10.24265/horizmed.2024.v24n2.10
Original Article
Pandemic
burnout and job satisfaction among doctors engaged in the SERUMS program in
Ayacucho
Sebastián Prado-Núñez 1,3,0000-0002-7350-5275
Alfredo Vásquez-Colina 2 0000-0003-2423-4349
1Hospital Nacional
Cayetano Heredia. Lima,
Peru.
2Hospital Nacional
Edgardo Rebagliati Martins.
Lima, Peru.
3Universidad Peruana
de Ciencias Aplicadas (UPC). Lima, Peru.
a. Resident
physician
b. Internal
medicine physician
c. Head of
the Emergency Medicine Department at Clínica Angloamericana
*Corresponding
author
ABSTRACT
Objective: To determine the association between burnout syndrome (BS) and job satisfaction (JS) among doctors engaged in the SERUMS program in Ayacucho in the context of the COVID-19
pandemic.
Materials and methods: An
observational, cross-sectional study was conducted, using both crude and
adjusted models, to determine the association between
BS, evaluated through
the Maslach Burnout
Inventory (MBI), and JS, assessed via the Job Satisfaction
Questionnaire S20/23. The associations were expressed as prevalence ratios (PR)
with their respective 95 % confidence intervals (95 % CI).
Results: Out of the 70 doctors engaged
in the SERUMS program, 77.14 % were aged between
18 and 33 years, 52.86 % were males,
51.43 % had less than one year work experience and 88.57 % worked at a health
center of the Ministry of Health (MINSA). The prevalence
of BS was 45.71 %. The prevalence of JS was as follows: dissatisfaction 30 %, satisfaction 32.86 % and indifference
37.14 %. In the crude analysis, a statistically significant association between BS and
JS was found (PR = 13.5;
95 % CI: 3.08-59.24) and in the analysis adjusted for sex, marital status
and length of work experience, the association between BS and JS remained statistically significant (PR = 14.15; 95 % CI: 3.02-66.32).
Conclusions: BS
is negatively associated with JS, with one in two doctors experiencing BS.
Moreover, there appears to be a higher likelihood of job dissatisfaction among
personnel with BS. This suggests that BS could serve as an indicator in
different management areas and be considered in health management
decision-making. Solving these issues could contribute to improving current
working conditions and, therefore, the healthcare system.
Keywords: Burnout, Psychological; Job Satisfaction; Physicians; Pandemics; COVID-19 (Source: MeSH NLM).
INTRODUCTION
Burnout syndrome (BS) is an indicator of mental and physical exhaustion
resulting from work demands or stress, with a prevalence among healthcare professionals of approximately
15 % in Spain, 14.4 % in Argentina and 7.9 % in Uruguay (1). Some studies report rates as high as 76 % in smaller groups of residents during the pandemic (2). Regarding job satisfaction (JS), research
conducted in a region of Spain shows that
62.6 % of healthcare
professionals are satisfied
with their jobs (3).
Peru is not exempt from the issue of BS. However, statistical
data on the subject remain limited. Studies indicate that
BS affects between 5.6 % (4) and 33.3 % (5) of healthcare professionals. Regarding JS, one region of Peru has reported
medium to high levels. While this places the country at an average level compared to others, it
does not suggest these figures are ideal. Healthcare professionals could
experience higher JS if certain
reversible factors, such as the timely identification and
management of BS, were addressed (6). It should be emphasized that
dissatisfaction resulting from BS can be reversed if recognized early and
managed appropriately, thereby preventing the loss of valuable healthcare
personnel.
The association between BS and JS has been explored
in some studies, revealing a significant and negative relationship between
the two. These studies demonstrate that the higher the level of
BS, the lower the JS among professionals, as evidenced
in non-pandemic contexts. The studied concepts also include the reasons contributing to
dissatisfaction: workload, salary and negative attitudes within the work team (5).
In this regard, it is crucial and necessary to understand
the situation in our country, particularly among primary care personnel
(health posts and centers), who faced
the pandemic with fewer resources compared to those in tertiary and quaternary
care hospitals. In addition, it should be noted that this group already
exhibited moderate levels of BS (7),
which likely impacted their JS.
