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From Residency to Retireme nt tells the stories of twenty American doctors over the last half century, which saw a period of continuous, turbulent, and transformative changes to the U.S. health care system. The cohort's experiences are reflective of the generation of physicians who came of age as presidents Carter and Reagan began to focus on costs and benefits of health services. Mizrahi observed and interviewed these physicians in six timeframes ending in 2016. Beginning with medical school in the mid-1970s, these physicians reveal the myriad fluctuations and uncertainties in their professional practice, working conditions, collegial relationships, and patient interactions. In their own words, they provide a \"view from the front lines\" both in academic and community settings. They disclose the satisfactions and strains in coping with macro policies enacted by government and insurance companies over their career trajectory. They describe their residency in internal medicine in a large southern urban medical center as a \"siege mentality\" which lessened as they began their careers, in Getting Rid of Patients , the title of Mizrahi's first book (1986). As these doctors moved on in their professional lives more of their experiences were discussed in terms of dissatisfaction with financial remuneration, emotional gratification, and intellectual fulfillment. Such moments of career frustration, however, were also interspersed with moments of satisfaction at different stages of their medical careers. Particularly revealing was whether they were optimistic about the future at each stage of their career and whether they would recommend a medical career to their children. Mizrahi's subjects also divulge their private feelings of disillusionment and fear of failure given the malpractice epidemic and lawsuits threatened or actually brought against so many doctors. Mizrahi's work, covering almost fifty years, provides rarely viewed insights into the lives of physicians over a professional life span.

From Residency to Retireme nt tells the stories of twenty American doctors over the last half century, which saw a period of continuous, turbulent, and transformative changes to the U.S. health care system. The cohort's experiences are reflective of the generation of physicians who came of age as presidents Carter and Reagan began to focus on costs and benefits of health services. Mizrahi observed and interviewed these physicians in six timeframes ending in 2016. Beginning with medical school in the mid-1970s, these physicians reveal the myriad fluctuations and uncertainties in their professional practice, working conditions, collegial relationships, and patient interactions. In their own words, they provide a \"view from the front lines\" both in academic and community settings. They disclose the satisfactions and strains in coping with macro policies enacted by government and insurance companies over their career trajectory. They describe their residency in internal medicine in a large southern urban medical center as a \"siege mentality\" which lessened as they began their careers, in Getting Rid of Patients , the title of Mizrahi's first book (1986). As these doctors moved on in their professional lives more of their experiences were discussed in terms of dissatisfaction with financial remuneration, emotional gratification, and intellectual fulfillment. Such moments of career frustration, however, were also interspersed with moments of satisfaction at different stages of their medical careers. Particularly revealing was whether they were optimistic about the future at each stage of their career and whether they would recommend a medical career to their children. Mizrahi's subjects also divulge their private feelings of disillusionment and fear of failure given the malpractice epidemic and lawsuits threatened or actually brought against so many doctors. Mizrahi's work, covering almost fifty years, provides rarely viewed insights into the lives of physicians over a professional life span.

This study aimed to measure the prevalence of burnout syndrome, anxiety, depression, and post-traumatic disorders (PTSD), as well as examine their associated factors among Thai healthcare workers (HCWs) during COVID-19 outbreak. We employed a multiple-method design at a tertiary-care hospital in Bangkok between May 22, 2021 and June 30, 2021 by using an online survey. The information included demographic characteristics, work details, perceived support, PTSD symptoms, Maslach Burnout Inventory: General Survey (MBI-GS), General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire (PHQ-2 and PHQ-9), and narrative response to an open-ended question. The associated factors of mental health problems were analysed by multiple logistic regression analyses. The qualitative data were analysed by the content analysis method. A total of 986 HCWs (89.1% female; mean age = 34.89 ± 11.05 years) responded to the survey. 16.3%,16%, and 53.5% of respondents had a high level of emotional exhaustion, depersonalisation, and diminished personal achievement, respectively. 33.1%, 13.8%, and 2.3% of respondents had anxiety, depression, and PTSD. Risk factors of emotional exhaustion were male sex (ORadj = 2.29), nurses (ORadj = 3.04), doctors (ORadj = 4.29), working at COVID-19 inpatient unit (ORadj = 2.97), and working at COVID-19 intensive care unit (ORadj = 3.00). Additionally, preexisting mental illness was associated with anxiety (ORadj = 2.89), depression (ORadj = 3.47), and PTSD (ORadj = 4.06). From qualitative analysis, participants reported that these factors would improve their mental health: supportive and respectful colleagues, appropriate financial compensation, reduced workload, clarity of policy and communication channel, and adequate personal protective equipment. Thai HCWs experienced negative mental health outcomes during the COVID-19 pandemic substantially. This issue needs attention and actions should be implemented to support them.

