Table 2. Details of studies on stress, burnout and quality of work life in ED physicians.
Study
Population (N) and
Instruments
Data
sample (n)
Estryn-Behar et al.
N=
(2011).
physicians
accumulate
more
Strengths and limits
analysis
3196
ED
Copenhagen
Univariate
Burnout was highly prevalent: 51.5%.
Strengths: large sample,
Burnout Inventory;
and
Being female (OR=3.44), not participating in continuing
number of different risk
Work-family
multivariate
education in past 12 months (OR=3.14), work-family
factors, random sample,
n=1924 physicians
conflict
(logistic
conflict (OR=6.14), lack of teamwork (OR=5.44), and worry
multivariate analyses
randomly
Scale; Copenhagen
regression)
about mistakes (OR=1.70) associated with higher risk of
Limitations:
burnout
number
Emergency
physicians
Findings
selected
large
stress factors than
to match the
Psychosocial
other
demographic
Questionnaire;
included to control for
Influence at work
confounding
physicians-
results
French
from
the
SESMAT
study
characteristics
of
of
variables
=
more
France’s
missing data, may have
physician
decreased
power
population
detect
statistically
(538
from
to
significant differences
emergency units)
Popa et al.
N=272 physicians
Maslach
(2010b).
randomly
Inventory
Occupational
from state
selected
COPE
Burnout
(ways
of
Univariate
MBI-HSS means among ED physicians (n=186): EE =25.2,
Strengths:
(correla-
DP=8, PA= 32.8. EE and DP higher in ED group than other
large
tions)
groups.
population,
sample,
relatively
random
high
burnout levels in
hospital
coping with stress);
MBI not correlated with gender, age, or marital status.
response rate.
emergency
EDs
Center for
Strong correlation between EE and professional experience
Limitations:
correlation
Epidemiologic
in EDs: during first 4 years of experience, EE average was
coefficients
not
Studies Depression
21.6, rose to 25.7 after another 3 years. 10.9% of ED
mentioned,
no
Scale (CES-D).
physicians reported higher EE before the 4th year of work
correlations
between
experience, and 17.4% before the 7th year. Coping
coping and burnout, no
mechanisms no different from general population, slight
multivariate
tendency
even though sample size
medicine—a stage
2 nationwide study
n=263
(96,7%
and analysis
response rate)
(186 ED
and
87
Emergency
SMU,
and
Resuscitation
toward
active
coping
and
behavioral
disengagement
would permit it.
ED specialists (mean = 4.51), surgeons (4.35), and general
Strengths:
approach
Services)
Lepnurm
et
al.
N=4958 physicians
13-item measure of
(2009).
(sample stratified
daily
distress
practitioners (4.33) reported highest levels of distress.
large
A measure of daily
to
,including
fatigue
Administrative (3.30), community health (3.35), clinical
stratified sample.
distress
female
specialists
(3.58),
Limitations: number of
anesthesiologists (3.61), psychiatrists (3.68), laboratory
specialists within each
(3.83), procedural (3.84), and radiologists (3.86) reported
practice was small; no
in
practising medicine
overrepresent
specialists,
(physical
and
Univariate
(3.46),
research
specialists
relatively
sample
size,
and physicians in
emotional
smaller
exhaustion)
communities or less
emotional reaction
significantly less distress than the average (4.05).
multivariate
populated
(feelings
For 3 categories reporting highest levels of distress, ED
moderate response rate.
provinces)
frustration,
and
of
physicians and surgeons reported significantly higher
analyses;
callousness,
and
reaction scores than fatigue scores (p < .001). Also true for
n= 2810 physicians
negative affect)
GPs, but difference was not significant. For physicians
(56.7%
(Cronbach
reporting lower than average distress, reaction scores
response
rate) (with 97 ED
fatigue
physicians)
reaction=
alphas:
=
0.75;
significantly lower than fatigue scores.
0.73;
Physicians with clinical and administrative responsibilities
distress measure =
reported highest levels of distress (mean = 4.40), compared
0.82)
with purely clinical physicians (3.94) and clinicianacademics (3.98).