Thus, we are confronted with a tangible problem that
warrants further study in the current context. Timely measures are needed, focusing
on the association between
BS and JS among primary
care personnel in the department of Ayacucho, particularly
doctors who are consistently exposed to diseases in their work. Consequently,
the decision was made to study doctors engaged
in the SERUMS program in this region, as the results could be
surprising given that they are young professionals with fewer years of experience.
The novelty of this research
lies in the fact that no similar study has been conducted
in our country. In the context of the pandemic, only the verbal
impressions of healthcare personnel are known, but there is no documented evidence
of how primary care doctors experienced BS and JS.
MATERIALS AND METHODS
Study design and population
This is an observational, analytical, cross-sectional and
retrospective study focusing on doctors engaged in the SERUMS program, of both
sexes and of legal age, who practiced medicine in Ayacucho between July 2020
and May 2021.
The sample comprised 70 participants, following a pilot study involving
35 doctors engaged in the SERUMS program.
Participants who did not provide
complete data, failed to answer all the questions or worked in primary
care but were not under the SERUMS program were excluded from the study.
The pilot study revealed that 66.67 % of doctors were
exposed to the outcome (indicating either JS or job dissatisfaction), while 33.33 % were not exposed
(indicating indifference to JS).
The sample size calculation was based on a 1:1 ratio, a 95 % confidence interval (95 % CI) and a
statistical power of 80 %. Consequently, the calculated sample size was 70 participants.
Variables and measurements
Information was collected using a single personal data
sheet. The Maslach Burnout Inventory
(MBI) questionnaire was used to assess BS, while the Job Satisfaction
Questionnaire S20/23 was employed to assess JS. Both the Spanish translation of the MBI and
the administration of these questionnaires among the healthcare personnel were
appropriately validated.
Statistical analysis
Chi-square tests or Fisher’s exact test were used to
evaluate differences between
categorical variables, while Student’s t test or Mann-Whitney U test
were applied for numerical variables, as appropriate. The JS variable was
divided into three categories: indifferent, dissatisfied and
satisfied. Multinomial logistic regression models were constructed to calculate
the crude prevalence ratios (cPR) and adjusted prevalence ratios (aPR),
along with their respective 95 % CI. The adjustment was made with confounding
variables according to epidemiological criteria as reported in other studies.
Ethical considerations
Informed consent was obtained from all the participants,
and confidentiality of the data was ensured.
RESULTS
General characteristics of the participants
A total of 70 doctors engaged in the SERUMS program in
Ayacucho were evaluated. The general characteristics of the respondents
revealed that 52.86 % (37 participants) were males and 77.14 % (54
participants) were aged between 18 and 30 years. The majority were single,
comprising 81.43 % (57 participants). Furthermore, 51.43 % (36 participants) had less than one year work experience and
88.57 % (62 participants) worked
at a health center of the
Ministry of Health (MINSA) (Table
1).
The prevalence of BS was 45.71 % (32 participants).
Regarding JS, 37.14 % (26 participants) were indifferent, 30.00 % (21 participants) were dissatisfied and 32.86 %
(23 participants) were satisfied (Table 1).
Table 1. General characteristics of doctors engaged
in the SERUMS program in Ayacucho
|
Characteristics |
TOTAL (N=70) |
|
|
n |
% |
|
|
Sex |
|
|
|
Female |
33 |
47.14 |
|
Male |
37 |
52.86 |
|
Age (years) |
|
|
|
18–30 |
54 |
77.14 |
|
31–40 |
16 |
22.86 |
|
Marital status |
|
|
|
Single |
57 |
81.43 |
|
Married |
9 |
12.86 |
|
Cohabiting |
4 |
5.71 |
|
Work experience (years) |
|
|
|
< 1 |
36 |
51.43 |
|
1–3 |
25 |
35.71 |
|
> 3 |
9 |
12.86 |
|
Health system |
|
|
|
MINSA |
62 |
88.57 |
|
EsSalud |
6 |
8.57 |
|
National Police of Peru (PNP) and Peruvian Armed
Forces (CCFFAA) |
2 |
2.86 |
|
BS |
|
|
|
No |
38 |
54.29 |
|
Yes |
32 |
45.71 |
|
JS |
|
|
|
Indifferent |
26 |
37.14 |
|
Dissatisfied |
21 |
30 |
|
Satisfied |
23 |
32.86 |
Regarding their workplace, 12 doctors engaged in the SERUMS
program (17.14 %) worked
in La Mar, 11 (15.71 %) in Huamanga,
10 (14.29 %) in Huanta and 8 (11.43 %) in Lucanas, collectively covering
over 50 % of the population
in the region.