The coronavirus disease 2019 (COVID-19) pandemic poses a challenge to the physical and mental well-being of doctors worldwide. Countries around the world introduced severe social restrictions, and significant changes to health service provision in the first wave of the pandemic to suppress the spread of the virus and prioritize healthcare for those who contracted it. This study interviewed 48 hospital doctors who worked in Ireland during the first wave of the pandemic and investigated their conceptualizations of their own well-being during that time (March–May 2020). Doctors were interviewed via Zoom™ or telephone. Interview transcripts were analyzed using structured thematic analysis. Five composite narratives are presented which have been crafted to illustrate themes and experiences emerging from the data. This study found that despite the risks of contracting COVID-19, many doctors saw some improvements to their physical well-being in the first wave of the pandemic. However, most also experienced a decline in their mental well-being due to anxiety, emotional exhaustion, guilt, isolation and poor support. These findings shed light on doctor well-being during COVID-19, and the ways in which they have been affected by the pandemic, both professionally and personally. The paper concludes by highlighting how doctors’ work life and well-being can be better supported during and after the COVID-19 pandemic.

Background Good work boosts mental health, self-esteem, and earnings, while physicians are more likely to experience burnout and dissatisfaction with work-life balance, leading to decreased productivity. This study aimed to identify the factors shaping the relationship between medical staff in academic and clinical departments and to describe the overall working environment. Methods The current study was conducted among demonstrators/residents, assistant lecturers, and lecturers from academic and clinical departments of a tertiary care hospital in Cairo, Egypt. Mixed methods were used. For the quantitative part, a comparative cross-sectional study was conducted on 228 clinical and 89 academic participants. The Doctor-Doctor Relationship and Workplace Environment Evaluation Scale (DDRWEE) was computed using 18 statements with a 3-point Likert scale. For the qualitative part, 16 in-depth interviews were conducted with 8 clinical and 8 academic participants. Results The mean age of academic staff was 32.8 ± 4.5 versus 30.9 ± 4.2 for clinical staff. The factors decreasing the DDRWEE Score were being clinical staff, weak scientific advantages from colleagues, weak practical advantages from seniors, weak ethical advantages from seniors, and thinking of resignation or changing career. For the qualitative part, six themes were generated: Factors affecting relations with colleagues both specifically and generally; Reliability of the statement: “When I become a senior, I will treat juniors the same way I was treated”; Causes of strained relationships between colleagues and reflections from personal experiences; Factors that enhance colleague relationships and reflections from personal experiences; Behavior of colleagues in the department when someone faces accountability: and Qualities of an ideal doctor and suggestions for creating a better doctor-to-doctor work environment. Conclusion The study emphasized the importance of creating a supportive academic and professional environment for medical staff, addressing their practical and emotional needs. This research suggests that while the DDRWEE score has good internal validity, external validation is needed for its wider applicability. Limitations The study’s generalizability to Egyptian physicians is limited due to sample convenience, the need for external validation of the DDRWEE score, and potential reporting bias due to the self-administered questionnaire.

Background As the gatekeepers of rural residents’ health, teams of village doctors play a vital role in improving rural residents’ health. However, the high turnover of village doctors, both individually and collectively, threaten the stability of village medical teams. This research evaluated the influence of job satisfaction, resilience, and work engagement on the village doctors’ turnover intention, and explored the mediating role of work engagement and resilience between job satisfaction and the turnover intention of village doctors in China. Methods A quantitative study using a self-administered questionnaire containing mostly structured items was conducted among village doctors with a sample size of 2693 from 1345 rural clinics in Shandong province, China, during May and June 2019. All variables including demographic characteristics, job satisfaction, resilience, work engagement and turnover intention were based on available literature, and measured on a 5- or 6-point Likert scale. Such statistical methods as one-way ANOVA, bivariate correlation, exploratory factor analysis (EFA), and Structural Equation Modelling (SEM) were used. Results Up to 46.9% of the subjects had a higher turnover intention and more than 26.3% of them had a medium turnover intention. The job satisfaction of village doctors could not only have a direct negative effect on turnover intention (β = − 0.37, p  < 0.001), but also have an indirect effect through work engagement (β = − 0.04, = < 0.001). Meanwhile, work engagement also had a direct negative impact on turnover intention (β = − 0.13, p  < 0.001), and resilience had an indirect negative impact on turnover intention through work engagement (β = − 0.09, p  < 0.001). The above results of this study strongly confirmed that job satisfaction, resilience, and work engagement were early, powerful predicators of village doctors’ turnover intention. Conclusion According to the results, the following should be taken seriously to improve job satisfaction: reasonable and fair income, effective promotion mechanism, fair social old-age security, reasonable workload, and strong psychological coping mechanisms for work stress. The turnover intention of village doctors could be reduced through improving job satisfaction, resilience and work engagement.

