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

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)
Publication Information
Korea Journal of Hospital Management / v.27, no.4, 2022 , pp. 22-35 More about this Journal
Abstract
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.
Keywords
burnout; consultation length; outpatients; physicians;
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Times Cited By KSCI : 4  (Citation Analysis)
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1 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.    DOI
2 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    DOI
3 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. 
4 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 
5 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.   DOI
6 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/. 
7 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    DOI
8 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    DOI
9 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    DOI
10 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. 
11 Kirwan M, Armstrong D: Investigation of burnout in a sample of British general practitioners. British Journal of General Practice 1995;45(394):259-260. 
12 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    DOI
13 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    DOI
14 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 
15 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    DOI
16 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    DOI
17 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    DOI
18 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. 
19 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    DOI
20 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    DOI
21 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    DOI
22 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    DOI
23 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. 
24 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. 
25 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    DOI
26 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    DOI
27 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    DOI
28 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. 
29 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. 
30 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    DOI
31 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    DOI
32 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. 
33 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. 
34 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 
35 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    DOI
36 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 
37 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. 
38 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 
39 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-    DOI
40 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. 
41 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    DOI
42 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.    DOI
43 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.    DOI
44 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.    DOI
45 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    DOI
46 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.    DOI
47 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    DOI
48 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    DOI