The frequency of BS components among the participants was
as follows: 61.43 % (43 participants) for emotional exhaustion, 71.43 % (50 participants) for depersonalization
and 58.57 % (41 participants) for reduced personal accomplishment (Table 2).
Table 2. Frequency of BS components
|
Exposure |
TOTAL
(N = 70) |
||
|
n |
% |
|
|
|
Emotional
exhaustion |
|
|
|
|
No |
27 |
38.57 |
|
|
Yes |
43 |
61.43 |
|
|
Depersonalization |
|
|
|
|
No |
20 |
28.57 |
|
|
Yes |
50 |
71.43 |
|
|
Reduced
personal accomplishment |
|
|
|
|
No |
29 |
41.43 |
|
|
Yes |
41 |
58.57 |
|
Differences were observed
in the level of JS and each of its contributing factors. Overall, being
indifferent stood out (37.14 %). In terms of supervision, the majority reported
being somewhat dissatisfied (28.57 %). Regarding the physical environment, most
participants reported being indifferent (27.14 %). Similarly, in terms of the
benefits received, they also reported being indifferent (32.86 %). As for
intrinsic JS, a predominance of being somewhat dissatisfied (25.71 %) was
observed. Finally, with respect to their level of participation, being
indifferent was the most common response (31.43 %).
Statistically significant differences were
found in JS in relation to the characteristics of the doctors
engaged in the SERUMS program concerning each BS component.
Specifically, 44.19 % experiencing emotional exhaustion, 40 % exhibiting
depersonalization and 48 % with reduced personal accomplishment reported higher
levels of dissatisfaction. No statistically
significant differences were identified
for the other variables (Table 3). It is noteworthy that dissatisfied doctors
engaged in the SERUMS program had a higher prevalence of each BS component
compared to their satisfied and indifferent counterparts.
Table 3. General characteristics of doctors engaged
in the SERUMS program according to the presence
of BS
|
Characteristics |
BS |
|
||||
|
No |
Yes |
p value |
||||
|
n % |
% |
n % |
% |
|
|
|
|
JS |
|
|
|
|
< 0,001* |
|
|
Indifferent |
18 |
47.37 |
8 |
25 |
|
|
|
Dissatisfied |
3 |
7.89 |
18 |
56.25 |
|
|
|
Satisfied |
17 |
44.74 |
6 |
18.75 |
|
|
|
Sex |
|
|
|
|
0.161* |
|
|
Female |
15 |
39.47 |
18 |
56.25 |
|
|
|
Male |
23 |
60.53 |
14 |
43.75 |
|
|
|
Age (years) |
|
|
|
|
0.453* |
|
|
18–30 |
28 |
73.68 |
26 |
81.25 |
|
|
|
31–40 |
10 |
26.32 |
6 |
18.75 |
|
|
|
Marital status |
|
|
|
|
0.808** |
|
|
Single |
30 |
78.95 |
27 |
84.38 |
|
|
|
Married |
5 |
13.16 |
4 |
12.5 |
|
|
|
Cohabiting |
3 |
7.89 |
1 |
3.13 |
|
|
|
Work experience (years) |
|
|
|
|
|
|
|
< 1 |
17 |
44.74 |
19 |
59.37 |
0.527** |
|
|
1–3 |
15 |
39.47 |
10 |
31.25 |
|
|
|
> 3 |
6 |
15.79 |
3 |
9.38 |
|
|
|
Health system |
|
|
|
|
|
|
|
MINSA |
34 |
89.47 |
28 |
87.5 |
0.303** |
|
|
EsSalud |
4 |
10.53 |
2 |
6.25 |
|
|
|
PNP and CCFFAA |
0 |
0 |
2 |
6.25 |
|
|
*Chi-square test.
