The effects of working and living conditions of physicians on burnout level and sleep quality
Main Article Content
Keywords
Sleep disorders; burnout syndrome; violence; mobbing; occupational stress
Abstract
Background: Burnout is a multidimensional syndrome associated with intense working conditions and negative psychosocial factors in physicians. The purpose of this study is to investigate the effects of living and working conditions of physicians on burnout level and sleep quality in Turkey. Methods: In this internet-based questionnaire study, 1053 physicians [General Practitioners (n=233); Basic Medical Sciences (n=26); Internal Medical Sciences (n=530), and Surgery Sciences (n=264)] were included in the study, filling the forms consisting of study conditions, Maslach Burnout Inventory (MBI) and the Pittsburgh Sleep Quality Index (PSQI) questions. Results: Negative occupational factors such as physicians having a night shift, high number of patients who are cared for daily, short examination period, low financial gain, exposure to violence, and mobbing were associated with poor sleep quality and burnout. Factors such as being subjected to violence, mobbing, and age are predictive of increasing burnout in women. Working on night shifts or being on-call were associated with all aspects of burnout. The proportion of those with poor sleep quality was significantly higher in those working night shifts (74.6%) than those working daytime shifts (67.2%) and those who were exposed to violence (75.1%) compared to those who were not exposed to violence (43.2%) (p=0.013, p<0.001, respectively). Conclusions: Impaired sleep quality, violence, mobbing, young age, excessive night shifts, short examination period, and low income may play a role in physician burnout. Our study data suggest that it is important to improve physicians’ unfavorable working conditions and to prevent violence against burnout.
References
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30. Martini S, Arfken CL, Churchill A, Balon R. Burnout comparison among residents in different medical specialties. Acad Psychiatry J Am Assoc Dir Psychiatr Resid Train Assoc Acad Psychiatry. 2004;28:240-242. doi: 10.1176/appi.ap.28.3.240
31. Meier DE, Back AL, Morrison RS. The inner life of physicians and care of the seriously ill. JAMA. 2001;286:3007-3014. doi: 10.1001/jama.286.23.3007
32. Verweij H, van der Heijden FMMA, van Hooff MLM, et al. The contribution of work characteristics, home characteristics and gender to burnout in medical residents. Adv Heal Sci Educ Theory Pract. 2017;22:803-818. doi: 10.1007/s10459-016-9710-9
33. Dyrbye LN, Varkey P, Boone SL, Satele D V, Sloan JA, Shanafelt TD. Physician Satisfaction and Burnout at Different Career Stages. Mayo Clin Proc. 2013;88:1358-1367. doi: 10.1016/j.mayocp.2013.07.016
34. Purvanova RK, Muros JP. Gender differences in burnout: A meta-analysis. J Vocat Behav. 2010;77:168-185. doi: 10.1016/j.jvb.2010.04.006
35. Liang R, Dornan T, Nestel D. Why do women leave surgical training? A qualitative and feminist study. Lancet. 2019;393:541-549. doi: 10.1016/S0140-6736(18)32612-6
36. Templeton K, Bernstein CA, Sukhera J, et al. Gender-Based Differences in Burnout: Issues Faced by Women Physicians. NAM Perspect. Published online 2019. doi:10.31478/201905a
37. Alacacioglu A, Yavuzsen T, Dirioz M, Oztop I, Yilmaz U. Burnout in nurses and physicians working at an oncology department. Psychooncology. 2009;18:543-548. doi: 10.1002/pon.1432
38. Linzer M, Visser MR, Oort FJ, et al. Predicting and preventing physician burnout: results from the United States and the Netherlands. Am J Med. 2001;111:170-175. doi: 10.1016/s0002-9343(01)00814-2
39. Kansoun Z, Boyer L, Hodgkinson M, Villes V, Lançon C, Fond G. Burnout in French physicians: A systematic review and meta-analysis. J Affect Disord. 2019;246:132-147. doi: 10.1016/j.jad.2018.12.056
40. Bria M, Baban A, Damitraşcu DL. Systematic review of burnout risk factors among European Healthcare Professionals. Cogn Brain, Behav An Interdiscip J. 2012;14:423-452.