Cydulka & Korte
n=1008
(2008).
60 items concerning
Univariate
In 2004, 65.2% of ED physicians reported high career
Strengths:
physicians
professional
and
satisfaction, 12.7% reported low career satisfaction, 34%
data,
(stratified random
interests, attitudes,
multivariate
reported stress as serious problem in day-to-day work, and
random sampling, very
sample evaluated in
and goals; training,
(logistic
31% reported burnout as serious problem in day-to-day
large
1994,
certification,
regression)
work.
multivariate analyses.
licensing;
Physicians who perceived lack of personal reward from
Limitations: measures; if
Longitudinal Study
professional
work (OR=2.8), believed shift length, number of night shifts
all dropouts represented
of
experience;
(OR=3.6), or colleagues were problematic (OR=3.7), who
dissatisfied
physicians,
reported low energy (OR=3.0) or fatigue (OR=6.0) more
career
satisfaction
likely to report burnout.
possibly
Physicians who considered work exciting (OR=5.0), found
Although
Career
satisfaction
in
emergency
medicine:
the
ABEM
2004)
Emergency
Physicians
ED
1999,
and
and
well-
being and
leisure
activities;
demographics
(no
longitudinal
stratified
and
sample,
overestimated;
data
are
Cronbach
alphas
work
mentioned)
personally
rewarding
(OR=2.8),
with
high
compensation (>300,000$) (OR=4.3), or who were involved
longitudinal, no attempt
to develop causal model.
with clinical teaching and consulting (OR=2.3) more likely
to report high career satisfaction levels.
Lin et al. (2008).
ED
physicians
Job satisfaction of
Univariate
External health policy environments (mean=3.02), and
Strengths:
Physician
(n=208) and nurses
ED physicians (66
and
hospital policies and regulations (mean=2.94) were aspects
random
(n= 234)
items;
Cronbach
multivariate
of job with lowest satisfaction. Highest job satisfaction
multivariate analyses.
alphas:
0.952
(linear
scores related to professional growth and accomplishment
0.806)
and
regression)
(mean=3.77) and medical autonomy (mean=3.75).
Limitations:
sectional design
and
nurse job climates
in
hospital-based
emergency
(random
departments
in
Taiwan:
management
and
implications
selection
to
ED
of 2 physicians and
nurses (69 items;
Being young (=0.027; p<0.01), being an executive
2 nurses in each of
Cronbach alphas:
physician (=-0.382; p<0.05), and working full-time
117
0.950 to 0.708)
(=0.713; p<0.01) predicted poor satisfaction with external
participating
hospital-based EDs)
large
and
sample,
cross-
health policy environments and hospital policies and
regulations. Age (=0.024; p<0.01) and permanent contract
(=0.380; p<0.01) were positive predictors of satisfaction
with medical autonomy.
Lin et al. (2011).
n=448
ED
Leader
The role of leader
physicians
and
behaviors
nurses
in
Behaviors
Univariate
Work satisfaction (m=73.5) was approximately 70/100 after
Strengths: large sample,
(Cronbach alphas:
and
adjustment for personal and employment characteristics.
random
0.84 to 0.88); Unit
multivariate
Leader
multivariate analyses
behaviors
unrelated
to
work
satisfaction,
sample,
hospital-based
(random
selection
performance
emergency
of 2 ED physicians
(Cronbach
alphas:
departmentalization and hospital accreditation level were
equation
related; physicians in medical centers had higher satisfaction
Limitations:
model)
than those in regional hospitals (regression coefficient  =-
sectional design
departments'
unit
and 2 ED nurses in
0.92);
performance
and
each of 112
satisfaction (1item).
work
participating
independently departmentalized ED divisions in hospitals
hospital-based EDs)
had more employee-oriented leader behaviors ( = 0.29, p <
employee
satisfaction
Employee
(structural
cross-
0.34, p < 0.05) or district hospitals ( = -0.49, p < 0.05);
0.05) and greater physician work satisfaction ( =0.21, p <
0.05).
Lin et al.
ED
(2012).