**Fisher’s exact test.
In relation to the characteristics of the doctors
engaged in the SERUMS program
concerning the level of JS, statistically
significant differences were only found for the presence of
BS.
It was observed that 56.25 % of dissatisfied professionals
had a higher prevalence of BS (Table 4).
Table 4. General characteristics of doctors engaged
in the SERUMS program according
to each BS component
|
Characteristics |
Emotional
exhaustion |
Depersonalization |
Reduced
personal accomplishment |
|
|||||||||||
|
No |
Yes |
p value |
No |
Yes |
p value |
No |
Yes |
p value |
|||||||
|
n |
% |
n |
% |
|
n |
% |
n |
% |
|
n |
% |
n |
% |
|
|
|
JS |
|
|
|
|
0.005* |
|
|
|
|
0.015* |
|
|
|
|
<0.001* |
|
Indifferent |
13 |
48.15 |
13 |
30.23 |
10 |
50 |
16 |
32 |
15 |
51.72 |
11 |
26.83 |
|||
|
Dissatisfied |
2 |
7.41 |
19 |
44.19 |
|
1 |
5 |
20 |
40 |
|
1 |
3.45 |
20 |
48.78 |
|
|
Satisfied |
12 |
44.44 |
11 |
25.58 |
|
9 |
45 |
14 |
28 |
|
13 |
44.83 |
10 |
24.39 |
|
|
Sex |
|
|
|
|
0.067* |
|
|
|
|
0.449* |
|
|
|
|
0.744* |
|
Female |
9 |
33.33 |
24 |
55.81 |
|
8 |
40 |
25 |
50 |
|
13 |
44.83 |
20 |
48.78 |
|
|
Male |
18 |
66.67 |
19 |
44.19 |
|
12 |
60 |
25 |
50 |
|
16 |
55.17 |
21 |
51.22 |
|
|
Age
(years) |
|
|
|
|
0.920* |
|
|
|
|
0.368* |
|
|
|
|
0.171* |
|
18–30 |
21 |
77.78 |
33 |
76.74 |
|
14 |
70 |
40 |
80 |
|
20 |
68.97 |
34 |
82.93 |
|
|
31–40 |
6 |
22.22 |
10 |
23.26 |
|
6 |
30 |
10 |
20 |
|
9 |
31.03 |
7 |
17.07 |
|
|
Marital
status |
|
|
|
|
0.902** |
|
|
|
|
0.168** |
|
|
|
|
0.230** |
|
Single |
22 |
81.49 |
35 |
81.4 |
|
14 |
70 |
43 |
86 |
|
21 |
72.41 |
36 |
87.8 |
|
|
Married |
4 |
14.81 |
5 |
11.62 |
|
5 |
25 |
4 |
8 |
|
5 |
17.24 |
4 |
9.76 |
|
|
Cohabiting |
1 |
3.7 |
3 |
6.98 |
|
1 |
5 |
3 |
6 |
|
3 |
10.34 |
1 |
2.44 |
|
|
Work
experience (years) |
|
|
|
|
0.055* |
|
|
|
|
0.205* |
|
|
|
|
0.973* |
|
< 1 |
9 |
33.33 |
27 |
62.79 |
|
7 |
35 |
29 |
50 |
|
15 |
51.72 |
21 |
51.22 |
|
|
1–3 |
13 |
48.15 |
12 |
27.91 |
|
10 |
50 |
15 |
30 |
|
10 |
34.48 |
15 |
36.59 |
|
|
> 3 |
5 |
18.52 |
4 |
9.3 |
|
3 |
15 |
6 |
12 |
|
4 |
13.79 |
5 |
12.2 |
|
|
Health
system |
|
|
|
|
0.588** |
|
|
|
|
1.000** |
|
|
|
|
0.377** |
|
MINSA |
24 |
88.89 |
38 |
88.37 |
|
18 |
90 |
44 |
88 |
|
25 |
86.21 |
37 |
90.24 |
|
|
EsSalud |
3 |
11.11 |
3 |
6.98 |
|
2 |
10 |
4 |
8 |
|
4 |
13.79 |
2 |
4.88 |
|
|
PNP and
CCFFAA |
0 |
0 |
2 |
4.65 |
|
0 |
0 |
2 |
4 |
|
0 |
0 |
2 |
4.88 |
|
*Chi-square test.
