burnout of family doctors in cities with high economic level is higher than that in cities with low economic lev-el.[15]The degree of harmony between the contract sign-ing group and the family doctor team members also has an impact on the job burnout of family doctors.During the follow-up,the medical staff with high degree of trust and cooperation with the contract signing crowd had better job burnout.[16]

3.3 Organizational Factors

The organizational factors influencing family burnout include occupational stress,work environment,work family conflict,role influence and organizational sup-port.[17]Experts found that workload has a significant im-pact on job burnout.conducted a survey on primary health care workers in Malaysia.[18]The results showed that the satisfaction of the staff to their departments would affect the level ofjob burnout,and the staff with low satisfaction to their units and departments had a higher level of job burnout.Nantha found that the infrastructure of institu-tions is not perfect,and the working environment is poor,especially in some economically underdeveloped areas,which will make the grassroots medical staff lose their en-thusiasm and vitality for work.[19]Experts conducted two surveys on primary care doctors in the United States,and the results showed that adverse working conditions would deepen the degree of job burnout and reduce job satisfac-tion.[20]At the same time,the conflict between work and family will also affect the level of job burnout,medical staff as a member of the family,for the family is very important.Research’s found that after alleviating work family conflict,the level of job burnout decreased.[21]As the role of family doctor is the bridge between community medical service and contract signing population,family doctor needs to complete his own task and take responsi-bility due to his work responsibility and expectation.We should not only be responsible for the contract signing crowd,but also deal with the role that should be done to adapt to the work mode,so the degree of role adaptation has an impact on the job burnout of family doctors.Lack of support and encouragement in work will also affect the job burnout of family doctors.In the face of work,the job burnout of the staff with higher support from leaders and colleagues and harmonious relationship among colleagues is better.[22]

3.4 Other Factors

The job burnout of family doctors is also affected by some other factors.For example,researchers found that the personal coping ability of family doctors has a sig-nificant impact on the job burnout of family doctors in medical work.[23]Others found that the relevant training needs and academic requirements of doctors are important influencing factors ofjob burnout.[24]

4.Intervention Measures and Coping Strate-gies of Family Doctors’Job Burnout

4.1 Relieve Fatigue Based on Mindfulness Train-ing Mode

Mindfulness training(MT)was proposed by Dr.kar-bakin of Massachusetts University in 1979 at Massachu-setts Medical College.It is applied in the field of medical care to help staff alleviate negative burnout,reduce work anxiety,objectively evaluate and accept themselves,im-prove negative thinking and eliminate negative energy in their hearts.[25]The research of foreign experts shows that after four weeks of mindfulness training,the degree of job burnout of the participants has been alleviated,the symptoms have been improved,and they have a higher love for themselves and their work.Domestic research-ers found that the job burnout of the medical staff in the blood purification center has a significant improvement effect,reducing the effect of anxiety and job burnout,and improving the bad mood.Researchers shows that through mindfulness training for 4 weeks and 8 weeks,family doctors’job burnout is improved,and the training effect of 8 weeks is better,and their job satisfaction is higher.[26]The results show that mindfulness training can reduce the burnout of medical staff and improve their well-being.In addition,according to the study,mindfulness training can improve the quality of sleep,help the body maintain a peaceful state of mind,and then improve the status of job burnout.[27]Therefore,through this way,from the physical and mental point of view,reduce psychological negative energy,eliminate bad emotions,and reduce the degree of burnout.

4.2“Balint Group Sharing Communication Meth-od”Was Used to Reduce Burnout

Balint group method,named after Balint,a famous psychoanalyst,was first applied to family doctors as a means of communication in their work practice,usually in the form of group discussion.In 2003,German research experts introduced Balint group method into China,and first applied it in the training of Shanghai Tongji Hospi-tal,a general hospital.The selected research object was community family doctors at first,and then it was extend-ed to other medical staff in the medical field,including nurses,medical managers,etc.,and achieved good results.The results show that:through Balint group,communi-ty family doctors can better understand their own work,alleviate the job burnout of community family doctors,improve the professional skills of medical staff and im-prove the doctor-patient relationship.Through empathy and communication skills,we can better understand each other’s professional identity and increase job satisfaction.Foreign studies also show that Balint group activities can help family doctors better deal with difficult clinical sit-uations,improve communication skills,further promote the development of doctor-patient relationship,release work pressure and improve job burnout.Researchers used Balint method to randomly pide the family doctors into two groups.[28]The intervention content included two lectures and 10 Balint courses for six months.After the training,all participants measured and evaluated the job burnout and job satisfaction before and after the inter-vention.The results showed that Balint group interactive communication method could meet the needs of medical staff the level of job burnout was lower than that before the test.Researchers proved that this method can effec-tively reduce the burnout of family doctors by carrying out the Balint group method for at least one year and com-paring the job burnout before and after the training.[29]The research shows that the family doctors trained by Balint method have higher enthusiasm in work than those not trained by Balint method.Therefore,it is feasible to take Balint group method to alleviate the job burnout of family doctors.Balint group method can be further developed and spread to reduce the job burnout of family doctors.

5.Conclusion

To sum up,there are many researches on family doc-tors’job burnout at home and abroad,while there are few literatures on coping strategies and intervention of family doctors’job burnout.Therefore,further exploration and practice are needed to help family doctors establish a good working attitude,maintain a positive and enthusiastic working state,improve the team’s collective quality,and promote the development of community medical practice.

References

[1]Freudenberger HJ.Staff Burn,Out[J].Journal of So-cial Issues,2010,30(1):159-165.

[2]MaslachC,Schaufeli WB,Leiter MP.Job burnout[J].Annual review of psychology,2001,52(1):397-4

[3]Chen X,Ran L,Zhang Y,et al.Moderating role of job satisfaction on turnover intent ion and burn-out among workers in primary care institutions:A cross-sectional study[J].BMC public health,2019,19(1):1526.