Relationships
of
physicians
Organizational
Univariate
Clan culture positively related to work satisfaction about ED
Strengths: large sample,
(n=208) and nurses
Culture Assessment
and
management (regression coefficient  =0.22, p < 0.01) and
random
(n= 234)
Instrument,
multivariate
hospital policies and regulations ( = 0.28, p < 0.001).
multivariate analysis
employee
(linear
Market culture negatively related to most dimensions of
satisfaction
regression)
emergency physician satisfaction: medical autonomy ( = -
hospital-based
emergency
(random
department culture
of 2 physicians and
(Cronbach
to work satisfaction
2 nurses in each of
0.952–0.806 for ED
and intent to leave
119
physicians, 0.950–
of
participating
0.708
hospital-based EDs)
nurses)
emergency
selection
ED
for
alphas:
0.17, p < 0.05), medical professionalism ( = -0.19, p <
0.05), leadership ( = -0.24, p < 0.01), communication
within ED ( = -0.19, p < 0.05), ED management ( = -0.21,
ED
p < 0.01) and hospital policies and regulations ( = -0.34, p
physicians
and
< 0.001).
nurses
Limitations:
sectional design
sample,
cross-
Escriba-Aguir et al.
N=
(2006).
physicians
Psychosocial work
nurses, members of
Job
environment
the Spanish Society
Questionnaire.
burnout
and
among
945
of
Medicine
and nursing staff
n=639
physicians
response
Maslach
and
Inventory;
Burnout
Content
Emergency
emergency medical
nurses
ED
Univariate
Prevalence of high EE (36.5%), low PA (63.7%) and high
Strengths:
Moderate
and
DP (38.7%).
response rate, random
multivariate
Probability of high EE greater among physicians exposed to
sample,
(logistic
high psychological demands (OR. 4.66), low job control
multivariate analysis
régression)
(OR. 1.65), and low supervisor (OR. 1.64) and co-worker
large
sample,
(OR. 1.54) support. No evidence of negative effect of
Limitations:
ED
physical workload on burnout syndrome. Physicians with
limited to members of
and
low control had low PA (OR. 2.55) and higher risk of EE
Spanish
(67.6%
(OR. 2.28). Probability of presenting high DP greater among
Emergency
rate);
those exposed to high psychological demands (OR. 1.48)
cross-sectional design
random
sample
Society
of
Medicine,
(association at the limit of statistical significance).
sample
Rugless & Taylor
Audit of sick leave
Sick
(2011). Sick leave
of all ED, general
Attitudes
in the emergency
medicine (GM) and
sick
department:
pharmacy in one
Karasek’s
attitudes and the
hospital
Content
impact
n=158
of
staff
job
volunteers
leave
rates;
toward
leave;
Questionnaire.
Job
Univariate
ED physicians generally report healthy psychosocial work
Strengths: high response
conditions
rate
(decision
latitude
=
69.9;
psychological
demands = 35.3; coworker support =12.4; supervisor
support=12.6)
Compared with nurses, ED physicians had significantly
Limitations:
no
multivariate
analyses;
volunteer
sample,
not
designation
and
ED
medical,
psychosocial work
nursing,
conditions
health and ancillary
more job insecurity and supervisor support but less
allied
random
psychological job demands (P < 0.05).
staff
(N=180;
88%
response rate)
Popa et al.
N=4725 emergency
Maslach
(2010).
medical workers
Inventory
Occupational
Burnout
Univariate
Mean level of burnout: 19.9 for EE, 7.05 for DP and 34.4 for
Strengths: large sample;
PA
high response rate.
Percentage of responders who scored moderate to high for
burnout levels in
n=4693 ED workers
EE or DP or moderate to low for PA: 37.75% of ED
Limitations:
no
emergency
(99.32%
physicians
multivariate
analyses,
medicine—a
rate): ED doctors
volunteer
(n=204), ED nurses
random
nationwide
and analysis
study
response
(n=800)
Abbreviations: ED, emergency department; EE, emotional exhaustion; DP, depersonalization; PA, personal accomplishment; OR= Odds ratio
sample,
not