41. Can H, Güçlü YA, Doğan S, Erkaleli MB. Burnout Syndrome Among the resident doctors in surgical and nonsurgical clinics. J Tepecik Educ Res Hosp. 2010;20:33-40. doi: 10.5222/terh.2010.25307
42. Embriaco N, Azoulay E, Barrau K, et al. High level of burnout in intensivists: prevalence and associated factors. Am J Respir Crit Care Med. 2007;175:686-692. doi: 10.1164/rccm.200608-1184OC
43. Metlaine A, Sauvet F, Gomez-Merino D, et al. Sleep and biological parameters in professional burnout: A psychophysiological characterization. PLoS One. 2018;13:e0190607. doi: 10.1371/journal.pone.0190607
44. Wisetborisut A, Angkurawaranon C, Jiraporncharoen W, Uaphanthasath R, Wiwatanadate P. Shift work and burnout among health care workers. Occup Med (Lond). 2014;64:279-286. doi: 10.1093/occmed/kqu009
45. Zis P, Anagnostopoulos F, Sykioti P. Burnout in medical residents: A study based on the job demands-resources model. Sci World J. 2014;2014:673279. doi: 10.1155/2014/673279
46. Sonnenschein M, Sorbi MJ, van Doornen LJP, Schaufeli WB, Maas CJM. Evidence that impaired sleep recovery may complicate burnout improvement independently of depressive mood. J Psychosom Res. 2007;62(4):487-494. doi: 10.1016/j.jpsychores.2006.11.011
47. Armutlukuyu M. The evaluation of burnout levels of the academic staff and research assistants working at medical faculties. (PhD Thesis). Published online 2014.
48. Okray Z. Academicians’ Burnout: A systematic review. Uluslararası Bilim Araştırmalar Derg. 2018;3:163-180. doi: 10.21733/ibad.370288
49. Hogue A, Huntington MK. Family Physician Burnout Rates in Rural versus Metropolitan Areas: A Pilot Study. South Dakota Med J South Dakota State Med Assoc. 2019;72:306-308.
50. Saijo Y, Chiba S, Yoshioka E, et al. Job stress and burnout among urban and rural hospital physicians in Japan. Aust J Rural Health. 2013;21(4):225-231. doi: 10.1111/ajr.12040
51. Tür FC, Toker I, Tür B, Hacar S, Türe B. Assessment of the Pittsburgh Sleep Quality Index among physician's speciality who work night shifts. Emerg Med Open J. 2015;1(1): 5-11. doi: 10.17140/EMOJ-1-102
52. Alhifzi S, Al-ghonimy A, Aboudi M Al, Abdullah R Al, Olaish A, Bahammam AS. Assessment of sleep quality, daytime sleepiness, and depression among emergency physicians working in shifts. J Nat Sci Med. 2018;1(1):17–21. doi: 10.4103/JNSM.JNSM_8_18
53. Lim SK, Yoo SJ, Koo DL, Park CA, Ryu HJ, Jung YJ, et al. Stress and sleep quality in doctors working on-call shifts are associated with functional gastrointestinal disorders. World J Gastroenterol. 2017;23(18):3330–3337. doi: 10.3748/wjg.v23.i18.3330.
54. Surani A, Surani A, Zahid S, Ali S, Farhan R, Surani S. To assess sleep quality among Pakistani junior physicians (house officers): A Cross-sectional study. Ann Med Health Sci Res. 2015;5(5):329-333. doi: 10.4103/2141-9248.165246.
2. Maslach C, Jackson SE. The measurement of experienced burnout. J Organ Behav. 1981;2:99-113. doi: 10.1002/job.4030020205
3. Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory. Third Edit. Consulting Psychologists Press; 1986.
