Burnout Prevalence and Associated Factors among Family Doctors in Xicheng District of Beijing

doi:10.12114/j.issn.1007-9572.2020.00.537

Abstract

Abstract: Background　Studies show that family doctors are a population at high risk of job burnout. Job burnout may closely related to the quality of contracted services delivered by family doctors as they are the direct provider of medical services. Objective　To investigate the prevalence of job burnout and its associated factors based on analyzing its associations with anxiety and depression in family doctors from community health organizations of Beijingo inicheng District，providing a reference for the development of comprehensive management and countermeasures for job burnout. Methods　From May to July 2019，a questionnaire survey was conducted among family doctors from 15 community health centers and affiliated health stations in Xicheng District，Beijing using the General Demographic Questionnaire，Maslach Burnout Inventory（MBI），Zung Self-Rating Anxiety Scale（SAS） and Zung Self-Rating Depression Scale（SDS）. Spearman correlation analysis was used to analyze the correlation of the dimension scores of SAS and SDS with those of MBI. Multivariate Logistic regression analysis was used to analyze the influencing factors of job burnout. Results　A total of 282 cases attended the survey，and 275 of them（97.5%） responded effectively. The respondents were mostly women （85.5%，235/275），married（86.9%，239/275），with attainment of university education（72.4%，199/275） and intermediate professional title（63.6%，175/275）. The prevalence of job burnout was 56.0%（154/275）. Spearman correlation analysis found that the domain scores of SAS and SDS were significantly correlated with those of MBI. Multivariate analysis revealed that the scores of SAS and SDS were associated with the prevalence of job burnout（P<0.05）. The scores of SAS and SDS were associated with emotional exhaustion（P<0.05）. Factors affecting depersonalization included temperament type，monthly income，number of contracted patients，satisfaction with doctor-patient relationship，and the scores of SAS and SDS（P<0.05）. The SDS score was associated with low personal accomplishment（P<0.05）. Conclusion　The job burnout in family doctors in Xicheng District of Beijing is not optimistic. To reduce job burnout prevalence，attention should be paid to the anxiety and depression prevalence in this group，and interventions should be given to those with these symptoms timely. Moreover，efforts should be made to increase the steadiness of sanguine family doctors. Furthermore，the specified number of contracted patients for a family doctor may be reduced appropriately，and the monthly income for family doctors as well as family doctor-patient relationship should be improved.

Key words: Family doctor, Community health centers, Burnout, Root cause analysis

摘要： 背景　国内外研究表明，家庭医生是职业倦怠高风险人群。家庭医生作为医疗服务的直接提供者，其职业倦怠情况直接关系到签约服务的质量。目的　调查北京市西城区社区卫生服务机构家庭医生的职业倦怠情况，探讨焦虑、抑郁与职业倦怠的关系，分析职业倦怠影响因素，为进一步综合管理及对策的提出提供参考。方法　于2019年5—7月对北京市西城区15家社区卫生服务中心及附属卫生站的家庭医生进行问卷调查，调查内容包括：一般情况调查表、职业倦怠量表（MBI）、焦虑自评量表（SAS）、抑郁自评量表（SDS）。采用Spearman秩相关分析SAS、SDS得分与职业倦怠各维度得分的相关性。采用多因素Logistic回归分析家庭医生职业倦怠的影响因素。结果　共发放问卷282份，回收有效问卷275份，有效回收率为97.5％。本研究中的家庭医生以女性（85.5%，235/275）、已婚（86.9%，239/275）、本科学历（72.4%，199/275）、中级职称（63.6%，175/275）为主。职业倦怠检出率为56.0%（154/275）。Spearman秩相关分析结果显示SAS、SDS得分与职业倦怠各维度得分相关（P<0.05）。多因素Logistic回归分析结果显示SAS、SDS得分是职业倦怠的影响因素（P<0.05）；SAS、SDS得分是情绪衰竭的影响因素（P<0.05）；气质类型、收入水平、签约患者总数、医患关系满意度、SAS得分、SDS得分是去个性化的影响因素（P<0.05）；SDS得分是个人成就感降低的影响因素（P<0.05）。结论　北京市西城区家庭医生职业倦怠情况不容乐观。为了减少职业倦怠应关注和干预家庭医生焦虑、抑郁情绪，注重多血质气质类型者稳定性格的培养，适当减少签约患者人数，提高薪资待遇，并进一步改善医患关系。

