This article was written by yxtlaviMedscape recently released a data report on physician burnout. After surveying more than 13,000 physicians from 29 different departments, the study found that 47 percent of physicians suffered from burnout. That figure is up from 42 percent last year. According to the survey, the burnout rate of doctors in China is as high as 66.5-87.8%, much higher than other countries. Physician burnout varies by department. According to Medscape, ER physician burnout has risen sharply, from 43% last year to 60% this year, making it the highest burnout rate of any department. 
Emergency Department, Critical Care Medicine Department, Obstetrics and Gynecology Department became the top three departments for burnout. Source: Medscape 66.5% of physicians experience burnout Occupational burnout (burnout), this concept was systematically put forward by American social psychologist Maslach in the 1980s, refers to the occurrence of individuals under the pressure of work A chronic state of physical and mental fatigue and exhaustion, including emotional exhaustion, depersonalization, and a low sense of achievement. Emotional exhaustion is the central point of burnout and is widely recognized as a mandatory criterion for burnout syndrome, representing emotional overexpansion and exhaustion; depersonalization is the feeling that all or part of one’s self is Unreal, false, negative attitude towards life; the sense of achievement in work will also be reduced. Doctors with these three states may be experiencing job burnout, resulting in symptoms such as exhaustion, headache, insomnia, etc. > Depression/anxiety levels that may even lead to suicide. For hospitals, it may lead to an increase in the turnover rate of doctors and risks to patients’ diagnosis and treatment. There are many factors that cause job burnout, and different influencing factors will appear for different age groups, different countries, or even the same doctor at different time periods. In 2018, Lilac Garden wrote an article on job burnout, detailing its influencing factors: workload, occupational environment, income, paperwork burden, etc. Medcape’s 2022 report also lists the latest rankings of influencing factors, with excessive administrative work (such as clerical work) accounting for 60%, occupying the first place. The second is not getting the trust of colleagues and overwork. 
Factors that produce burnout. Source: MedscapeOf course, there are far more factors that lead to burnout than the list above. There are also special factors for Chinese physicians. Front Public Health In a January 2022 survey of 25,120 Chinese doctors, 60.8% of the participants admitted to having at least one symptom of burnout , 11.2% of the participants believed that there were all symptoms of burnout (emotional exhaustion, depersonalization, low sense of achievement), and the overall prevalence was as high as 66.5-87.8%. Among them, male medical staff, with shorter working years, working in tertiary hospitals; and psychiatry, intensive care, emergency department, internal medicine, oncology There is a higher risk of burnout among medical staff in the medical and pediatric specialties. So, what makes Chinese doctors more prone to burnout? Different doctors in China 1. China< /strong>The ratio of doctors to general population is only 1:343, which is lower than 1:280 in the WestJune 2019 From January 2020 to January 2020, Peking Union Medical College and the Chinese University of Hong Kong conducted a study of Chinese physician burnout, showing that the proportion of Chinese physicians is low: By the end of 2021, There are 4.08 million practicing doctors in China, and the ratio of doctors to the total population is 1:343, which is lower than the ratio of Western countries (about 1:280). The ratio of doctors is low, which means that the diagnosis and treatment tasks and working hours undertaken by a single doctor will increase, resulting in a load state. At the same time, China has the problem of uneven medical resources: Beijing, Shanghai, Shenzhen and other first-tier cities absorb patients from nearby provinces and cities; tertiary hospitals are also absorbing patients that should be Patients who go to primary hospitals. This also confirms the conclusion that “doctors in tertiary hospitals are more prone to job burnout” by Xiehe and CUHK. The study found that 88.5% of doctors in tertiary hospitals are more burnout than doctors in primary hospitals. BMJ another study showed that in 17 townships After the reform of encouraging primary hospitals to seek medical treatment, even though the number of medical visits in primary hospitals has increased, hospital expenditures have not fluctuated. Improving