Christine A Sinsky, Roger L Brown, Lisa Rotenstein, Lindsey E Carlasare, Purva Shah, Tait D Shanafelt
{"title":"美国医生的工作控制与职业倦怠和职业意向的关系：一项多机构研究。","authors":"Christine A Sinsky, Roger L Brown, Lisa Rotenstein, Lindsey E Carlasare, Purva Shah, Tait D Shanafelt","doi":"10.7326/ANNALS-24-00884","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Physician control over their clinical work is hypothesized to be associated with both burnout and career intentions.</p><p><strong>Objective: </strong>To assess the association of perceived work control with burnout and career intentions.</p><p><strong>Design: </strong>A multi-institution study.</p><p><strong>Setting: </strong>Cross-sectional survey.</p><p><strong>Participants: </strong>A sample of U.S. physicians between November 2022 and December 2023.</p><p><strong>Measurements: </strong>A novel multicomponent measure of work control, Mini-Z single-item burnout measure, intent to reduce clinical hours (ITR), and intent to leave the current practice.</p><p><strong>Results: </strong>Among respondents, 61.4% (1318 of 2144) reported adequate control over patient load, 60.6% (1301 of 2144) adequate control over membership of their clinical team, and 61.3% (1434 of 2339) adequate control over workload. Adequate control over hiring of staff and clinical schedule were reported by 49.0% (772 of 1574) and 74.6% (1175 of 1574), respectively. Most respondents (58.3% [692 of 1186]) reported that they had sufficient authority/autonomy over that for which they are accountable. On multivariable analyses adjusting for personal and professional characteristics, poor control over patient load, team composition, clinical schedule, domains for which the physician is accountable, and workload were independently associated with burnout. Poor control over patient load and workload were each independently associated with ITR.</p><p><strong>Limitation: </strong>This is a cross-sectional study, so causation cannot be determined, and it is a convenience sample of practices with more than 100 physicians, so it may not be representative of all U.S. physicians.</p><p><strong>Conclusion: </strong>In this large, cross-sectional study, poor control over specific aspects of work was associated with burnout and intentions to reduce clinical effort or leave one's organization. Efforts to reduce burnout and improve retention should consider how to provide physician control over appropriate aspects of their clinical work environment.</p><p><strong>Primary funding source: </strong>American Medical Association.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":19.6000,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Association of Work Control With Burnout and Career Intentions Among U.S. Physicians : A Multi-Institution Study.\",\"authors\":\"Christine A Sinsky, Roger L Brown, Lisa Rotenstein, Lindsey E Carlasare, Purva Shah, Tait D Shanafelt\",\"doi\":\"10.7326/ANNALS-24-00884\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Physician control over their clinical work is hypothesized to be associated with both burnout and career intentions.</p><p><strong>Objective: </strong>To assess the association of perceived work control with burnout and career intentions.</p><p><strong>Design: </strong>A multi-institution study.</p><p><strong>Setting: </strong>Cross-sectional survey.</p><p><strong>Participants: </strong>A sample of U.S. physicians between November 2022 and December 2023.</p><p><strong>Measurements: </strong>A novel multicomponent measure of work control, Mini-Z single-item burnout measure, intent to reduce clinical hours (ITR), and intent to leave the current practice.</p><p><strong>Results: </strong>Among respondents, 61.4% (1318 of 2144) reported adequate control over patient load, 60.6% (1301 of 2144) adequate control over membership of their clinical team, and 61.3% (1434 of 2339) adequate control over workload. Adequate control over hiring of staff and clinical schedule were reported by 49.0% (772 of 1574) and 74.6% (1175 of 1574), respectively. Most respondents (58.3% [692 of 1186]) reported that they had sufficient authority/autonomy over that for which they are accountable. On multivariable analyses adjusting for personal and professional characteristics, poor control over patient load, team composition, clinical schedule, domains for which the physician is accountable, and workload were independently associated with burnout. Poor control over patient load and workload were each independently associated with ITR.</p><p><strong>Limitation: </strong>This is a cross-sectional study, so causation cannot be determined, and it is a convenience sample of practices with more than 100 physicians, so it may not be representative of all U.S. physicians.</p><p><strong>Conclusion: </strong>In this large, cross-sectional study, poor control over specific aspects of work was associated with burnout and intentions to reduce clinical effort or leave one's organization. Efforts to reduce burnout and improve retention should consider how to provide physician control over appropriate aspects of their clinical work environment.</p><p><strong>Primary funding source: </strong>American Medical Association.</p>\",\"PeriodicalId\":7932,\"journal\":{\"name\":\"Annals of Internal Medicine\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":19.6000,\"publicationDate\":\"2024-11-26\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Internal Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.7326/ANNALS-24-00884\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Internal Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.7326/ANNALS-24-00884","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
Association of Work Control With Burnout and Career Intentions Among U.S. Physicians : A Multi-Institution Study.
Background: Physician control over their clinical work is hypothesized to be associated with both burnout and career intentions.
Objective: To assess the association of perceived work control with burnout and career intentions.
Design: A multi-institution study.
Setting: Cross-sectional survey.
Participants: A sample of U.S. physicians between November 2022 and December 2023.
Measurements: A novel multicomponent measure of work control, Mini-Z single-item burnout measure, intent to reduce clinical hours (ITR), and intent to leave the current practice.
Results: Among respondents, 61.4% (1318 of 2144) reported adequate control over patient load, 60.6% (1301 of 2144) adequate control over membership of their clinical team, and 61.3% (1434 of 2339) adequate control over workload. Adequate control over hiring of staff and clinical schedule were reported by 49.0% (772 of 1574) and 74.6% (1175 of 1574), respectively. Most respondents (58.3% [692 of 1186]) reported that they had sufficient authority/autonomy over that for which they are accountable. On multivariable analyses adjusting for personal and professional characteristics, poor control over patient load, team composition, clinical schedule, domains for which the physician is accountable, and workload were independently associated with burnout. Poor control over patient load and workload were each independently associated with ITR.
Limitation: This is a cross-sectional study, so causation cannot be determined, and it is a convenience sample of practices with more than 100 physicians, so it may not be representative of all U.S. physicians.
Conclusion: In this large, cross-sectional study, poor control over specific aspects of work was associated with burnout and intentions to reduce clinical effort or leave one's organization. Efforts to reduce burnout and improve retention should consider how to provide physician control over appropriate aspects of their clinical work environment.
Primary funding source: American Medical Association.
期刊介绍：
Established in 1927 by the American College of Physicians (ACP), Annals of Internal Medicine is the premier internal medicine journal. Annals of Internal Medicine’s mission is to promote excellence in medicine, enable physicians and other health care professionals to be well informed members of the medical community and society, advance standards in the conduct and reporting of medical research, and contribute to improving the health of people worldwide. To achieve this mission, the journal publishes a wide variety of original research, review articles, practice guidelines, and commentary relevant to clinical practice, health care delivery, public health, health care policy, medical education, ethics, and research methodology. In addition, the journal publishes personal narratives that convey the feeling and the art of medicine.
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