关键词: 家庭医生, 社区卫生中心, 职业倦怠, 影响因素分析

LIU Meixing,DING Jing,JI Yan, et al. Burnout Prevalence and Associated Factors among Family Doctors in Xicheng District of Beijing　[J]. Chinese General Practice, 2021, 24(13): 1656-1664. DOI: 10.12114/j.issn.1007-9572.2020.00.537.
刘美星,丁静,季燕等. 北京市西城区家庭医生职业倦怠现状及影响因素研究[J]. 中国全科医学, 2021, 24(13): 1656-1664. DOI: 10.12114/j.issn.1007-9572.2020.00.537.

References

［1］MASLACH C，JACKSON S E．The measurement of experienced burnout［J］．Journal of Occupational Behavior，1981，2（2）：99-113．DOI：10.1002/job.4030020205．
［2］SEGURA O．Burnout：concepts and implications affecting public health［J］．Biomedica，2014，34（4）：535-545．DOI：10.1590/S0120-41572014000400006.
［3］李超平，时勘．分配公平与程序公平对工作倦怠的影响［J］．心理学报，2003，35（5）：677-684．DOI：CNKI:SUN:XLXB.0.2003-05-015．
［4］李永鑫．三种职业人群工作倦怠的比较研究：基于整合的视角［D］．上海：华东师范大学，2005．
［5］陆斯琦．临床医生焦虑、抑郁与其防御方式的关系［J］．中国健康心理学杂志，2018，26（2）：244-247．DOI：10.13342/j.cnki.cjhp.2018.02.022.
［6］蔡景泉，李文秀．北京海淀区基层医务人员职业倦怠现况调查［J］．中国健康心理学杂志，2018，26（1）：82-85．DOI：10.13342/j.cnki.cjhp.2018.01.023．
［7］卢慧敏，黄琦，杨丹丹，等．家庭医生团队职业倦怠现状及影响因素研究［J］．中国全科医学，2019，22（10）：1223-1228．DOI：10.12114/j.issn.1007-9572.2019.10.018.
LU H M，HUANG Q，YANG D D，et al．Family doctor team burnout and influencing factors：a survey［J］．Chinese General Practice，2019，22（10）：1223-1228．DOI：10.12114/j.issn.1007-9572.2019.10.018.
［8］沈琦，刘帅，崔恒清，等．上海市闵行区家庭医生工作压力与职业倦怠状况研究［J］．中国全科医学，2019，22（31）：3815-3818，3829．DOI：10.12114/j.issn.1007-9572.2019.00.439．
SHEN Q，LIU S，CUI H Q，et al．Occupational stress and burnout in family doctors in Minhang District，Shanghai［J］．Chinese General Practice，2019，22（31）：3815-3818，3829．DOI：10.12114/j.issn.1007-9572.2019.00.439．
［9］Medscape national physician burnout，depression & suicide report 2019［EB/OL］．（2019-01-16）［2020-04-12］．http://www.medscape.com/slideshow/2019-lifestyle-burnout-depression-6011056.accessed january16,2019．
［10］GUILLAUME P，ANTOINE G，FANNY M ，et al．Influence of medical shortage on GP burnout：a cross-sectional study［J］．Family Practice，2019，36（3）：291-296．DOI：10.1093/fampra/cmy080.
［11］O'DEA B，O'CONNOR P，LYDON S，et al．Prevalence of burnout among Irish general practitioners：a cross-sectional study［J］．Irish Journal of Medical Science，2016，186（2）：1-7．DOI：10.1007/s11845-016-1407-9.
［12］DREHER A，THEUNE M，KERSTING C，et al．Prevalence of burnout among German general practitioners：comparison of physicians working in solo and group practices［J］．PLoS One，2019，14（2）：e0211223．DOI：10.1371/journal.pone.0211223.
［13］GAN Y，JIANG H，LI L，et al．Prevalence of burnout and associated factors among general practitioners in Hubei，China：a cross-sectional study［J］．BMC Public Health，2019，19（1）：1607．DOI：10.1186/s12889-019-7755-4.
［14］金光辉，陈超，王文季，等．北京市城区全科医生工作内容的非参与观察研究［J］．医学与社会，2018，31（2）：8-10．DOI：10.13723/j.yxysh.2018.02.003.
［15］郑艳玲，余芳，陈艳黎，等．我国全科医生职业倦怠状况及影响因素研究［J］．中国全科医学，2019，22（7）：764-769．DOI：10.12114/j.issn.1007-9572.2019.07.005.
ZHENG Y L，YU F，CHEN Y L，et al．Prevalence and influencing factors for job burnout among general practitioners in China［J］．Chinese General Practice，2019，22（7）：764-769．DOI：10.12114/j.issn.1007-9572.2019.07.005.
