Investigation of the relationship between convenient visits and doctors' fatigue using burnout and work engagement scales.

OBJECTIVES: Fatigue caused by high workload is often responsible for the high attrition among doctors, and has contributed to a disruption in community medicine. In order to address this problem, institutional mechanisms at the hospital level are required. Previous studies have shown that systemic measures at the hospital level and a change in the mindset of patients can help manage the problem. "Convenient visits" refer to emergency visits for non-emergency problems. It is an avoidable cause of high workload on doctors. Convenient visits also refer to emergency consultation for non-emergency symptoms. As this is a new phenomenon, its relationship with doctors' fatigue needs further research. We investigated the relationship between convenient visits and doctors' fatigue using burnout and work engagement scales.

METHODS: We selected 44 hospitals, with >200 beds each, in provincial cities of prefectures with a doctor-population ratio lower than the national average. These cities were considered likely to manifest the phenomenon of 24-hour society and include overworked doctors. Ordinance-designated cities were excluded from this study owing to wide population variability. Three doctors from each hospital were randomly selected from among physicians, surgeons, and pediatricians. We distributed questionnaires (a questionnaire concerning convenient visits, Maslach Burnout Inventory-Human Services Survey, and Utrecht Work Engagement Scale) to 132 doctors.

RESULTS: Forty-two doctors responded to the survey. The median proportion of convenient visits among emergency visits was 50%. Sixty percent of the doctors surveyed were annoyed by convenient visits. Other doctors indicated good collaboration between the hospitals and communities or that they were not currently annoyed by convenient visits, although they had been annoyed previously. The emotional exhaustion in doctors, who worked in hospitals that did not restrict convenient visits, was significantly higher than in those who worked in hospitals that restricted these visits. A significant risk of serious burnout was found via crude and multiple logistic regression analysis (adjusted for age and gender, or adjusted for age, gender, clinical department, frequency of work shifts, and sleep duration during work shifts).

CONCLUSION: Doctors working in hospitals that do not protect them against convenient visits are more prone to burnout. Although the number of convenient visitors is increasing, many hospitals lack systemic measures to manage them. This contributes to doctors' burnout. We suggest that hospitals control convenient visits for preventing doctors' burnout. Collaboration between hospitals and communities is required to help alleviate this problem.