急診醫師疲勞相關因素探討及其對離職意願之影響

Abstract

過去數十年來，國外已有許多研究探討職場疲勞問題，反觀國內研究仍十分不足，本研究利用哥本哈根疲勞量表為疲勞的評估工具，並參照國外的職場疲勞模式，試圖找出急診醫師職場疲勞的相關因素及其對離職意願的影響。 本研究對象為台灣急診醫學會之急診專科醫師，研究方法為橫斷性問卷調查法，共發出問卷840份，回收有效問卷共528份，回收樣本具代表性。本研究發現急診專科醫師以男性居多，年齡集中在30至50 歲之間，每月平均班數介於13至17班之間，計薪方式則以底薪加績效者最多。急診醫師的「工作疲勞」指數平均為57.9，「服務疲勞」指數平均為48.5，明顯高於國內其他行業的受僱者。50歲以上的醫師「工作要求」、「工作疲勞」、「服務疲勞」皆為最低，單身無子女者的「工作疲勞」與「服務疲勞」均高於已婚有子女者，夜班比例為60-80%者的「工作要求」和「服務疲勞」分數較高，計薪方式為無底薪純績效者的「工作疲勞」和「離職意願」較高。醫學中心急診醫師的「工作要求」與「工作疲勞」最高，公立醫院醫師的「工作疲勞」與「離職意願」比私立醫院醫師高。 急診醫師的工作年資與「工作疲勞」、「服務疲勞」、「每月班數」皆呈負相關，「每月班數」則與「工作要求」呈正相關。預測「工作疲勞」的多元迴歸模式中，「醫療糾紛」具有最佳的解釋力，其次為「工作─家庭衝突」、「臨床教學」、「工作參與」、「輪班工作」、「工作保障」、「學習成長」、「年齡」。預測「服務疲勞」的多元迴歸模式中，「臨床教學」具有最佳的解釋力，其次為「醫療糾紛」、「回饋」、「年齡」、「學習成長」、「家庭支持」、「工作保障」。而預測「離職意願」的多元迴歸模式中，「工作疲勞」具有最佳的解釋力，其次為「服務疲勞」、「工作環境」、「工作氣氛」。本研究以相關結果做出具體建議，可做為醫療機構管理者在人力資源管理與職場健康促進之參考。

Objective: To investigate the distribution and correlates of burnout and its impact on turnover intention among emergency physicians in Taiwan. Methods: Questionnaires containing the Chinese version of the Copenhagen Burnout Inventory (C-CBI) were delivered to 840 diplomates of the Taiwan Society of Emergency Medicine (TSEM).Psychological job demands, job resources, work hours, shift length, pay systems, and institutes characteristics were also assessed. Results: Of the 528 physicians returning the questionnaire, most were male of 30 to 50 years old. The mean burnout scores of emergency physicians were much higher than paid employees in Taiwan. Physicians who were single, had 60-80% clinical hours to be night shifts, working in a medical center had higher burnout scores. Those who were remunerated through a performance-based pay without a basic salary, working in public hospitals had not only higher burnout scores but also stronger intention of turnover. Elder physicians had lower level of job demands and burnout. The length of practice is negatively related to burnout and shifts number, and shifts number is positively related to job demands. Litigation concerns, work-home conflicts and academic responsibilities were significantly associated with burnout, while burnout is significantly associated with turnover intention of emergency physicians. Conclusion: This study not only confirms the relatively high level of burnout in emergency physicians but also identified the correlates of burnout and its impact on turnover intention. As a result, it provides directions for human resources management and health promotion strategies in the emergency department.