[4]Soler J K,Yaman H,Esteva M,et al.Burnout in European family doctors:the EGPRN study[J].Fam-Pract,2008,25(4):245-265.

[5]Shanafelt T D,Boone S,Tan L,et al.Burnout and satisfaction with work-life balance among US phy-sicians relative to the general US population[J].Ar-chives of internal medicine,2012,172(18):1377-1385.

[6]Hall L H,Johnson J,Watt I,et al.Association of GP wellbeing and burnout with patient safety in UK pri-mary care:a cross-sectional survey[J].British Jour-nal of General Practice,2019.

[7]Dreher A,Theune M,Kersting C,et al.Prevalence of burnout among German general practitioners:Comparison of physicians working in solo and group practices[J].PLoS ONE,2019,14(2).

[8]O’DEA B,O’CONNOR P,LYDON S,et al.Prev-alence of burnout among Irish general prac-titioners:a cross-sectional study[J].Ir J Med Sci,2017,186(2):447-453.

[9]ADAM S,MOHOS A,KALABAY L,et al.Potential correlates of burnout among general practitioners and residents in Hungary:the significant role of gender,age,dependant care and experience[J].BMC Fam Pract,2018,19(1):193.DOI:10.1186/s12875-018-0886-3.

[10]Kushnir T,Cohen A H,Kitai E.Continuing medical education and primary physicians’job stress,burn-out and dissatisfaction[J].Medical education,2000,34(6):430-436.

[11]Saijo Y,Yoshioka E,Hanley S J B,et al.Job stress factors affect workplace resignation and burnout among Japanese rural physicians[J].The Tohoku journal of experimental medicine,2018,245(3):167-177.

[12]Zhang S,Wang J,Xie F,et al.Across-sectional study of job burnout,psychological attachment,and the career calling of Chinese doctors.BMC Health ServRes.2020;20(1):193.

[13]Győrffy Z,D weik D,Girasek E.Workload,mental health and burnout in dicators among female physi-cians.Hum Resour Health.2016:12.

[14]Chichra A,Abhijnhan A,Tharyan P.Job stress and satisfaction in faculty of a teaching hospital in south India:A cross-sectional survey.J Postgrad Med.2019;65(4):201-206.

[15]Rahman N A,Husin M,Dahian K,et al.Job satis-faction of public and private primary care physicians in Malaysia:analysis of findings from QUALI-CO-PC[J].Human Resources for Health,2019,17(1).

[16]Nantha Y S,Lei H W,Chan M H.Assessing pre-dictors of intention to prescribe sick leave among primary care physician susing the theory of planned behaviour.BMC Fam Pract.2018;19(1):18.

[17]Shanafelt TD,West CP,Sinsky C,et al.Changes in Burnout and Satisfaction With Work-Life Inte-gration in Physicians and the General US Working Population Between2011 and2017.Mayo Clin-Proc.2019;94(9):1681-1694.

[18]Zhang J,Duan Z.Relationship of work-family con-flict,self-reported social support and job satisfac-tion to burnout syndrome among medical workers in south west China:A cross-sectional study.PLo SOne.2017;12(2):e0171679.

[19]Nantha Y S,Lei H W,Chan M H.Assessing pre-dictors of intention to prescribe sick leave among primary carephysicians using the theory of planned behaviour.BMCFamPract.2018;19(1):18.

[20]Gu J,Zhen T,Song Y,Xu L.Job satisfaction of certified primary care physicians in rural Shandong Province,China:across-sectionalstudy.BMC Health ServRes.2019;19(1):7 5.

[21]GanY,GongY,ChenY.Turnover in tention and related factors among general practitionersin Hubei,China:across-sectional study.BMC Fam-Pract.2018;19(1):74.

[22]Chemali Z,Ezzeddine FL,Gelaye B,et al.Burnout among health care providers in the complex environ-men to fthe Middle East:a systematic review.BMC Public Health.2019;19(1):1337

[23]Rosta J,Aasland O G,Nylenna M.Changes in job satisfaction among doctors in Norway from2010 to2017.A study based on repeated surveys.BMJ Open[J].BMJ Open,2019,9(9):e027891.

[24]Luken M,Sammons A.Systematic Review of Mind-fulness Practice for Reducing Job Burnout[J].Am J Occup Ther,2016,70(2):7002250020p1.

[25]Kor P P K,Liu J Y W,Chien W T.Effects of a mod-ified mindfulness-based cognitive therapy for familcaregivers of people with dementia:A pilot random-ized controlled trial[J].Intemational Joumal of Nurs.ing Studies,2019.

[26]Perula-de Tome,Luis-angel,Atalaya V MGarci a-Campayo,Javier,et al.Controlled clinicaltrial comparing the effectiveness of a mindfulnessand self-compassion 4-session programme versus an8-session programme to reduce work stress and bum-out in family and community medicine physiciansand nurses:MINDUUDD study protocol.BMCFamily Practice,2019,20(1).

[27]Lomas T,Medina J C,Itzan I,et al.The impact ofmindfulness on well-being and performance in theworkplace:an inclusive systematic review of the em-pirical literature[]].European Joumal of Work andOrganizational Psychology,2017,26(4).

[28]Chemaliz,Ezzeddine F L,Gelaye B,et al.Bumoutamong healthcare providers in the complex envi-ronment of the Middle East:a systematic review[JBMC Public Health,2019,19(1):1337.

[29]Stojanovic-tasic M Latas M Mfilosevic N,et al.IsBalint training associated with the reduced bumoutamong primary health care doctors?[J.Libyan Jou-nal of Medicine,2018,13(1):1 440123.