ObjectiveTo assess job satisfaction for different categories of Norwegian doctors from 2010 to 2016–2017.DesignCross-sectional surveys in 2010, 2012, 2014 and 2016–2017 of partly overlapping samples.SettingNorway from 2010 to 2016–2017.ParticipantsDoctors working in different job positions (hospital doctors, general practitioners (GPs), private practice specialists, doctors in academia). Response rates were 67% (1014/1520) in 2010, 71% (1279/1792) in 2012, 75% (1158/1545) in 2014 and 73% (1604/2195) in 2016–2017. The same 548 doctors responded at all four points in time.Main outcome measureJob Satisfaction Scale (JSS), a 10-item widely used instrument, with scores ranging from 1 (low satisfaction) to 7 (high satisfaction) for each item, and an unweighted mean total sum score.AnalysisGeneral Linear Modelling, controlling for gender and age, and paired t-tests.ResultsFor all doctors, the mean scores of JSS decreased significantly from 5.52 (95% CI 5.42 to 5.61) in 2010 to 5.30 (5.22 to 5.38) in 2016–2017. The decrease was significant for GPs (5.54, 5.43 to 5.65 vs 5.17, 5.07 to 5.28) and hospital doctors (5.14, 5.07 to 5.21 vs 5.00, 4.94 to 5.06). Private practice specialists were most satisfied, followed by GPs and hospital doctors. The difference between the GPs and the private practice specialists increased over time.ConclusionsFrom 2010 to 2016–2017 job satisfaction for Norwegian doctors decreased, but it was still at a relatively high level. Several healthcare reforms and regulations over the last decade and changes in the professional culture may explain some of the reduced satisfaction.

Objective To determine the prevalence of depression and burnout among residents in paediatrics and to establish if a relation exists between these disorders and medication errors.Design Prospective cohort study.Setting Three urban freestanding children’s hospitals in the United States.Participants 123 residents in three paediatric residency programmes.Main outcome measures Prevalence of depression using the Harvard national depression screening day scale, burnout using the Maslach burnout inventory, and rate of medication errors per resident month.Results 24 (20%) of the participating residents met the criteria for depression and 92 (74%) met the criteria for burnout. Active surveillance yielded 45 errors made by participants. Depressed residents made 6.2 times as many medication errors per resident month as residents who were not depressed: 1.55 (95% confidence interval 0.57 to 4.22) compared with 0.25 (0.14 to 0.46, P<0.001). Burnt out residents and non-burnt out residents made similar rates of errors per resident month: 0.45 (0.20 to 0.98) compared with 0.53 (0.21 to 1.33, P=0.2).Conclusions Depression and burnout are major problems among residents in paediatrics. Depressed residents made significantly more medical errors than their non-depressed peers; however, burnout did not seem to correlate with an increased rate of medical errors.

This paper investigates gender issues in Ph.D. entrepreneurship. The empirical analysis is based on data from a questionnaire survey run in 2014–15 in Italy. We analyse how Ph.D. students perceive the institutional entrepreneurial environment, the drivers and the factors hindering entrepreneurship and gender-equality among faculties at the parent institution. We find evidence of a gender bias in Ph.D. entrepreneurship and that the perception about the factors either hampering or supporting entrepreneurship is deeply different between sexes. The academic environment can have a fundamental impact on students’ decisions to start new ventures and on the probability that they will abandon their entrepreneurial intentions. Female student entrepreneurs particularly benefit from the opportunity to engage with a gender-balanced work environment.

PurposeSociety is critically dependent on an adequate supply of hospital doctors to ensure optimal health care. Voluntary turnover amongst hospital doctors is, however, an increasing problem for hospitals. The aim of this study was to systematically review the extant academic literature to obtain a comprehensive understanding of the current knowledge base on hospital doctor turnover and retention. In addition to this, we synthesise the most common methodological approaches used before then offering an agenda to guide future research.Design/methodology/approachAdopting the PRISMA methodology, we conducted a systematic literature search of four databases, namely CINAHL, MEDLINE, PsycINFO and Web of Science.FindingsWe identified 51 papers that empirically examined hospital doctor turnover and retention. Most of these papers were quantitative, cross-sectional studies focussed on meso-level predictors of doctor turnover.Research limitations/implicationsSelection criteria concentrated on doctors who worked in hospitals, which limited knowledge of one area of the healthcare environment. The review could disregard relevant articles, such as those that discuss the turnover and retention of doctors in other specialities, including general practitioners. Additionally, being limited to peer-reviewed published journals eliminates grey literature such as dissertations, reports and case studies, which may bring impactful results.Practical implicationsGlobally, hospital doctor turnover is a prevalent issue that is influenced by a variety of factors. However, a lack of focus on doctors who remain in their job hinders a comprehensive understanding of the issue. Conducting “stay interviews” with doctors could provide valuable insight into what motivates them to remain and what could be done to enhance their work conditions. In addition, hospital management and recruiters should consider aspects of job embeddedness that occur outside of the workplace, such as facilitating connections outside of work. By resolving these concerns, hospitals can retain physicians more effectively and enhance their overall retention efforts.Social implicationsFocussing on the reasons why employees remain with an organisation can have significant social repercussions. When organisations invest in gaining an understanding of what motivates their employees to stay in the job, they are better able to establish a positive work environment that likely to promote employee well-being and job satisfaction. This can result in enhanced job performance, increased productivity and higher employee retention rates, all of which are advantageous to the organisation and its employees.Originality/valueThe review concludes that there has been little consideration of the retention, as opposed to the turnover, of hospital doctors. We argue that more expansive methodological approaches would be useful, with more qualitative approaches likely to be particularly useful. We also call on future researchers to consider focussing further on why doctors remain in posts when so many are leaving.