Hazards of fatigue: learning from aviation

Fatigue can lead to a degradation in mental and physical performance. This increases the risk for error, which can be disastrous in healthcare or aviation. Professionals in these fields are at a greater risk for fatigue as they often work long hours at unnatural times. While the aviation industry has taken active measures to investigate and reduce fatigue through regulations imposed by its governing bodies, recognition of these effects has been slower in the medical field. Doctors are frequently reporting burnout and feel as though they are unable to perform effectively at work. As a consequence, physician retention is at an all-time low. The aviation industry provides a model for changes that need to be made to the healthcare schedules. If these are not implemented, the situation may continue to deteriorate and it is the patients who will ultimately suffer.

A cross-sectional job satisfaction survey of physicians in Bhutan to address the problem of retention

Introduction: A persistent shortage of physicians and relatively high attrition (>10% over 7 years) have been longstanding challenges for Bhutan despite efforts at improvement. Little is known about physicians’ job satisfaction. The study was done to assess level of job satisfaction amongst physicians in Bhutan and identify factors affecting it, thereby be able to better understand factors affecting physician retention. Methods: A national, cross-sectional study on job satisfaction of all Bhutanese physicians was conducted in 2016. Physicians were defined as satisfied if they answered yes to >50% of general survey questions about job satisfaction and and associations between demographic or job characteristics (e.g., married vs. unmarried, clinical vs. non- clinical) and job satisfaction were examined. Physicians were also queried about specific elements of their jobs (e.g., pay, working conditions) and explored associations between demographic or job characteristics and job elements. Results: Of 147 physicians who completed the job survey, 94 (64%) were classified as satisfied. There were significant differences in job satisfaction between married and unmarried physicians (72% vs 49%, p=0·01), specialists and generalists (73% vs 55%, p=0·04), nonclinical and clinical physicians (89% vs 61%, p=0·02), and physicians in referral and district hospitals (75% vs 48%, p <0·01). Across all demographic and job characteristics, salary satisfaction was low (11%). In multivariable analysis, non-clinicians had significantly greater satisfaction than clinicians with salary, annual leave, and work-family balance. Physicians in referral hospitals had significantly greater satisfaction than physicians in district facilities with work hours and working conditions. Conclusion: Survey findings suggest that, although job satisfaction appeared high, improved physician retention may require increased pay, opportunities for promotion to desired settings and job categories, and improved staffing and work conditions in district healthcare facilities.

Physician Retention in the Same State as Residency Training: Data From 1 Michigan GME Institution

ABSTRACT Background In a time of threats to the funding for graduate medical education (GME) and projected physician shortages, drawing attention to the value of physician training programs may be useful. One approach is to study the number and percentage of physicians who enter practice in the state in which they trained. Objective We sought to examine the percentage of graduates from a single Michigan-based GME institution over a 15-year period, who practiced medicine in Michigan during their career. Methods We performed a retrospective review of historical data for all graduates currently in practice, derived from 18 GME training programs from 2000 through 2014. Practice location data were collected and confirmed using multiple sources for accuracy. Results Data were available for 1168 graduates. The average age at the time of graduation was 32.6 ± 4.4 years (mean and standard deviation [SD]), and 60.2% were men (703 of 1168). There were 546 graduates (46.7%) who practiced in Michigan after graduation. Almost 80% of the graduates (279 of 358) who completed medical school and GME in Michigan also practiced in Michigan. Of those, 87.8% (245 of 279) also completed a bachelor's degree in Michigan. Conclusions The findings show that graduates from our GME programs were highly likely to practice in Michigan if they completed their pre-GME education in Michigan.