4. Seidler A, Thinschmidt M, Deckert S, et al. The role of psychosocial working conditions on burnout and its core component emotional exhaustion – a systematic review. J Occup Med Toxicol. 2014;9:1-13. doi: 10.1186/1745-6673-9-10
5. Martínez-Zaragoza F. Personality and interpersonal behaviour may impact on burnout in nurses. Evid Based Nurs. 2018;21:24. doi: 10.1136/eb-2017-102797
6. Rodrigues H, Cobucci R, Oliveira A, et al. Burnout syndrome among medical residents: A systematic review and meta-analysis. PLoS One. 2018;13:e0206840. doi: 10.1371/journal.pone.0206840
7. Amoafo E, Hanbali N, Patel A, Singh P. What are the significant factors associated with burnout in doctors? Occup Med (Lond). 2015;65(2):117-121. doi:10.1093/occmed/kqu144
8. Azam K, Khan A, Alam MT. Causes and Adverse Impact of Physician Burnout: A Systematic Review. J Coll Physicians Surg JCPSP. 2017;27:495-501.
9. McHill AW, Czeisler CA, Shea SA. Resident physician extended work hours and burnout. Sleep. 2018;41:zsy112. doi: 10.1093/sleep/zsy112
10. Shanafelt TD, Boone S, Tan L, et al. Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population. Arch Intern Med. 2012;172(18):1377-1385. doi: 10.1001/archinternmed.2012.3199
11. WHO Global Consultation on Violence and Health. Violence: a public health priority. Geneva, World Health Organization, 1996 (document WHO/ EHA/SPI.POA.2). -12. WHO | Violence against health workers. Accessed May 5, 2021. https://www.who.int/violence_injury_prevention/violence/workplace/en/
13. Cheng W-J, Cheng Y. Night shift and rotating shift in association with sleep problems, burnout and minor mental disorder in male and female employees. Occup Environ Med. 2017;74:483-488. doi: 10.1136/oemed-2016-103898
14. Li J, Bidlingmaier M, Petru R, Pedrosa Gil F, Loerbroks A, Angerer P. Impact of shift work on the diurnal cortisol rhythm: a one-year longitudinal study in junior physicians. J Occup Med Toxicol. 2018;13:23. doi: 10.1186/s12995-018-0204-y
15. Howard SK. Sleep deprivation and physician performance: Why should I care? Proc (Bayl Univ Med Cent). 2005;18:108-112. doi: 10.1080/08998280.2005.11928045.
16. Westbrook JI, Raban MZ, Walter SR, Douglas H. Task errors by emergency physicians are associated with interruptions, multitasking, fatigue and working memory capacity: a prospective, direct observation study. BMJ Qual Saf. 2018;27:655-663. doi: 10.1136/bmjqs-2017-007333
17. Stewart NH, Arora VM. The Impact of Sleep and Circadian Disorders on Physician Burnout. Chest. 2019;156:1022-1030. doi: 10.1016/j.chest.2019.07.008
18. Ergin C. Doktor ve hemsirelerde tukenmislik ve maslach tukenmislik olceginin uyarlanmasi. VII Ulus Psikol Kongresi, 22th Sept 1992 Ankara. Published online 1992.
19. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28:193-213. doi: 10.1016/0165-1781(89)90047-4
20. Ağargün MY, Kara H, Anlar Ö. The Validity and Reliability of the Pittsburgh Sleep Quality Index. Türk Psikiyatr Derg. 1996;7:107-115.
21. Rotenstein LS, Torre M, Ramos MA, et al. Prevalence of Burnout Among Physicians: A Systematic Review. JAMA. 2018;320:1131-1150. doi: 10.1001/jama.2018.12777
22. Soler JK, Yaman H, Esteva M, et al. Burnout in European family doctors: the EGPRN study. Fam Pract. 2008;25:245-265. doi: 10.1093/fampra/cmn038
23. Yaman H, Soler JK. The job related burnout questionnaire. A multinational pilot study. Aust Fam Physician. 2002;31(11):1055-1056.
24. Erol A, Sariçiçek A, Gülseren Ş. Asistan hekimlerde tükenmişlik: İş doyumu ve depresyonla ilişkisi. [Burnout in residents: Association with job satisfaction and depression.]. Anadolu Psikiyatr Derg. 2007;8:241-247.