physician shortagesIt doesn’t seem easy. Over the past decade, many medical students have decided to switch careers due to declining pass rates for physician qualification exams, overwork, doctor-patient disputes, and declining earnings for doctors. In a survey of 1,613 prospective practising graduate students,60.8% were willing to change careers, twice the rate of non-medical graduate students. BMJ predicts that by 2035, China will lack at least 200,000 pediatricians, 161,000 general practitioners and 40,000 psychiatrists. The proportion of doctors is low and the workload is low, which leads to job burnout. Factors such as workload cause some medical students to give up medical practice, which seems to be caught in a cycle. In addition to the shortage of doctors, another possible reason for the peculiarity is that Chinese doctors are facing more medical violence. 2. Medical violence in China grew by 11%< em>BMC Health Serv Res published a document in 2020, arguing that violence in public places by healthcare workers has become a global problem. The article especially pointed out that “Chinese doctors are especially serious”, and medical violence in China is increasing year by year. In China, the number of medical staff injured by medical disputes increased from 2,604 in 2002 to 5,519 in 2006 and 17,000 in 2010 people, an increase of about 11% year by year. According to the 2018 survey by the Chinese Medical Doctor Association, more than 60% of medical workers have experienced doctor-patient conflict, and more than 63% of hospitals nationwide have Medical staff, injured, maimed and even killed by disaffected patients and their relatives. The Lancet once issued an article “Chinese doctors are under threat”, calling for an end to violence against Chinese doctors. The article points out that violence may be difficult to end without radical improvements in the economic and social status of doctors. Without ending violence against doctors, the solution to burnout will become a false proposition. 3. More than half of the GPs said their monthly salary was less than 3,000 yuanExcept for some Factors that appear in the practice of medicine, even in the early stages of a physician’s career, may present the hidden danger of burnout. Studies have shown that the burnout of Chinese doctors will sprout from the school days. This stems from the fact that China’s doctor training system is different from other countries. For Chinese doctors, in the past ten years, they have not kept pace with their peers, and they may face a gap between their peers’ high salaries and their own monthly income of less than 1,000 yuan in the regular training period. In 2020, Lilac Garden once conducted a monthly income survey on Pearson.Nearly 30% (27.5%) indicated that every The monthly income is less than 1,000 yuan, 8% of them said that they have “no income” during the training period, and 32.3% of them have a monthly income of more than 3,000 yuan. Among those with a monthly income of more than 3,000 yuan, 50.6% are trained by social training, 44.9% are trained by unit personnel, and only have four certificates in one. 4.4%. In the United States, the annual income of a GP physician is about $63,400, which is much higher than the average annual income of a U.S. resident. 
The source of salary statistics for training doctors: self-made Several factors, such as the small number of doctors, medical violence, the training system, etc., have long been commonplace, but have not been resolved. Falling back to the doctors themselves, the psychological reasons may also hide professional burnout deeper. The Burnout Urgent 1. Burnout is ignored by doctorsMental reasons may be misunderstood as ” Because they are psychologically fragile, they are more prone to burnout.”The opposite is true. Because TAs have strong resilience in the face of difficulties, they will make burnout ignored by themselves. Resilience refers to an individual’s well-adjusted process in the face of adversity, trauma, tragedy, threat, or other major stressful events, that is, an individual’s ability to bounce back in the face of difficult experiences. It has three basic characteristics: the ability to accept and overcome difficulties; the ability to deal with crises; the ability to seek solutions. So, what is the relationship between resilience and burnout? For example, Br J Gen Pract surveyed the resilience of healthcare in China and the United States. The average rating in China is 63, compared with 32 in the United States. During the new crown epidemic, the US dropped to around 29, while Chinese medical care rose to above 70, reflecting the high resilience of Chinese medical care in the face of adversity.