**Fisher’s exact test.
In the crude regression analysis,
an association was found
between job dissatisfaction and the presence
of BS (PR = 13.50,
95 % CI: 3.08-59.24). Likewise, when evaluating this association according to each BS
component, higher prevalence of dissatisfaction was observed for emotional
exhaustion (PR = 9.50, 95 % CI: 1.83-49.33), depersonalization (PR = 12.50, 95 % CI: 1.44-108.19) and
reduced personal accomplishment (PR = 27.27, 95 % CI: 3.16-235.02).
After adjusting for confounding variables such as age, sex, years of work experience and marital
status based on epidemiological
criteria, the association remained statistically significant, with a slight
increase compared to the reference
group (PR = 14.15, 95 % CI: 3.02-66.32). This significance
was also maintained for each BS component: emotional exhaustion (PR = 13.58, 95 % CI: 2.15-85.66),
depersonalization (PR = 11.62, 95 % CI: 1.31-103.26) and reduced personal accomplishment (PR = 36.64, 95 % CI: 3.46-346.96) (Table 5).
Table 5. Association between
BS y level of JS among doctors
engaged in the SERUMS program
|
Exposure |
JS |
|
||||||||||
|
Dissatisfied |
Satisfied |
|
||||||||||
|
Crude
mode |
Adjusted
modela |
Crude
modela |
Adjusted
modela |
|||||||||
|
PR |
95 % CI |
p value |
PR |
95 % CI |
p value |
PR |
95 % CI |
p value |
PR |
95 % CI |
p value |
|
|
BS |
|
|
|
|
|
|
|
|
|
|
|
|
|
No |
Ref. |
--- |
--- |
Ref. |
--- |
--- |
Ref. |
--- |
--- |
Ref. |
--- |
--- |
|
Yes |
13.5 |
3.08-59.24 |
<0.001 |
14.15 |
3.02-66.32 |
0.001 |
0.79 |
0.23-2.77 |
0.718 |
0.88 |
0.24-3.25 |
0.849 |
|
Emotional |
|
|
|
|
|
|
|
|
|
|
|
|
|
exhaustion |
|
|
|
|
|
|
|
|
|
|
|
|
|
No |
Ref. |
--- |
--- |
Ref. |
--- |
--- |
Ref. |
--- |
--- |
Ref. |
--- |
--- |
|
Yes |
9.5 |
1.83-49.33 |
0.007 |
13.58 |
2.15-85.66 |
0.005 |
0.92 |
0.30-2.82 |
0.879 |
1.45 |
0.39-5.27 |
0.576 |
|
Depersonalization |
|
|
|
|
|
|
|
|
|
|
|
|
|
No |
Ref. |
--- |
--- |
Ref. |
--- |
--- |
Ref. |
--- |
--- |
Ref. |
--- |
--- |
|
Yes |
12.5 |
1.44-108.19 |
0.022 |
11.62 |
1.31-103.26 |
0.028 |
0.97 |
0.31-3.07 |
0.962 |
1.02 |
0.30-3.46 |
0.98 |
|
Reduced
personal |
|
|
|
|
|
|
|
|
|
|
|
|
|
accomplishment |
|
|
|
|
|
|
|
|
|
|
|
|
|
No |
Ref. |
--- |
--- |
Ref. |
--- |
--- |
Ref. |
--- |
--- |
Ref. |
--- |
--- |
|
Yes |
27.27 3.16-235.02 0.003 |
36.63 3.46-346.96 0.003 |
1.05 |
0.34-3.26 |
0.934 |
0.82 |
0.24-2.79 |
0.758 |
||||
95 % CI: 95 % confidence interval; PR: prevalence ratio.
a Multinomial logistic
regression model.
b Adjusted by sex, age, marital status
and work experience.
DISCUSSION
The aim of this study was to measure the association
between BS and JS among
doctors engaged in the SERUMS program during the early
years of the COVID-19 pandemic in the department of Ayacucho.
