Correlates of physician burnout across regions and specialties: a meta-analysis.

BACKGROUND: Health care organizations globally realize the need to address physician burnout due to its close linkages with quality of care, retention and migration. The many functions of health human resources include identifying and managing burnout risk factors for health professionals, while also promoting effective coping. Our study of physician burnout aims to show: (1) which correlates are most strongly associated with emotional exhaustion (EE) and depersonalization (DP), and (2) whether the associations vary across regions and specialties. METHODS: Meta-analysis allowed us to examine a diverse range of correlates. Our search yielded 65 samples of physicians from various regions and specialties. RESULTS: EE was negatively associated with autonomy, positive work attitudes, and quality and safety culture. It was positively associated with workload, constraining organizational structure, incivility/conflicts/violence, low quality and safety standards, negative work attitudes, work-life conflict, and contributors to poor mental health. We found a similar but weaker pattern of associations for DP.Physicians in the Americas experienced lower EE levels than physicians in Europe when quality and safety culture and career development opportunities were both strong, and when they used problem-focused coping. The former experienced higher EE levels when work-life conflict was strong and they used ineffective coping. Physicians in Europe experienced lower EE levels than physicians in the Americas with positive work attitudes. We found a similar but weaker pattern of associations for DP.Outpatient specialties experienced higher EE levels than inpatient specialties when organization structures were constraining and contributors to poor mental health were present. The former experienced lower EE levels when autonomy was present. Inpatient specialties experienced lower EE levels than outpatient specialties with positive work attitudes. As above, we found a similar but weaker pattern of associations for DP. CONCLUSIONS: Although we could not infer causality, our findings suggest: (1) that EE represents the core burnout dimension; (2) that certain individual and organizational-level correlates are associated with reduced physician burnout; (3) the benefits of directing resources where they are most needed to physicians of different regions and specialties; and (4) a call for research to link physician burnout with performance.

Concordance with ASCO guidelines for surveillance after colorectal cancer treatment: a population-based analysis.

PURPOSE: Intensive surveillance after curative treatment of colorectal cancer (CRC) is associated with improved overall survival. This study examined concordance with the 2005 ASCO surveillance guidelines at the population level. METHODS: A cohort of 250 patients diagnosed with stage II or III CRC in 2004 and alive 42 months after diagnosis was identified from health administrative data in Manitoba, Canada. Colonoscopy, liver imaging, and carcinoembryonic antigen (CEA) testing were assessed over 3 years. Guidelines were met if patients had at least one colonoscopy in 3 years and at least one liver imaging test and three CEA tests annually. Multivariate logistic regression assessed the effect of patient and physician characteristics and disease and treatment factors on guideline concordance. RESULTS: Guidelines for colonoscopy, liver imaging, and CEA were met by 80.4%, 47.2%, and 22% of patients, respectively. Guideline concordance for colonoscopy was predicted by annual contact with a surgeon, higher income, and the diagnosis of colon (rather than rectal) cancer. Adherence was lower in those older than 70 years and with higher comorbidity. For liver imaging, significant predictors were annual contact with an oncologist, receipt of chemotherapy, and diagnosis of colon cancer. Concordance with CEA guidelines was higher with annual contact with an oncologist and high levels of family physician contact, and lower in urban residents, in those older than 70, and in those with stage II disease. CONCLUSION: Completion of recommended liver imaging and CEA testing fall well below guidelines in Manitoba, whereas colonoscopy is better provided. Addressing this gap should improve outcomes for CRC survivors.

The results of the first Canadian national physician assistant survey.

The first Canadian physician assistant (PA) survey was done in 2010 and used to establish baseline information on Canadian PAs' educational background, practices, role, responsibility, and satisfaction with their careers.

The effect of education on health among US residents in relation to country of birth.

This research explores the impact of education on health in relation to an individual's country of birth using the US National Health and Nutrition Examination Surveys for 2001-2004. We analyze health equations that relate health to education and other variables. Health is measured in terms of self-reported overall health, an index of biological risk factors, and body mass index. The primary hypothesis tested is whether education has a greater impact on immigrants' productive and allocative efficiency, because of their need to learn about how to remain healthy and access appropriate health care in a new environment. The empirical results indicate that for US residents, who were foreign-born, education is associated with a greater beneficial effect on every health outcome compared to those born in the United States. More education is related to an even greater positive effect on health for immigrants from Mexico, the origin of most immigrants, than from other countries. These results provide additional support for the portions of the 2007 Immigration Reform Act rejected by the US Congress, which placed a higher priority on education and job skills than current law. Since increased education and improved health are associated, such policy reform would help reduce the demands on the US health-care system.