Comparison of Chinese and American medicine Source:Do it yourself
This data does not mean that the burnout of Chinese doctors is lower than that of the United States, but it shows that when adversity strikes, they are highly resilient Let Chinese medical staff survive the darkest moment, thereby covering up the burnout of Chinese doctors. A separate study by Appl Psychol Health Well Being also showed that in the face of severe situations, physician resilience can act as a buffer, protecting individuals from adverse events. influences. As the immediate stressful event subsides, physicians adjust their status through resilience, diluting the emphasis on burnout. High resilience, which is conducive to strengthening teamwork and maintaining normal diagnosis and treatment, but it may not be a good thing for individuals. In order to cope with extremely challenging life circumstances, doctors, May present illusory positivity through avoidance and denial, overcompensating with unrealistic optimism about the future, also known as post-traumatic growth (PTG). Resilience has been shown to be positively correlated with PTG. That is to say, in the face of various difficulties, doctors and nurses experience job burnout. In order to overcome burnout and enhance personal resilience, PTG occurs in the process; through unreal positive emotions to relieve psychological pressure, the initial job burnout is forgotten, ignored, or even unaware. . Of course, even physicians who can identify their burnout may be passively addressing the problem. 2. Only 26% of doctors seek help< span>In a 2020 survey of surgeons, only 26% of physicians sought help when they were experiencing burnout. The main reason is the fear of being known to seek treatment and affecting their practice. 
Factors preventing doctors from seeking help. Source: MedscapeMedcape also investigates barriers. Results show that49% of physicians believe they can handle burnout on their own and would not choose to seek professional help. Most physicians choose to ease their burnout symptoms by listening to music, chatting with family members, and getting more sleep. But alleviation does not cure the underlying problem, and doctors are forced to go back and forth in a cycle of exhaustion and recovery. In addition to the above two internal reasons, in recent years, what is more special is the prevalence of new coronavirus. During this period, the new crown has brought additional psychological pressure to medical staff. 3. COVID-19 brings new pressuresMarch 2020, 2020 A survey of 20,497 healthcare workers in 42 healthcare organizations at three points in October 2021 and March 2021 showed that the levels of stress and burnout among healthcare workers are increasing significantly. high. Over 30% of hospital inpatient staff rated daily stress as “high or very high,” 61% reported “highly fearful,” and 40% admitted to being anxious or depressed non-stop upgradin. Behind the new crown, many factors are troubling medical staff. Int Orthop Listed “fear of infection”, “fear of infecting family members”, “fear of lack of protective equipment”, “worry of patients dying”, “overworked hours” long” and so on. 
Int> factors for Orthop. Source: ReferencesMaterials[1]A doctor from the front line received Front Psychol In the interview, he said that due to insufficient capacity in the early stage of the epidemic, only severe patients were admitted, and the prognosis was very poor. “It seemed okay to talk to the patient at noon, but he died that night, and I couldn’t believe it, and I couldn’t accept it,” another doctor said. “The day after talking to the patient, I brought the patient I got an orange. When I arrived, I found that he had passed away.” Although the current epidemic situation is different from two years ago, as mentioned above, job burnout is a a “long-term” effect. Even after the severity of the epidemic has faded, the burnout left behind will continue to burden healthcare workers for a long time. Each country is implementing measures to alleviate physician burnout and keep healthcare systems functioning properly. Troubleshoot burnout, not just the doctor The subjective and objective factors that lead to job burnout are clearly visible. Accordingly, to alleviate job burnout, start here. The new Physician Law, which will be implemented from March 1, 2022, requires reasonable arrangement of working hours for physicians, the implementation of a paid vacation system, and regular health examination. Actively promoting a three-level diagnosis and treatment system, distributing medical resources across the country, and allowing patients to “do not suffer from serious illnesses” as much as possible, can also reduce the burden on doctors in theory. JAMA released the “Physician Wellbeing Charter” in 2018, which was forwarded by well-known clinics such as Mayo Clinic. The Charter calls for increasing the well-being of doctors and slowing down the pace of their work. The article emphasizes, “Physicians are best equipped to meaningfully connect with and care for patients when they are healthy.” In addition to improving the existing objective environment, another thing is that doctors need to effectively identify whether they are suffering from burnout. Int J Environ Res Public Health A burnout study published in February 2022, citing symptoms of job burnout.
Mild: Affected persons have mild physical symptoms (headache, back pain, low back pain), showed some fatigue, and was in worse condition at the time of surgery.
