한국병원경영학회지 (Korea Journal of Hospital Management)

한국병원경영학회 (Korean Society of Hospital Management)
권호 표지

의사의 진찰시간과 진료환자 수가 직무소진에 미치는 영향

Effects of consultation length and the number of outpatients on physicians' occupational burnout

  • 문성제 (대한의사협회 의료정책연구소) ;
  • 박정훈 (대한의사협회 의료정책연구소) ;
  • 이정찬 (대한의사협회 의료정책연구소)
  • Sungje, Moon (Research Institute for Healthcare Policy, Korean Medical Association) ;
  • Jeong Hun, Park (Research Institute for Healthcare Policy, Korean Medical Association) ;
  • Jung Chan, Lee (Research Institute for Healthcare Policy, Korean Medical Association)
  • 투고 : 2022.12.06
  • 심사 : 2022.12.16
  • 발행 : 2022.12.30
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초록

Purpose: Physician's occupational burnout has been a very important issue that can cause negative consequences not only for individual's physical and mental health, but also for patient's health and the overall national healthcare system. For the reason, this study confirmed how consultation length and the number of outpatients affect physician's occupational burnout in the medical environment. Methodology: In the study, the data of '2020 Korean Physician Survey' conducted by Korean Medical Association(KMA) was used for the analysis, and a total of 4,215 physicians were selected as study samples. The differences in the degree of occupational burnout according to the physicians' general characteristics were confirmed through uni-variate analysis, and also a regression analysis was conducted to confirm the effects of consultation length and the number of outpatients on physician's occupational burnout. Findings: As a result. the overall degree of physician's occupational burnout decreased(𝛽=-0.051, p<0.01) as the consultation length increased. Specifically, the physician's emotional exhaustion increased(𝛽=0.051, p<0.01), while the reduction of accomplishment decreased(𝛽=-0.131, p<0.001). Furthermore, the overall occupational burnout decreased(𝛽=-0.047, p<0.01) as a proportion of advice and education during the consultation increased, and it had an effect on the decrease in depersonalization(𝛽=-0.045, p<0.01) and the reduction of accomplishment(𝛽=-0.065, p<0.001). At last, as the number of outpatients increased, the overall occupational burnout increased(𝛽=0.041, p<0.05) with more emotional exhaustion(𝛽=0.095, p<0.001), depersonalization(𝛽=0.065, p<0.001), and less reduction of personal achievement(𝛽=-0.081, p<0.001). Practical implication: Consequently, it is necessary to prevent physician's occupational burnout by ensuring sufficient consultation length and providing a medical environment to treat an appropriate number of patients. Therefore, national policies should expand health insurance coverage and compensate medical fees for sufficient consultation length that both patients and physicians can satisfy. It will ultimately contribute to ensuring the patients' health and improving the quality of national healthcare services.

