Advertisement
Mayo Clinic Proceedings Home

The Effects of Fatigue and Dissatisfaction on How Physicians Perceive Their Social Responsibilities

      Abstract

      Objective

      To examine how fatigue and dissatisfaction with practicing medicine relate to US physicians’ perceptions of their professional responsibilities in a time of upheaval in health care.

      Methods

      From May 30, 2012, through September 1, 2012, we mailed an 8-page paper survey, including measures of perceived social responsibility, fatigue, and satisfaction, to a random sample of 3897 physicians selected from the American Medical Association Physician Masterfile. We performed bivariate tests and multivariable logistic regression to examine associations between key predictors (fatigue and satisfaction) and 3 dependent variables: obligations to care for the uninsured and underinsured, obligations to address policy issues, and agreement with cost-containment.

      Results

      A total of 2556 physicians (65.6%) responded to the survey. Nearly half of physicians (1160 [45.4%]) reported high levels of fatigue, whereas most (1810 [70.8%]) expressed satisfaction with practicing medicine. Dissatisfaction in practicing medicine proved to be a significant predictor in how physicians perceive their professional responsibilities and in medical decision-making. Overall, physicians who rated themselves as very dissatisfied had a significantly reduced likelihood of favoring limiting reimbursement to expand basic coverage (odds ratio, 0.5; 95% CI, 0.3-0.7), recognizing an obligation to care for the uninsured (odds ratio, 0.5; 95% CI, 0.3-0.7), and addressing societal health policy issues (OR, 0.7; 95% CI, 0.5-0.9).

      Conclusion

      Although fatigue and satisfaction are strongly associated, only satisfaction appears to correlate with physicians’ perceived social responsibilities. Physicians who are dissatisfied with their profession may be less inclined to address health policy issues, embrace charity care, or practice cost containment.

      Abbreviations and Acronyms:

      AMA (American Medical Association), OR (odds ratio)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Keeton K.
        • Fenner D.E.
        • Johnson T.R.
        • Hayward R.A.
        Predictors of physician career satisfaction, work-life balance, and burnout.
        Obstet Gynecol. 2007; 109: 949-955
        • Shanafelt T.D.
        • 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: 1377-1385
        • Shanafelt T.D.
        • Bradley K.A.
        • Wipf J.E.
        • Back A.L.
        Burnout and self-reported patient care in an internal medicine residency program.
        Ann Intern Med. 2002; 136: 358-367
        • Wallace J.E.
        • Lemaire J.B.
        • Ghali W.A.
        Physician wellness: a missing quality indicator.
        Lancet. 2009; 374: 1714-1721
        • Dyrbye L.N.
        • Shanafelt T.D.
        Physician burnout: a potential threat to successful healthcare reform.
        JAMA. 2011; 305: 2009-2010
        • Scheurer D.
        • McKean S.
        • Miller J.
        • Wetterneck T.
        U.S. physician satisfaction: a systematic review.
        J Hosp Med. 2009; 4: 560-568
        • Deshpande S.P.
        • Demello J.
        An empirical investigation of factors influencing career satisfaction of primary care physicians.
        J Am Board Fam Med. 2010; 23: 762-769
        • Leigh J.P.
        • Tancredi D.J.
        • Kravitz R.L.
        Physician career satisfaction within specialties.
        BMC Health Serv Res. 2009; 9: 166
        • West C.P.
        • Huschka M.M.
        • Novotny P.J.
        • et al.
        Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study.
        JAMA. 2006; 296: 1071-1078
        • Antiel R.M.
        • Curlin F.A.
        • James K.M.
        • Tilburt J.C.
        Physicians' beliefs and U.S. healthcare reform: a national survey.
        N Engl J Med. 2009; 361: e23
        • Tilburt J.C.
        • Wynia M.K.
        • Sheeler R.D.
        • et al.
        Views of US physicians about controlling healthcare costs.
        JAMA. 2013; 310: 380-388
        • Dyrbye L.N.
        • Massie Jr., F.S.
        • Eacker A.
        • et al.
        Relationship between burnout and professional conduct and attitudes among US medical students.
        JAMA. 2010; 304: 1173-1180
        • Sabbatini A.K.
        • Tilburt J.C.
        • Campbell E.G.
        • et al.
        Controlling health caosts: physicians responses to patient expectations for medical care.
        J Gen Intern Med. 2014; 29: 1234-1241
        • Antiel R.M.
        • James K.M.
        • Egginton J.S.
        • et al.
        Specialty, political affiliation, and perceived social responsibility are associated with U.S. physician reactions to healthcare reform legislation.
        J Gen Intern Med. 2014; 29: 399-403
        • West C.P.
        • Tan A.D.
        • Habermann T.M.
        • Sloan J.A.
        • Shanafelt T.D.
        Association of resident fatigue and distress with perceived medical errors.
        JAMA. 2009; 302: 1294-1300
        • American Association for Public Opinion Research
        Standard Definitions: Final Dispositions of Case Codes and Outcome Rates for Surveys.
        7th ed. Association for Public Opinion Research, American Deerfield, IL2011
        • American Medical Association
        Physician Characteristics and Distribution in the U.S., 2013.
        American Medical Association, Chicago, IL2013
        • Iglehart J.K.
        Health reform, primary care, and graduate medical education.
        N Engl J Med. 2010; 363: 584-590
        • Kirch D.G.
        • Henderson M.K.
        • Dill M.J.
        Physician workforce projections in an era of healthcare reform.
        Annu Rev Med. 2012; 63: 435-445
        • Pratt W.R.
        Physician career satisfaction: examining perspectives of the working environment.
        Hosp Top. 2010; 88: 43-52

      Linked Article

      • Dissatisfaction as a Unifying Force for Social Action
        Mayo Clinic ProceedingsVol. 90Issue 5
        • Preview
          In their article published in the February 2015 issue of Mayo Clinic Proceedings, O’Donnell et al1 are right to mention dissatisfaction with the practice of medicine as a major factor that generates physicians’ lackluster interest in addressing health policy issues. However, there is another factor that must be mentioned, the fact that most medical students do not learn the importance of defending medicine’s ideals in medical school or in residency. They are too busy learning the basics of being doctors, and once they are in practice, the importance of participating in medical affairs seems like a waste of time compared with the demands of practice, personal life, and continuing medical education.
        • Full-Text
        • PDF