After adjusting for confounding variables, an association was found between BS and JS, with dissatisfied personnel
comprising the most affected group.
The study population faced the pandemic in rural areas of Peru, where logistical support was limited, and vaccines to reduce COVID-19 morbidity and mortality were not yet available.
Our
findings revealed an association between BS and JS, with almost 50 % of the participants experiencing BS, and more than 50 % exhibiting
at least one of its three components. Within BS
parameters, depersonalization emerged as the most prevalent
component, affecting 71 % of the participants. This may be attributed to the heavy workload faced by these doctors at the beginning
of the pandemic.
Previous literature has demonstrated a functional and
negative relationship between BS and JS at both national and international
levels (5);
however, most studies were conducted outside of a pandemic context. Faced with
an extraordinary event like a pandemic, a lack of experience
in managing such a situation was evident. Studies from Japan, Jordan and
Romania (2,8,29) confirm the presence of BS,
with higher prevalence during the pandemic, which aligns with our findings. In
our study, the prevalence of BS was
45.71 %, a significantly higher rate compared to national-level studies in
various samples, which reported prevalence rates ranging from 2.8 % to 33.3 % (5,26).
It is highlighted that, in the context of the pandemic,
overburdened hospitals, low salaries and BS were factors contributing to low JS
(2).
This is evident in the present study, where 30 % of the doctors engaged in the
SERUMS program were dissatisfied, 37.14 % were indifferent and
32.86 % were satisfied with their working
conditions at the time. These
findings indicate a negative correlation with BS, suggesting that
emotional exhaustion, depersonalization and reduced personal
accomplishment significantly impact job perception.
Dissatisfaction could increase the prevalence of BS by 14.15 times (PR = 14.15, 95 % CI: 3.02-66.32), emotional exhaustion by 13.58 times (PR = 13.58,
95 % CI: 2.15-85.66), depersonalization
by 11.62 times (PR = 11.62, 95 % CI: 1.31-103.26) and reduced personal accomplishment by 36.64 times
(PR = 36.64, 95 %
CI: 3.46-346.96). However,
doctors engaged in the SERUMS program experiencing BS and each
of its components may face a higher
risk of increased dissatisfaction. These values
reflect a clear relationship between the study variables, but their temporal ambiguity
prevent us from determining
which precedes the other. Based on the results of the current study,
longitudinal studies are needed to clarify this relationship. Although trends
in previous literature suggest a negative functional relationship, further research
is necessary to draw conclusions about causality.
The hypothesis of the present
study was that the presence of
BS among professionals was related to job dissatisfaction, and this has
been confirmed by the demonstrated association between the two. Additionally, a
higher prevalence of dissatisfaction was observed during the pandemic, which-although
previously studied in hospital settings rather than among doctors
engaged in the SERUMS
program-still reflects an increase in the percentage of affected professionals.
In conclusion, an association was found between BS and JS,
with one out of two doctors engaged in the SERUMS program in Ayacucho presenting this syndrome. Regarding JS, one-third of the doctors
were satisfied, one-third dissatisfied and one-third
indifferent. Additionally, the
prevalence of dissatisfied doctors across the three components of BS was higher
compared to those without BS. Our findings also suggest that doctors engaged in
the SERUMS program in Ayacucho with BS are more likely to experience job dissatisfaction
compared to those without BS. Thus, the prevalence of BS and JS during the pandemic was higher than in non-pandemic
contexts, particularly among doctors engaged in the SERUMS program working
mostly in rural areas.
This information is valuable for health services management,
as reducing the prevalence of these problems
would likely result in more committed
healthcare personnel and lower
the risk of medical errors.
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Author contributions: The
authors were responsible for the collection, analysis and writing of this
article.
Funding sources:
The article was funded by the authors.
Conflicts of interest: The authors declare no conflicts of interest.
*Corresponding author:
Jesús Sebastián Prado Núñez
Address: Calle Droseras 112, Ate. Lima, Perú. Telephone: +51 942782017
Email: jspradon@gmail.com
Reception
date:
December 6, 2022
Evaluation
date:
January 4, 2023
Approval
date:
January 24, 2023