25. Ozyurt A, Hayran O, Sur H. Predictors of burnout and job satisfaction among Turkish physicians. QJM Mon J Assoc Physicians. 2006;99:161-169. doi: 10.1093/qjmed/hcl019
26. Ardiç K, Polatci S. Emotional Exhaustion: An Application to Academic Personal (The Case Of Gazi Osman Pasa University). Gazi Üniversitesi İktisadi ve İdari Bilim Fakültesi Derg. 2008;10:69-96.
27. Maslach C, Schaufeli WB, Leiter MP. Job Burnout. Annu Rev Psychol. 2001;52:397-422. doi: 10.1146/annurev.psych.52.1.397
28. Bayram B, Çetin M, Çolak Oray N, Can İÖ. Workplace violence against physicians in Turkey's emergency departments: a cross-sectional survey. BMJ Open. 2017;7:e013568. doi: 10.1136/bmjopen-2016-013568
29. Mc K. Violence against the medical profession. J Anaesthesiol Clin Pharmacol. 2017;33:145-147. doi: 10.4103/joacp.joacp_102_17
30. Martini S, Arfken CL, Churchill A, Balon R. Burnout comparison among residents in different medical specialties. Acad Psychiatry J Am Assoc Dir Psychiatr Resid Train Assoc Acad Psychiatry. 2004;28:240-242. doi: 10.1176/appi.ap.28.3.240
31. Meier DE, Back AL, Morrison RS. The inner life of physicians and care of the seriously ill. JAMA. 2001;286:3007-3014. doi: 10.1001/jama.286.23.3007
32. Verweij H, van der Heijden FMMA, van Hooff MLM, et al. The contribution of work characteristics, home characteristics and gender to burnout in medical residents. Adv Heal Sci Educ Theory Pract. 2017;22:803-818. doi: 10.1007/s10459-016-9710-9
33. Dyrbye LN, Varkey P, Boone SL, Satele D V, Sloan JA, Shanafelt TD. Physician Satisfaction and Burnout at Different Career Stages. Mayo Clin Proc. 2013;88:1358-1367. doi: 10.1016/j.mayocp.2013.07.016
34. Purvanova RK, Muros JP. Gender differences in burnout: A meta-analysis. J Vocat Behav. 2010;77:168-185. doi: 10.1016/j.jvb.2010.04.006
35. Liang R, Dornan T, Nestel D. Why do women leave surgical training? A qualitative and feminist study. Lancet. 2019;393:541-549. doi: 10.1016/S0140-6736(18)32612-6
36. Templeton K, Bernstein CA, Sukhera J, et al. Gender-Based Differences in Burnout: Issues Faced by Women Physicians. NAM Perspect. Published online 2019. doi:10.31478/201905a
37. Alacacioglu A, Yavuzsen T, Dirioz M, Oztop I, Yilmaz U. Burnout in nurses and physicians working at an oncology department. Psychooncology. 2009;18:543-548. doi: 10.1002/pon.1432
38. Linzer M, Visser MR, Oort FJ, et al. Predicting and preventing physician burnout: results from the United States and the Netherlands. Am J Med. 2001;111:170-175. doi: 10.1016/s0002-9343(01)00814-2
39. Kansoun Z, Boyer L, Hodgkinson M, Villes V, Lançon C, Fond G. Burnout in French physicians: A systematic review and meta-analysis. J Affect Disord. 2019;246:132-147. doi: 10.1016/j.jad.2018.12.056
40. Bria M, Baban A, Damitraşcu DL. Systematic review of burnout risk factors among European Healthcare Professionals. Cogn Brain, Behav An Interdiscip J. 2012;14:423-452.