［16］TORPPA M A，KUIKKA L，NEVALAINEN M，et al．Emotionally exhausting factors in general practitioners' work［J］．Scandinavian Journal of Primary Health Care，2015，33（3）：178-183．DOI：10.3109/02813432.2015.1067514．
［17］KOSAN Z，ARAS A，CAYIR Y，et al．Burnout among family physicians in Turkey：a comparison of two different primary care systems［J］．Nigerian Journal of Clinical Practice，2019，22（8）：1063-1069．DOI：10.4103/njcp.njcp_355_17.
［18］CAGAN O，GUNAY O．The job satisfaction and burnout levels of primary care health workers in the province of Malatya in Turkey［J］．Pak J Med Sci，2015，31（3）：543-547．
［19］张若冬．气质类型与诊疗疾病［J］．医学与哲学，1985，6（10）：36-37．DOI：CNKI:SUN:YXZX.0.1985-10-014.
［20］李建新．急诊护士职业倦怠气质类型及压力管理的相关性研究［D］．山东：泰山医学院，2012 .
［21］MIYOSHI R，MATSUO H，TAKEDA R，et al．Burnout in Japanese residents and its associations with temperament and character［J］．Asian Journal of Psychiatry，2016，24：5-9．
［22］王毅，程诚，屈冬燕，等．社区女性医护人员职业倦怠情况及其影响因素分析［J］．中国健康心理学杂志，2018，26（4）：569-572．DOI：10.13342/j.cnki.cjhp.2018.04.024.
［23］徐静，周亚夫，葛运运，等．国内外全科医生的覆盖范围及待遇和相应支付方式［J］．中国全科医学，2013，16（24）：2787-2789．DOI：10.3696/j.issn.1007-9572.2013.08.076.
XU J，ZHOU Y F，GE Y Y，et al．Comparison of the general practitioners' coverage，remuneration and related payment methods at home and abroad［J］．Chinese General Practice，2013，16（24）：2787-2789．DOI：10.3696/j.issn.1007-9572.2013.08.076.
［24］FABER D A，JOSHI S，EBELL M H．US residency competitiveness，future salary，and burnout in primary care vs specialty fields［J］．JAMA Internal Medicine，2016，176（10）：1561-1563．DOI：10.1001/jamainternmed.2016.4642.
［25］SHANG X，HUANG Y，BI L，et al．Residents' awareness of family doctor contract services，status of contract with a family doctor，and contract service needs in Zhejiang Province，China：a cross-sectional study［J］．International Journal of Environmental Research & Public Health，2019，16（18）：3312．DOI：10.3390/ijerph16183312.
［26］GARETH I，应美珂．英国医学会称：全科医师接诊时间需保证15分钟［J］．英国医学杂志：中文版，2017，20（12）：682．DOI：10.3760/cma.j.issn.1007-9742.2017.12.104．
［27］WEISMAN C S，NATHANSON C A．Professional satisfaction and client outcomes：a comparative organizational analysis［J］．Medical Care，1985，23（10）：1179-1192．DOI：10.1097/00005650-198510000-00007.
［28］常璇．全科医生工作满意度、职业倦怠与留职意愿的关系研究［D］．济南：山东大学，2015．
［29］YILMAZ A．Burnout，job satisfaction，and anxiety-depression among family physicians：a cross-sectional study［J］．Family Med Prim Care，2018，7（5）：952-956．DOI：10.4103/jfmpc.jfmpc_59_18.
［30］OSBORN M，SATROM J，SCHLENKER A，et al．Physician assistant burnout，job satisfaction，and career flexibility in Minnesota［J］．JAAPA，2019，32（7）：41-47．DOI：10.1097/01.JAA.0000558344.55492.5a．
［31］林渺泉，刘俊荣．医师职业倦怠与其医患关系的相关性研究［J］．广州医科大学学报，2018，46（2）：94-98．DOI：10.3969/j.issn.2095-9664.2018.02.25.
［32］王琪如，谭晓东．工作满意度和职业倦怠对医务人员离职意向的作用分析［J］．中国卫生资源，2019，22（2）：122-126，149．DOI：10.3969/j.issn.1007-953X.2019.02.011.
［33］高文慧，张新庆，李闪闪，等．九省份45家医院临床科室医务人员对医患关系紧张状况的认知分析［J］．东南大学学报（哲学社会科学版），2018，20（4）：124-129，145．DOI：10.3969/j.issn.1671-511X.2018.04.014.
［34］苗京楠，王晓燕，张建，等．医患关系的多种属性探究——基于北京市三级医院的实地研究［J］．中国医学伦理学，2016，29（1）：126-128．
［35］ESLAVA-SCHMALBACH J，NATHALY GARZó-ORJUELA，NATHALIETAMAYO M，et al．Prevalence and factors associated with burnout syndrome in Colombian anesthesiologists［J］．International Journal of Preventive Medicine，2020，11（1）：5．DOI：10.4103/ijpvm.IJPVM_150_18.

