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The Personal and Professional Consequences of Physician Burnout: A Systematic Review
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Author: Eric S. Williams, U. of Alabama
Author: Cheryl Rathert, Virginia Commonwealth U.
Author: Sandra Catherine Buttigieg, U. of Malta
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The Well-being of the healthcare workforce emerged as both a major concern and as the “quadruple aim” to enable the “triple aim” of improving patient experiences, reducing costs, and improving population health. Physician burnout is especially pernicious given its effects on physicians, patients, healthcare organizations, and society. Using Conservation of Resources theory as a frame, we conducted a systematic review of the empirical literature on physician burnout and physician outcomes that included 43 articles. Nine outcomes including empathy, depression, and suicidal ideation were organized into three categories (reduced activity, distress, and despair) using the “burnout cascade” model articulated by Weber & Jaekel-Reinhard (2000). Findings show that emotional exhaustion had the greatest impact on all outcomes followed while depersonalization and lack of professional accomplishment manifested fewer associations. The results suggest that burnout is a complex, dynamic phenomenon which unfolds over time. Future research and implications of these results were discussed.
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Paper is No Longer Available Online: Please contact the author(s).
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Job Satisfaction and Guideline Adherence among Physicians: Moderating Role for Autonomy and Control
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Author: Anthony Waddimba, Parkland Center for Clinical Innovation
Author: David Mohr, VA Boston Healthcare System
Author: Gary J Young, Northeastern U.
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The adoption of pay-for-performance (P4P) as a reimbursement model for physicians has generated concerns about the potential negative effects for physicians’ job satisfaction and by extension their clinical performance. Yet studies of the relationship between physician job satisfaction and clinical performance have generally yielded inconsistent findings. We investigated whether physicians’ perceptions of autonomy support and job control significantly moderate the relationship between job satisfaction and guideline adherence in a P4P context. We performed a secondary analysis of a dataset created by merging information on clinical services provided by primary physicians with survey data on their job-related attitudes. For physicians who reported high autonomy support from the market-dominant HMO, a positive satisfaction-adherence association existed (ß=.11; p=<.0001). However, job satisfaction was negatively associated with lower adherence among physicians who reported low autonomy support from the market-dominant HMO (ß= -.14; p=<.0001). Similarly, high job control was a positive moderator (ß=.07; p=<.0001) of the influence of job satisfaction on guideline adherence whereas low job control was a negative moderator (ß= -.10; p=<.0001). Our results suggest that payers attempting to over-direct affiliated physicians can demotivate satisfied physicians from achieving top-level guideline adherence, thereby squandering opportunities for intrinsic satisfaction to improve guideline adherence. To optimize the potential for job satisfaction to motivate physicians for greater clinical performance, payers should be attentive to physicians’ sense of autonomy and job control.
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Paper is No Longer Available Online: Please contact the author(s).
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The Role of Change Readiness and Colleague Support in the Role Stressors-Withdrawal Relationship (WITHDRAWN)
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Author: Denis Chenevert, HEC
Author: Steven Kilroy, Tilburg U.
Author: Janine Bosak, Dublin City U.
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The purpose of this study is to investigate the impact of role stressors (role ambiguity, role conflict, and role overload) on change readiness and in turns their effects on the withdrawal process. In addition, it explores the moderating role of colleague support in the relationship between role stressors and change readiness. Data was collected from health care workers (N=457) in a large Canadian hospital undergoing large scale change. The results revealed that role ambiguity and role conflict had a significant negative association with change readiness. Change readiness was related to turnover intentions which was related to higher levels of absenteeism and actual turnover. Change readiness partially mediated the relationship between role ambiguity and turnover intentions but not for role conflict and role overload. Turnover intentions partially mediated the relationship between change readiness and actual turnover but not for absenteeism. Role conflict had a direct rather than an indirect effect via change readiness on turnover intentions. Finally, colleague support moderated the relationship between all three role stressors and change readiness.
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Paper is No Longer Available Online: Please contact the author(s).
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Making Do by Getting Real: Psychological Contract Violations and Physicians’ Early Career Agency
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Author: Mahima Mitra, Oxford U., Saïd Business School
Author: Sue Dopson, U. of Oxford
Author: Timothy Hoff, Northeastern U.
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Elite professions such as doctors, lawyers, and engineers are undergoing profound change. Career trajectories among these highly-skilled workers can be construed as an emergent process characterized by a high degree of agency. This paper examines how psychological contract violations and their associated emotions shape young doctors’ career agency. Such an agency-oriented careers perspective focused on individual sensemaking is missing in the study of elite professions at present. Using evidence from interviews and focus groups, we find that early career primary care doctors develop expectations about their career and work which they then perceive to be violated. These violations are expressed through emotions such as frustration, regret, and anxiety, as well as negative expectancy regarding the viability of certain future career choices. We find that these perceived violations also trigger among young physicians a set of early career attitudes and behaviors that present as more transactional and self-interested. Our findings support this novel view of elite professionals as highly proactive and aware enactors of their medical careers. The specific flavor of their agency has implications for professional power and cohesion, as well as how best to train and socialize these experts at an early career point.
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Paper is No Longer Available Online: Please contact the author(s).
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