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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 30  |  Issue : 3  |  Page : 789-793

Burnout and quality of life among physicians in primary healthcare facilities in Egypt: a cross-sectional study


1 Department of Family Medicine and Community, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Family Medicine, Gizerat El Shier Family Health Center, El Kanater El Kharia, Egypt

Date of Submission14-Aug-2016
Date of Acceptance31-Aug-2016
Date of Web Publication15-Nov-2017

Correspondence Address:
Dalia H Mohamed
Department of Family Medicine, Gizerat El Shier Family Health Center, El Kanater El Kharia, Qalyubia Governorate, 13511
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_442_16

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  Abstract 

Objectives
The aim of this study was to deter mine the prevalence of burnout among physicians in primary healthcare facilities and explore the relationship between perceived quality of life and levels of burnout among the physicians.
Background
Healthcare workers, particularly physicians, are exposed to high levels of stress at work. Burnout syndrome may increase the risk for medical errors and affects the physician's quality of life.
Patients and methods
The study was a cross-sectional one conducted on 76 physicians in El Kanater El Kharia primary healthcare units and centers in Qalyubia Governorate, Egypt. It was conducted during a period of 10 months. All participants were interviewed using Maslach Burnout Inventory and World Health Organizations Quality of Life – Brief Questionnaire.
Results
Approximately 66.7% of the general practitioners (GPs) had high burnout, whereas only 26.7% of specialists had high burnout. Emotional exhaustion was higher in GPs compared with family physicians and specialists. The incidence of emotional exhaustion was 80.7, 75, and 46.7%, respectively. High depersonalization of 89.5% was seen in GPs compared with 50 and 40% in family physicians and specialists, respectively. Approximately two-third of the specialists had high personal accomplishment in comparison with 40.3 and 22% of GPs and family physicians. There was a statistically significant negative correlation between the physical and the psychological domains of the quality of life and the burnout score.
Conclusion
These results viewed the importance of balanced life as a barrier against burnout and its implication on the quality of life.

Keywords: burnout, primary health care , physicians, quality of life


How to cite this article:
Farahat TM, Hegazy NN, Mohamed DH. Burnout and quality of life among physicians in primary healthcare facilities in Egypt: a cross-sectional study. Menoufia Med J 2017;30:789-93

How to cite this URL:
Farahat TM, Hegazy NN, Mohamed DH. Burnout and quality of life among physicians in primary healthcare facilities in Egypt: a cross-sectional study. Menoufia Med J [serial online] 2017 [cited 2019 Nov 18];30:789-93. Available from: http://www.mmj.eg.net/text.asp?2017/30/3/789/218281


  Introduction Top


Burnout is a syndrome seen in people in demanding jobs in which constant demands and intense interactions with people on daily basis happen, such as social workers, teachers, and healthcare professionals [1].

Burnout is a physical, mental, and emotional response to constant high levels of stress and ineffective or inadequate coping methods. It is typically conceptualized as a syndrome characterized by emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA) [2].

Despite the fact that physicians may deal with other people's personal problems all day, they are the least likely to admit that they are under stress themselves. Self-care is not a part of the doctor's professional training and is typically low on their list of priorities [3]. It has been postulated that burnout may harm personal health, family life, and social functions beyond the working environment [4]. It was noted that higher levels of burnout were associated with poor quality of private life. Moreover, the quality of relationships with relatives was also impaired [5]. The conservation of the physician's well-being is vital both as a topic per say and for the contribution that it makes to patient safety and the quality of the medical services given to the patients. It has been associated with negative effects on patient care, including major medical and medication errors, suboptimal care practices, and decreased patient satisfaction with medical care [6].

Despite the relevance of physician well-being to patient care outcomes, little is known about patterns of demographic factors in primary healthcare physicians.

The aim of this study was to determine the prevalence of burnout among physicians in the primary healthcare facilities and explore the relationship between perceived quality of life and levels of burnout among the physicians.


  Patients and Methods Top


The study was a cross-sectional study. The study was conducted in El Kanater El Kharia, Qalyubia Governorate, Egypt, due to its accessibility to the researcher. It lies in Lower Egypt and is located at the apex of the Nile Delta at the location of the Delta Barrages, the first modern irrigation structure across the Nile. It was conducted in the context of time frame of 10 months (starting on the first of August 2014 to the end of May of 2015), with all physicians working in the family health centers and units in El Kanater El Kharia, Qalyubia Governorate, Egypt. It comprises five family health centers and 16 family health units in El Kanater El Kharia.

The study sitting was chosen. Human rights and ethical considerations were followed during the study, with total confidentiality of any obtained data. Menoufia Faculty of Medicine Committee for Medical Research Ethics had reviewed and formally approved the study before it began. Written consent form was taken from the local healthcare authorities in the studied centers as well as from all participants after explaining the aim of the study. A pilot study was conducted on 10 participants. They were interviewed using a semistructured questionnaire with the following sections:

  • First part: The first part includes physician's sociodemographic data to obtain name, age, sex, occupation, marital status, number of children, income, years of experience, and the weekly hours of work
  • Second part: This part includes Arabic valid reliable version of Maslach Burnout Inventory [7]. Twenty-two items of Maslach Burnout Inventory were asked to assess the three domains of burnout syndrome: EE, DP, and PA. The EE subscale assesses the feeling of being emotionally overextended and exhausted by one's work. The DP subscale deals with the impersonal response toward recipients of one's service, care, treatment, or instructions. The PA subscale assesses the feeling of competence and successful achievement in one's work with people. Thereafter, the burnout score was calculated [8]
  • Third part: It encloses an Arabic valid reliable version of World Health Organizations Quality of Life – Brief Questionnaire [9].


