Emergency physicians accumulate more stress factors than other physicians–results from the French SESMAT study
- M Estryn-Behar1,
- M-A Doppia2,
- K Guetarni1,
- C Fry1,
- G Machet3,
- P Pelloux4,
- I Aune5,
- D Muster6,
- J-M Lassaunière7,
- C Prudhomme8
- 1Department of Occupational Medicine, SCMT, Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
- 2Department of Anaesthesia,CHU, Caen, France
- 3Department of Pharmacy, Hôpital Charles Richet Assistance Publique – Hôpitaux de Paris, Paris, France
- 4Emergency Unit, Hôpital Saint-Antoine Assistance Publique – Hôpitaux de Paris, Paris, France
- 5Emergency Unit, CH, Corbeil-Juvisy, France
- 6Department of Occupational Medicine, Hôpital de Hagueneau, Haguenau, France
- 7Palliative Care Unit, SCMT, Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, 1 Paris, France
- 8Emergency Unit, Hôpital Avicenne, Assistance Publique–Hôpitaux de Paris, Paris, France
- Correspondence to Madeleine Estryn-Behar, SCMT, Hôtel-Dieu, Assistance Publique – Hôpitaux de Paris, Parvis Notre-Dame, 75004 Paris, France;
Contributors MEB conceived the study, designed the study and obtained research funding. MAD and IA supervised the conduct of the study and data collection. KG and CF managed the data, including quality control, and all authors contributed substantially to the revision of the paper. MEB takes responsibility for the paper as a whole.
- Accepted 29 March 2010
- Published Online First 1 December 2010
Introduction France is facing a shortage of available physicians due to a greying population and the lack of a proportional increase in the formation of doctors. Emergency physicians are the medical system's first line of defence.
Methods The authors prepared a comprehensive questionnaire using established scales measuring various aspects of working conditions, satisfaction and health of salaried physicians and pharmacists. It was made available online, and the two major associations of emergency physicians promoted its use. 3196 physicians filled out the questionnaire. Among them were 538 emergency physicians. To avoid bias, 1924 physicians were randomly selected from the total database to match the demographic characteristics of France's physician population: 42.5% women, 57.5% men, 8.2% <35 years old, 33.8% 35–44 years old, 34.5% 45–54 years old and 23.6% ≥55 years old. The distribution of physicians in the 23 administrative regions and by speciality was also precisely taken into account. This representative sample was used to compare subgroups of physicians by speciality.
Results The outcomes indicate that the intent to leave the profession (ITL) was quite prevalent across French physicians and even more so among emergency physicians (17.4% and 21.4% respectively), and burnout was highly prevalent (42.4% and 51.5%, respectively). Among the representative sample and among emergency physicians, work–family conflict (OR=4.47 and OR=6.14, respectively) and quality of teamwork (OR=2.21 and OR=5.44, respectively) were associated with burnout in a multivariate analysis, and these risk factors were more prevalent among emergency physicians than other types. A serious lack of quality of teamwork appears to be associated with a higher risk of ITL (OR=3.92 among the physicians in the representative sample and OR=4.35 among emergency physicians), and burnout doubled the risk of ITL in multivariate analysis.
Conclusions In order to prevent the premature departure of French doctors, it is important to improve work–family balance, working processes through collaboration, multidisciplinary teamwork and to develop team training approaches and ward design to facilitate teamwork.
The content was presented orally at the Conference ‘Doctors' Health Matters’ in London 2008.
Funding The NEXT study was financed by the European Union within the 5° framework. Key action n°6.3: the population and disabilities (QLK6-CT-2001-00475). The extension to physicians (SESMAT study) was financed by Assistance Publique-Hôpitaux de Paris and the regional Council of Ile-de-France and the regional Council of Rhône-Alpes.
Competing interests None.
Ethics approval This study was conducted with the approval of the University of Wuppertal, Wuppertal, Germany.
Provenance and peer review Not commissioned; externally peer reviewed.