Moderate: Insomnia, lack of concentration. Apathy, irritability, cynicism, fatigue, boredom, progressive loss of motivation, even depression, incompetence, guilt and powerlessness, emotional exhaustion.
Severe: absenteeism, aversion to work, alcoholism, dependence on psychotropic substances.
Extreme: Extreme withdrawal, aggression, near-death feelings, chronic depression, and suicide attempts.
When the doctor has the above symptoms, be alert to whether you are in occupational burnout, and promptly inform your family, Ask a friend or colleague for help. Another question is, who can the TA turn to when the doctor needs help? Understandably, physicians are unable to communicate negative emotions to colleagues, nor to bring work emotions back to their families; Burnout, and worry about affecting practice because of burnout, can only choose to swallow the emotion silently. During this process, the burden falls on the individual physician. The doctor has been comforting others, but no one can comfort the doctor. There is more than one factor that contributes to burnout, and more than one doctor should be responsible. What role should hospitals, departments, medical schools, and some systems play is still an issue worth exploring.
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Title map Source: Visual China
References:
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[3]Fink-Samnick, Ellen MSW, ACSW, LCSW, CCM, CCTP, CRP, DBH-C Collective Occupational Trauma, Health Care Quality, and Trauma-Informed Leadership, Professional Case Management: May/June 2022 – Volume 27 – Issue 3 – p 107-123 doi: 10.1097/NCM.0000000000000559
[4]Jefferson, Laura et al. “GP wellbeing during the COVID-19 pandemic: a systematic review.” The British journal of general practice : the journal of the Royal College of Gen< span>eral Practitioners vol. 72,718 e325-e333. 28 Apr. 2022, doi:10.3399/BJGP.2021.0680
[5]Dong, L., Meredith, L. S., Farmer, C. M., Ahluwalia, S. C., Chen, P. G., Bouskill, K., Han, B., Qureshi, N., Dalton, S., Watson, P., Schnurr, P. P., Davis, K., Tobin, J. N., Cassells, A., & Gidengil, C. A. (2022). Protecting the mental and physical well-being of frontline health care workers during COVID-19: Study protocol of a cluster randomized controlled trial. Contemporary clinical trials, 117, 106768. Advance online publication. https://doi.org/10.1016/j.cct.2022.106768[6]Jefferson, Laura et al. “GP wellbeing during the COVID-19 pandemic: a systematic review.” The British journal of general practice : the journal of the Royal College of General Practitioners vol. 72,718 e325-e333. 28 Apr. 2022, doi:10.3399/BJGP.2021.068[7]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7460250/[8]Xiao Y, Dong D, Zhang H, Chen P, Li X, Tian Z, Jing Z, Zhang S. Burnout and Well-Being Among Medical Professionals in China: A National Cross-Sectional Study. Front Public Health. 2022 Jan 17;9:761706. doi: 10.3389/fpubh.2021.761706. PMID: 35111713; PMCID: PMC8801677.[9]https://www.medscape.com/slideshow/2022-lifestyle-burnout-6014664#2[10]Fink-Samnick, Ellen MSW, ACSW, LCSW, CCM, CCTP, CRP, DBH-C Collective Occupational Trauma, Health Care Quality, and Trauma-Informed Leadership, Professional Case Management: May/June 2022 – Volume 27 – Issue 3 – p 107-123 doi: 10.1097/NCM.0000000000000559Fink-Samnick, Ellen MSW, ACSW, LCSW, CCM, CCTP, CRP, DBH-C Collecti[11]Dong, L., Meredith, L. S., Farmer, C. M., Ahluwalia, S. C., Chen, P. G., Bouskill, K., Han, B., Qureshi, N., Dalton, S., Watson, P., Schnurr, P. P., Davis, K., Tobin, J. N., Cassells, A., & Gidengil, C. A. (2022). Protecting the mental and physical well-being of frontline health care workers during COVID-19: Study protocol of a cluster randomized controlled trial. Contemporary clinical trials, 117, 106768. Advance online publication. https://doi.org/10.1016/j.cct.2022.106768