The World Health Organizations Quality of Life – Brief Questionnaire instrument comprises 26 items, which measure the following broad domains: physical health, psychological health, social relationships, and environmental health. Each item is rated on five points according to the frequency of occurrence.

All physicians working in the selected area were invited to participate in the study. The registered working number during the period of the study was 83 physicians. Only 13 physicians representing 8.4% of the registered physicians refused to share in the research. The 76 participants were divided into three groups:

  1. General practitioners (GPs), 57 participants, accounting for 75%
  2. Family physicians, four participants, representing 5%
  3. Specialists, 15 participants, representing nearly 20%.


Statistical analysis

Data were collected, tabulated, and statistically analyzed using an IBM personal computer with statistical package for the social science (SPSS, version 20, SPSS Inc., Chicago, Illinois, USA) where the following statistics were applied: (a) descriptive statistics, in which quantitative data were presented in the form of mean ± SD, and range, and qualitative data were presented in the form of numbers and percentages; and (b) analytical statistics, which is used to find out the possible association between studied factors and the targeted disease. The used tests of significance included the χ2 test, the Fischer exact test, the analysis of variance F test, the Kruskal–Wallis test, and Pearson's correlation (r). A P value more than 0.05 was statistically nonsignificant, a P value less than 0.05 statistically significant, and a P value less than 0.001 statistically highly significant.


  Results Top


As regards the burnout subscales in the studied group, it was observed that ~93% of the GPs (132) had high burnout compared with 5 and 2% in family physicians and specialists [Figure 1].
Figure 1: Burnout among the studied groups.

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As regards the sociodemographic data of the studied groups working in the primary healthcare units and centers in El Kanater, nearly half of the studied group constituted female patients. The mean age of the participants was 33.7 years [Table 1].
Table 1: Sociodemographic characteristics of studied group (n=76)

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There was a highly significant difference in EE as regards the number of children, income, and years of experience. EE happens with increasing number of children, low income, and decreased years of experience. EE was higher in GPs and in those with more than three children and lower income [Table 2].
Table 2: Relationship between emotional exhaustion subscales and sociodemographic character of the studied group

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There was a highly significant difference in DP in age, marital state, occupation, income, and years of experience. DP is significantly high in age less than 30 years, married physicians, with more than three children, low income, and decreased years of experience. DP was higher in GPs, with age less than 30 years, married physicians with more than three children, and those with low income and less years of experience [Table 3].
Table 3: Relationship between depersonalization subscales and sociodemographic character of the studied group

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There was a significant difference in PA subscale in occupation. PA was higher in GPs compared with family physicians and specialists [Table 4].
Table 4: Relationship between personal accomplishment burnout subscales and sociodemographic character of the studied group

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The mean score of social relationship domain of quality of life was higher in specialists than in family physicians and GPs. It was 54.8, 45.5, and 42.2%, respectively; the difference was statistically significant [Table 5].
Table 5: Mean and standard deviation of quality of life domains in the studied group (n=76)

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There was a statistically significant negative correlation between the physical domain of quality of life and burnout [Figure 2].
Figure 2: Correlation between burnout and physical domain of quality of life.

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There was a statistically significant negative correlation between the psychological domain of quality of the life and burnout [Figure 3].
Figure 3: Correlation between burnout and psychological domain of quality of life.

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  Discussion Top


The current study had showed that approximately two-thirds of the GPs and half of the family physicians had high burnout. This is in agreement with the study by the European General Practice Research Network Burnout Study Group, which included 1400 family physicians in 12 European countries, that revealed the following: 43% of respondents scored high for EE, 35% for DP, and 32% for low PA, whereas 12% of participants suffered from burnout in all three dimensions [10]. Correspondingly, similar results were found in studies conducted in some Arab countries such as Kuwait and Saudi Arabia [11],[12]. However, a lower rate (162 participants) was recorded in Qatar [13]. The complex nature of providing accessible, continuing, and comprehensive care to patients and their families and managing ethical dilemmas puts family physicians at high risk for depletion of their emotional resources and development of burnout. A significant relation between younger physicians and high DP was identified. Moreover, those having three children or more, lower income, and less than 5 years of experience were associated with EE and DP. This is in agreement with studies conducted in Kuwait and Saudi Arabia [11],[12]. This could be attributed to the need of the young physicians for independence and achieving their goals.

The current work showed that GPs had the lowest social life in comparison with family physicians and specialists. It can be justified that early years of medical practice appear to be the peak time for distress among physicians for identifying proof and collecting money.

High levels of burnout, especially in the EE component, leads to a deterioration in the quality of life both physically and psychologically. This is in accordance with a study performed in Spain and India [4],[14]. Despite different study populations the results were the same, which might be due to the nature of the human being.


  Conclusion and Recommendations Top


Burnout syndrome is a serious phenomenon. It is common among young GPs working at the front line of care access in primary healthcare centers. It disturbs their quality of life. Thus, early recognition of the problem prevents further deterioration of their mental and physical health and more efficient service delivery. Training programs on coping strategies with burnout and work stress are recommended, as a part of continuous medical education that can improve logical analysis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Abdulghafour YA, Bo-hamra AM, Al-Randi MS, Kamel MI, El-Shazly MK. Burnout syndrome among physicians working in primary health care centers in Kuwait. Alex J Med 2011; 47:351–357.  Back to cited text no. 11
    
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Abdulla L, Al-Qahtani DM, Al-Kuwari MG. Prevalence and determinants of burnout syndrome among primary healthcare physicians in Qatar. South African Fam Pract 2014; 53:380–383.  Back to cited text no. 13
    
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Leiter MP, Frank E, Matheson TJ. Demands, values, and burnout relevance for physicians. Can Fam Physician 2009; 55:1224–1225; 1225.e1–6.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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