［36］JIAWEI Z，YANJIE Y，XIAOHUI Q，et al．Relationship between anxiety and burnout among Chinese physicians：a moderated mediation model［J］．PLoS One，2016，11（8）：e0157013．

［37］苑杰，尚翠华，张苹，等．医生焦虑的影响因素及与工作资源的关系［J］．精神医学杂志，2017，30（4）：258-261．DOI：CNKI:SUN:SDJB.0.2017-04-007.

YUAN J，SHANG C H，ZHANG P，et al．A related study of anxiety and the relationship between anxiety and job resources in physicians［J］．Journal of Psychiatry，2017，30（4）：258-261．DOI：CNKI:SUN:SDJB.0.2017-04-007.

［38］袁媛，陈英，韩海宏，等．医务人员焦虑抑郁现状与工作强度的相关性［J］．中国健康心理学杂志，2019，27（7）：1059-1063．DOI：10.13342/j.cnki.cjhp.2019.07.024.

YUAN Y，CHEN Y，HAN HH，et al．The status of anxiety and depression and their correlation with work intensity in medical staffs［J］．China Journal of Health Psychology，2019，27（7）：1059-1063．DOI：10.13342/j.cnki.cjhp.2019.07.024.

［39］张宁．护士的职业倦怠与抑郁焦虑情绪状况及影响因素［J］．中国卫生产业，2018，15（32）：177-178．DOI：10.16659/j.cnki.1672-5654.2018.32.177.http://www-wanfangdata-com-cn.vpn.ccmu.edu.cn/details/detail.do?_type=perio&id=zgwscy201832082

［40］DING Y W，QU J W，YU X S，WANG S．The mediating effects of burnout on the relationship between anxiety symptoms and occupational stress among community healthcare workers in China：a cross-sectional study［J］．PloS one，2014，9（9）．DOI：10.1371/journal.pone.0107130.

［41］谷景亮，甄天民，高金武，等．山东省基层医生职业倦怠与焦虑现状调查与分析［J］．预防医学情报杂志，2018，34（5）：577-581．DOI：CNKI:SUN:YFYX.0.2018-05-009.

GU J L，ZHEN T M，GAO J W，et al．Investigation and analysis of occupational burnout and anxiety among doctors in primary healthcare institutions in Shandong province［J］．Journal of Preventive Medicine Information，2018，34（5）：577-581．DOI：CNKI:SUN:YFYX.0.2018-05-009.

［42］GOVÊIA C S，CRUZ T T M D，MIRANDA D B D，et al．Association between burnout syndrome and anxiety in residents and anesthesiologists of the Federal District［J］．Revista brasileira de anestesiologia，2018，68（5），442-446．DOI：10.1016/j.bjane.2018.02.006．

［43］刘玉萍，张静，付学丽．肿瘤专科医院护士职业倦怠与抑郁情绪、社会支持的关系研究［J］．护理管理杂志，2014（5）：331-333．

LIU Y P，ZHANG J，FU X L.Research on relationships among job burnout，depression and social support of tumor hospital nurses［J］．Journal of Nursing Administration，2014（5）：331-333．

［44］PAIVA C E，MARTINS B P，PAIVA B R．Doctor，are you healthy? A cross-sectional investigation of oncologist burnout，depression，and anxiety and an investigation of their associated factors［J］．BMC Cancer．2018，18（1）：1044．DOI：10.1186/s12885-018-4964-7.