키워드

참고문헌

  1. World Health Organization. Burn-out an "occupational pheno-menon": International Classification of Diseases. Geneva: World Health Organization 2019. [cited 2019 Jun 13]. Available from: https://www.who.int/mental_health/evidence/burn-out/en/. 
  2. HA JH. Burnout and mental health of physicians. Journal of the Korean Medical Association 2019;62(7):346-348. https://doi.org/10.5124/jkma.2019.62.7.346 
  3. Bailie R, Sibthorpe B, Douglas B, Broom D, Attewell R, McGuiness C. Mixed feelings: satisfaction and disillusionment among Australian GPs. Family Practice 1998;15:58-66. https://doi.org/10.1093/fampra/15.1.58 
  4. Burdi MD, Baker LC. Physicians' perceptions of autonomy and satisfaction in California. Health Affairs 1999;18:134-145. https://doi.org/10.1377/hlthaff.18.4.134 
  5. Dowell AC, Hamilton S, McLeod DK. Job satisfaction, psychological morbidity and job stress among New Zealand general practitioners. The New Zealand medical journal 2000;14;113(1113):269-272. 
  6. Kirwan M, Armstrong D: Investigation of burnout in a sample of British general practitioners. British Journal of General Practice 1995;45(394):259-260. 
  7. Calnan M, Wainwright D, Forsythe M, Wall B, Almond S. Mental health and stress in the workplace: the case of general practice in the UK. Social Science & Medicine 2001;52(4):499-507. https://doi.org/10.1016/S0277-9536(00)00155-6 
  8. JO SJ, Shin YC, Jeon SW, Kim HJ, Shin YS, Kim DE, et al. The Physician's Model of Mental Health Care: Based on the mental health status of Korean doctors. Korean Medical Association Research institute for healthcare policy 2022 
  9. Rotenstein LS, Torre M, Ramos MA, Rosales RC, Guille C, Sen S, et al. Prevalence of burnout among physicians: a systematic review. Journal of the American Medical Association 2018;320(11):131-1150. doi:10.1001/jama.2018.12777 
  10. LEE SY. Understanding and Management of Burnout. Journal of Korean Neuropsychiatric Association 2020;59(2):105-114. https://doi.org/10.4306/jknpa.2020.59.2.105 
  11. Salvagioni DAJ, Melanda FN, Mesas AE, Gonzalez AD, Gabani FL, Andrade SM. Physical, psychological and occupational consequences of job burnout: a systematic review of prospective studies. PLoS One 2017;12(10):e0185781. https://doi.org/10.1371/journal.pone.0185781 
  12. Shanafelt TD, Balch CM, Bechamps G, Russell T, Dyrbye L, Satele D, et al. Burnout and medical errors among American surgeons. Annals of surgery 2010;251(6):995-1000. doi: 10.1097/SLA.0b013e3181bfdab3 
  13. DeVoe J, Fryer GE Jr, Hargraves JL, Phillips RL, Green LA. Does career dissatisfaction affect the ability of family physicians to deliver high-quality patient care? The Journal of family practice 2002;51(3):223-228. 
  14. Williams E, Manwell L, Konrad T, Linzer M. The relationship of organizational culture, stress, satisfaction, and burnout with physician-reported error and suboptimal patient care: results from the MEMO study. Health Care Manage Review 2007;32(3):203-212. doi: 10.1097/01.HMR.0000281626.28363.59 
  15. Panagioti M, Geraghty K, Johnson J, Zhou A, Panagopoulou E, Chew-Graham C et al. Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction: A Systematic Review and Meta- analysis. JAMA Internal Medicine. 2018;178(10) :1317-1330. doi:10.1001/jamainternmed.2018.3713 
  16. Shanafelt TD. Enhancing meaning in work: A prescription for preventing physician burnout and promoting patient-centered care. Journal of the American Medical Association 2009;302(12):1338-1340. doi:10.1001/jama.2009.1385 
  17. Shanafelt TD, Sloan JA, Habermann TM. The well-being of physicians. The American Journal of Medicine 2003;114(6):513-519. DOI:https://doi.org/10.1016/S0002-9343(03)00117-7 
  18. Williams ES, Konrad TR, Linzer M, McMurray J, Pathman DE, Gerrity M, et al. Physician, practice, and patient characteristics related to primary care physician physical and mental health: Results from the PhysicianWorklife Study. Health Service Research. 2002;37(1):121-143. 
  19. Appleton K, House A, Dowell A. A survey of job satisfaction, sources of stress and psychological symptoms among general practitioners in Leeds. The British Journal of general practice 1998;48(428):1059-1063. 
  20. Huby G, Gerry M, McKinstry B, Porter M, Shaw J, Wrate R. Morale among general practitioners: qualitative study exploring relations between partnership arrangements, personal style, and workload. British Medical Journal 2002;325(7356):140-144. doi: https://doi.org/10.1136/bmj.325.7356.140 
  21. Sibbald B, Bojke C, Gravelle H. National survey of job satisfaction and retirement intentions among general practitioners in England. British Medical Journal 2003;4(326):22-25. doi: https://doi.org/10.1136/bmj.326.7379.22 
  22. Wilson A, McDonald P, Hayes L, Cooney J. Longer booking intervals in general practice: effects on doctors' stress and arousal. The British Journal of general practice 1991;41(346):184-187. 
  23. Howie JG, Hopton JL, Heaney DJ, Porter AM. Attitudes to medical care, the organization of work, and stress among general practitioners. The British Journal of General Practice 1992;42(358):181-185. 
  24. Deveugele M, Derese A, van den Brink-Muinen A, Bensing J, Maeseneer JD. Consultation length in general practice: cross sectional study in six European countries. British Medical Journal 2002;325(7362):472. doi: https://doi.org/10.1136/bmj.325.7362.472 