41. Can H, Güçlü YA, Doğan S, Erkaleli MB. Burnout Syndrome Among the resident doctors in surgical and nonsurgical clinics. J Tepecik Educ Res Hosp. 2010;20:33-40. doi: 10.5222/terh.2010.25307
42. Embriaco N, Azoulay E, Barrau K, et al. High level of burnout in intensivists: prevalence and associated factors. Am J Respir Crit Care Med. 2007;175:686-692. doi: 10.1164/rccm.200608-1184OC
43. Metlaine A, Sauvet F, Gomez-Merino D, et al. Sleep and biological parameters in professional burnout: A psychophysiological characterization. PLoS One. 2018;13:e0190607. doi: 10.1371/journal.pone.0190607
44. Wisetborisut A, Angkurawaranon C, Jiraporncharoen W, Uaphanthasath R, Wiwatanadate P. Shift work and burnout among health care workers. Occup Med (Lond). 2014;64:279-286. doi: 10.1093/occmed/kqu009
45. Zis P, Anagnostopoulos F, Sykioti P. Burnout in medical residents: A study based on the job demands-resources model. Sci World J. 2014;2014:673279. doi: 10.1155/2014/673279
46. Sonnenschein M, Sorbi MJ, van Doornen LJP, Schaufeli WB, Maas CJM. Evidence that impaired sleep recovery may complicate burnout improvement independently of depressive mood. J Psychosom Res. 2007;62(4):487-494. doi: 10.1016/j.jpsychores.2006.11.011
47. Armutlukuyu M. The evaluation of burnout levels of the academic staff and research assistants working at medical faculties. (PhD Thesis). Published online 2014.
48. Okray Z. Academicians’ Burnout: A systematic review. Uluslararası Bilim Araştırmalar Derg. 2018;3:163-180. doi: 10.21733/ibad.370288
49. Hogue A, Huntington MK. Family Physician Burnout Rates in Rural versus Metropolitan Areas: A Pilot Study. South Dakota Med J South Dakota State Med Assoc. 2019;72:306-308.
50. Saijo Y, Chiba S, Yoshioka E, et al. Job stress and burnout among urban and rural hospital physicians in Japan. Aust J Rural Health. 2013;21(4):225-231. doi: 10.1111/ajr.12040
51. Tür FC, Toker I, Tür B, Hacar S, Türe B. Assessment of the Pittsburgh Sleep Quality Index among physician's speciality who work night shifts. Emerg Med Open J. 2015;1(1): 5-11. doi: 10.17140/EMOJ-1-102
52. Alhifzi S, Al-ghonimy A, Aboudi M Al, Abdullah R Al, Olaish A, Bahammam AS. Assessment of sleep quality, daytime sleepiness, and depression among emergency physicians working in shifts. J Nat Sci Med. 2018;1(1):17–21. doi: 10.4103/JNSM.JNSM_8_18
53. Lim SK, Yoo SJ, Koo DL, Park CA, Ryu HJ, Jung YJ, et al. Stress and sleep quality in doctors working on-call shifts are associated with functional gastrointestinal disorders. World J Gastroenterol. 2017;23(18):3330–3337. doi: 10.3748/wjg.v23.i18.3330.
54. Surani A, Surani A, Zahid S, Ali S, Farhan R, Surani S. To assess sleep quality among Pakistani junior physicians (house officers): A Cross-sectional study. Ann Med Health Sci Res. 2015;5(5):329-333. doi: 10.4103/2141-9248.165246.
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Hacimusalar Y, Misir E, Civan Kahve A, Demir Hacimusalar G, Guclu MA, Karaaslan O. The effects of working and living conditions of physicians on burnout level and sleep quality . Med Lav [Internet]. 2021 Oct. 28 [cited 2024 Jul. 17];112(5):346-59. Available from: https://mattioli1885journals.com/index.php/lamedicinadellavoro/article/view/11268
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How to Cite
1.
Hacimusalar Y, Misir E, Civan Kahve A, Demir Hacimusalar G, Guclu MA, Karaaslan O. The effects of working and living conditions of physicians on burnout level and sleep quality . Med Lav [Internet]. 2021 Oct. 28 [cited 2024 Jul. 17];112(5):346-59. Available from: https://mattioli1885journals.com/index.php/lamedicinadellavoro/article/view/11268