［45］WURM W，VOGEL K，HOLL A，et al．Depression-burnout overlap in physicians［J］．PLoS One．2016，11（3）：e0149913．DOI：10.1371/journal.pone.0149913.

［46］汤丽霞，王红，张育红，等．心理接纳在护理人员职业倦怠和抑郁之间的调节作用［J］．郑州大学学报（医学版），2018，53（4）：462-466．DOI：10.13705/j.issn.1671-6825.2017.10.063.

TANG L X，WANG H，ZHANG Y H，et al．Moderating effects of psychological acceptance on the relationship between burnout and depression of nurses［J］．Journal of Zhengzhou University（Medical Sciences），2018，53（4）：462-466．

［47］FITZPATRICK O，BIESMA R，RONÁN M CONROY，et al．Prevalence and relationship between burnout and depression in our future doctors：A cross-sectional study in a cohort of preclinical and clinical medical students in Ireland［J］．BMJ Open，2019，9（4）：e023297．DOI：10.1136/bmjopen-2018-023297.

［48］BIANCHI R，SCHONFELD I S，LAURENT E．The trouble with burnout：an update on burnout-depression overlap［J］．The American Journal of Psychiatry，2019，176（1）：79．DOI：10.1176/appi.ajp.2018.18091026.

［49］AHOLA K，HAKANEN J，PERHONIEMI R，et al．Relationship between burnout and depressive symptoms：a study using the person-centred approach［J］．Burnout Research，2014，1（1）：29-37．DOI：10.1016/j.burn.2014.03.003.

［50］BIANCHI R，SCHONFELD I S，LAURENT E．Physician burnout is better conceptualised as depression［J］．Lancet （London，England），2017，389（10077）：1397-1398．DOI：10.1016/S0140-6736（17）30897-8.
［51］EPSTEIN R M，PRIVITERA M R．Physician burnout is better conceptualised as depression-Authors'reply［J］．Lancet （London，England），2017，389（10077）：1398．DOI：10.1016/S0140-6736（17）30898-X.
［52］王伯军，张华，曲永清，等．护士的职业倦怠与抑郁焦虑情绪［J］．中国心理卫生杂志，2013，27（4）：312-313．DOI：10.3969/j.issn.1000-6729.2013.04.017.http://www-wanfangdatacom.cn.vpn.ccmu.edu.cn/details/detail.do?_type=perio&id=zgxlwszz201304017.
［53］宋丽萍，都菁，蔡晶，等．职业倦怠与抑郁的关系及社会支持的调节作用研究［J］．中国全科医学，2018，21（1）：93-97．DOI：10.3969/j.issn.1007-9572.2018.01.020.
SONG L P，DU J，CAI J，et al．Relationship between job burnout and depression in nurses with the moderating effect of social support［J］．Chinese General Practice，2018，21（1）：93-97．DOI：10.3969/j.issn.1007-9572.2018.01.020.