  25. Mercer SW, Fitzpatrick B, Gourlay G, Vojt G, McConnachie A, Watt GC. More time for complex consultations in a high-deprivation practice is associated with increased patient enablement. The British Journal of general practice 2007;57(545):960-966. doi: 10.3399/096016407782604910 
  26. Irving G, Neves AL, Dambha-Miller H, Oishi A, Tagashira H, Verho A, et al. International variations in primary care physician consultation time: a systematic review of 67 countries. BMJ Open. 2017;7(10):e017902. http://dx.doi.org/10.1136/bmjopen-2017-017902 
  27. Schafer WL, van den Berg MJ, Groenewegen PP. The association between the workload of general practitioners and patient experiences with care: results of a cross-sectional study in 33 countries. Human resources for health 2020;18(1):76. 
  28. Howie JG, Porter AM, Heaney DJ, Hopton JL Long to short consultation ratio: a proxy measure of quality of care for general practice. The British Journal of general practice 1991;41(343):48-54. 
  29. Royal College of General Practitioners. Fit for the Future: A vision for general practice. London: Royal College of General Practitioners 2019. [cited 2022 Nov 23]. Available from: https://www.rcgp.org.uk/representing-you/future-of-general-practice 
  30. Organisation for Economic Co-operation and Development. OECD Health Statistics 2020. Geneva: Organisation for Economic Co-operation and Development 2020. Available from: https://www.oecd.org/health/health-data.htm 
  31. Organisation for Economic Co-operation and Development. The Economics of Patient Safety Part IV: Safety in the Workplace. Organisation for Economic Co-operation and Development 2021. 
  32. IM BC, Kim SY, Kim KN, JU JM, Kang SH, Kim SY, et al. Research on the effect analysis of the pilot project for the in-depth medical examination at a tertiary general hospital. Seoul University Hospital 2014 
  33. Maslach C. Jackson SE. The measurement of experienced burnout. Journal of Organizational Behavior 1981;2(2):99-113. https://doi.org/10.1002/job.4030020205 
  34. Bakker A, Schaufeli W, Sixma H, Bosveld W, van Dierendonck D. Patients demands, lack of reciprocity and burnout: a five year longitudinal study. Journal of Organizational Behavior 2000;21(4):425-441. https://dx.do i.org/10.1002/(SICI )1099-1379(200006)21:4<425::AID-JOB21>3.0.CO;2- 
  35. Lee IS, Park MS, Jeong MG.. A Study on the Effect of Job Burnout-Based on the Professions Working in Financial Companies, Korea Journal of Business Administration 2007;20(6):2879-2900. 
  36. Kwon EK. The effect of job stress on job exhaustion on Middle School teacher. Journal of Digital Convergence 2018;16(8):81-87. https://doi.org/10.14400/JDC.2018.16.8.081 
  37. Kwon EK. The effect of job stress on job exhaustion on Middle School teacher. Journal of Digital Convergence 2018;16(8):81-87. Cited from Lee HK. Control effectiveness of manager coaching behavior in relation to job characteristics and job losses, a master's thesis, Korea University, Seoul. 2014.  https://doi.org/10.14400/JDC.2018.16.8.081
  38. Zantinge EM, Verhaak PF, de Bakker DH, van der Meer K, Bensing JM. Does burnout among doctors affect their involvement in patients' mental health problems? A study of videotaped consultations. BMC family practice 2009;10(1):1-10. doi: 10.1186/1471-2296-10-60. 
  39. Vedsted P, Sokolowski I, Olesen F. Open access to general practice was associated with burnout among general practitioners. International Journal of Family Medicine 2013:383602. DOI: 10.1155/2013/383602 
  40. Lamothe M, Boujut E, Zenasni F, Sultan S. To be or not to be empathic: the combined role of empathic concern and perspective taking in understanding burnout in general practice. BMC family practice 2014;15(15): 1-7. doi: 10.1186/1471-2296-15-15. 
  41. Wright AA, Katz IT. Beyond burnout - redesigning care to restore meaning and sanity for physicians. The New England Journal of Medicine 2018;378(4):309-311. doi: 10.1056/NEJMp1716845. 
  42. Orton PK, Gray DP. Factors influencing consultation length in general/family practice. Family Practice 2016;36(5):529-534. https://doi.org/10.1093/fampra/cmw056 
  43. Pedersen AF, Noroxe KB, Vedsted P. Influence of patient multimorbidity on GP burnout: a survey and register-based study in Danish general practice. British Journal of General Practice 2020;70(691):e95-101. DOI: https://doi.org/10.3399/bjgp20X707837 
  44. Howie JG, Heaney DJ, Maxwell M, Walker JJ, Freeman GK, Rai H. Quality at general practice consultations: cross sectional survey. British Medical Journal 1999;319(7212):738-743. doi: 10.1136/bmj.319.7212.738. 
  45. Kaplan SH, Greenfield S, Ware Jr JE. Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Medical care, 1989;3:S110-S127. DOI: 10.1097/00005650-198903001-00010 
  46. Wilson A, Childs S. The relationship between consultation length, process and outcomes in general practice: a systematic review. The British Journal of general practice 2002;52(485): 1012-1020. 
  47. Kwon YJ, Shin HY, NA HI, KIM JH, JU JM, Yeo NG, et al. Research on the introduction of in-depth examination fees for the reorganization of the examination fee system(Step 2). Health Insurance Review & Assessment Service 2019 
  48. Crosbie B, O'Callaghan ME, O'Flanagan S, Brennan D, Keane G, Behan W. A real-time measurement of general practice workload in the Republic of Ireland: a prospective study. British Journal of General Practice 2020;70(696):e489-e496. doi: 10.3399/bjgp20X710429. Print 2020 Jul.