[1]	HU Jieman, TAN Feixiang, YUAN Anxin, CHEN Shiyu, TANG Chulei, YIN Yueheng, BA Lei, XU Qin. Analysis of the Trajectory of Postoperative Frailty and Influencing Factors in Patients with Colorectal Cancer [J]. Chinese General Practice, 2025, 28(26): 3276-3282.
[2]	CHOU Xintong, PENG Hanyu, MA Hui, ZHANG Zhen, SU Xian, QIU Hongyan. Maternal Preferences in Contraceptive Decision-making: an Analysis of Influencing Factors [J]. Chinese General Practice, 2025, 28(26): 3294-3299.
[3]	WEI Jiaohua, PENG Huiru, PENG Jianye, TAN Wenting, HUANG Jine, FANG Li. Expression of the Serum MOTS-c and Its Correlation with Atrial Remodeling in Patients with Atrial Fibrillation [J]. Chinese General Practice, 2025, 28(26): 3271-3276.
[4]	YU Zizi, LIU Duli, LI Ximin, RUAN Chunyi, YIN Xiangyang, CAI Le. Analysis of the Prevalence and Self-management of Hypertension and Its Influencing Factors in Rural [J]. Chinese General Practice, 2025, 28(25): 3137-3143.
[5]	FAN Boyang, ZHANG Yu, SUN Wenning, ZHANG Huifang, WANG Yingjie, ZHANG Ao, ZHAO Yang, WANG Haipeng. Study of Behavioral Intention and Influencing Factors of Integrated Medical and Preventive Care Provided by Grassroots Doctors for Patients with Chronic Diseases [J]. Chinese General Practice, 2025, 28(25): 3144-3150.
[6]	WANG Rupeng, NAN Jing, HU Yiran, YANG Shenghua, JIN Zening. Predictive Value of the Triglyceride-Glucose Body Mass Index for Slow Flow/No-reflow Phenomenon in Patients with Type 2 Diabetes Mellitus and Acute Myocardial Infarction Undergoing Emergency Percutaneous Coronary Intervention [J]. Chinese General Practice, 2025, 28(24): 2985-2992.
[7]	WU Yue, WANG Xuetong, KE Bilian. Evaluation of Vision-related Quality of Life in Myopic Macular Degeneration Patients with Low Vision and Associated Factors [J]. Chinese General Practice, 2025, 28(23): 2908-2914.
[8]	DING Zijun, ZHOU Nannan, LUO Xing, LUO Jieyu, HAO Wenjuan, ZHANG Chunjiang, JIN Xin, ZHAO Dan. Cognitive Impairment in Patients on Maintenance Hemodialysis and Its Influencing Factors: a Multicenter Cross-sectional Study [J]. Chinese General Practice, 2025, 28(23): 2885-2893.
[9]	CHEN Youlan, LAN Yanqi, WU Ahua, ZHANG Haixia, HUANG Jiankang, GUO Zhinan. The Health Management Effect of Contracted Family Doctor Services under the Joint Management of Three Teachers in Xiamen City on Elderly Hypertensive Patients [J]. Chinese General Practice, 2025, 28(22): 2769-2775.
[10]	WEI Xiaoxia, CHEN Nuo, WANG Juanjuan, ZHU Jingfen. The Effects of Depression and Anxiety on Smoking Behavior among Vocational School Students [J]. Chinese General Practice, 2025, 28(22): 2826-2832.
[11]	ZHAO Xiaoqing, GUO Tongtong, ZHANG Xinyi, LI Linhong, ZHANG Ya, JI Lihong, DONG Zhiwei, GAO Qianqian, CAI Weiqing, ZHENG Wengui, JING Qi. Construction and Validation of a Risk Prediction Model for Cognitive Impairment in Community-dwelling Older Adults [J]. Chinese General Practice, 2025, 28(22): 2776-2783.
[12]	HAO Aihua, ZENG Ziying, JIN Aiqiong, TANG Lingling, ZHENG Zique, MA Jingtai, ZHAO Jianguo, ZENG Weilin, XIAO Jianpeng, NIE Hui, YANG Ying. Analysis of Factors Influencing Avoidable Hospitalization for Elderly Hypertensive Patients [J]. Chinese General Practice, 2025, 28(19): 2370-2375.
[13]	JING Tao, DAI Yongmei, LUO Jianying, LUO Wei, JI Yelinfan, PENG Chi, ZHANG Cuijun, CAO Yanjun, ZHENG Qing, HUANG Yu, SHEN Hejun. The Body Mass Index, Dietary Knowledge Acquisition Level, Sedentary Time and Influencing Factors among Chinese High School Students [J]. Chinese General Practice, 2025, 28(16): 2025-2032.
[14]	HUANG Zhijie, MAI Zhihua, WANG Haoxiang, HE Yuming, DENG Qiaoyan, DAI Ranran, ZHOU Zhiheng. Multimorbidity of Hypertension, Diabetes, and Dyslipidemia and Influencing Factors of Family Function among the Elderly [J]. Chinese General Practice, 2025, 28(16): 2001-2010.
[15]	JIN Feng, LI Wangling, XIE Fei. Case Sharing of Closed-loop Management Based on the Prevention and Treatment Platform for Chronic Obstructive Pulmonary Disease [J]. Chinese General Practice, 2025, 28(16): 2059-2064.