DOI QR코드

DOI QR Code

Association Between Burnout and Intention to Emigrate in Peruvian health-care Workers

  • Received : 2018.02.03
  • Accepted : 2018.08.13
  • Published : 2019.03.30

Abstract

Background: Emigration of health-care workers is a problem within global health systems which affects many countries, including Peru. Several factors have caused health-care workers to emigrate, including burnout syndrome (BS). This study aims to identify the association between BS and its dimensions with the intention of physicians and nurses to emigrate from Peru in 2014. Methods: A cross-sectional study, based on a secondary analysis of the National Survey of Health Users (ENSUSALUD - 2014) was conducted. Sampling was probabilistic, considering the 24 departments of Peru. We include the questionnaire for physicians and nurses, accounting for 5062 workers. BS was measured by the Maslach Burnout Inventory-Human Services Survey. Adjusted odds ratio (OR) was calculated using multiple logistic regression. Results: Of the study population, 44.1% were physicians, 37.7% males, and 23.1% were working in Lima. It was found that 2.8% [95% confidence interval (CI): 2.19-3.45] of health-care workers had BS. The overall prevalence of intention to emigrate among health-care workers was 7.4% (95% CI: 6.36-8.40). Association was found between BS and intention to emigrate in Peruvian health-care workers (OR = 2.15; 95% CI: 1.05-4.40). Emotional exhaustion was the BS dimension most associated with intention to emigrate (OR = 1.80; 95% CI: 1.16-2.78). Conclusion: Physicians and nurses from Peru who suffered from BS were more likely to have intention to emigrate. Policies should be established to reduce BS as a strategy to control "brain drain" from health-care workers of Peru.

Keywords

References

  1. Dovlo D. Taking more than a fair share? The migration of health professionals from poor to rich countries. PLoS Med 2005;2(5):e109. https://doi.org/10.1371/journal.pmed.0020109.
  2. Pang T, Lansang MA, Haines A. Brain drain and health professionals. BMJ 2002;324(7336):499-500. https://doi.org/10.1136/bmj.324.7336.499.
  3. Lofters AK. The "brain drain" of health care workers: causes, solutions and the example of Jamaica. Can J Public Health 2012;103(5):e376-8. PMID=23617992.001. https://doi.org/10.1007/BF03404445
  4. Mullan F. The metrics of the physician brain drain. N Engl J Med 2005;353(17):1810-8. https://doi.org/10.1056/NEJMsa050004.
  5. Bernardini-Zambrini DA, Garcia Gutierrez JF, Mayta-Tristan P. Migracion de medicos peruanos a Espana, 2005-2009. Rev Peru Med Exp Salud Publica 2011;28:694-5. https://doi.org/10.1590/s1726-46342011000400024.
  6. Aluttis C, Bishaw T, Frank MW. The workforce for health in a globalized context - global shortages and international migration. Glob Health Action 2014;7. https://doi.org/10.3402/gha.v7.23611.
  7. Dywili S, Bonner A, O'Brien L. Why do nurses migrate? - a review of recent literature. J Nurs Manag 2013;21(3):511-20. https://doi.org/10.1111/j.1365-2834.2011.01318.x.
  8. Poppe A, Jirovsky E, Blacklock C, Laxmikanth P, Moosa S, De Maeseneer J, Kutalek R. Why sub-Saharan African health workers migrate to European countries that do not actively recruit: a qualitative study post-migration. Glob Health Action 2014;7:24071. https://doi.org/10.3402/gha.v7.24071.
  9. Opoku ST, Apenteng BA. Seeking greener pastures? The relationship between career satisfaction and the intention to emigrate: a survey of Ghanaian physicians. Int Health 2014;6(3):208-12. https://doi.org/10.1093/inthealth/ihu030.
  10. Stilwell B, Diallo K, Zurn P, Vujicic M, Adams O, Dal Poz M. Migration of health-care workers from developing countries: strategic approaches to its management. Bull World Health Organ 2004;82(8):595-600. Available from: http://www.who.int/bulletin/volumes/82/8/595.pdf.
  11. Xie Z, Wang A, Chen B. Nurse burnout and its association with occupational stress in a cross-sectional study in Shanghai. J Adv Nurs 2011;67(7):1537-46. https://doi.org/10.1111/j.1365-2648.2010.05576.
  12. Davey MM, Cummings G, Newburn-Cook CV, Lo EA. Predictors of nurse absenteeism in hospitals: a systematic review. J Nurs Manag 2009;17(3):312-30. https://doi.org/10.1111/j.1365-2834.2008.00958.x.
  13. Sjogren K, Fochsen G, Josephson M, Lagerstrom M. Reasons for leaving nursing care and improvements needed for considering a return: a study among Swedish nursing personnel. Int J Nurs Stud 2005;42(7):751-8. https://doi.org/10.1016/j.ijnurstu.2004.11.001.
  14. Loubon CO, Salas R, Correa R. Aspectos epidemiologicos del sindrome de burnout en el personal sanitario. Hospital aquilino tejeira. Febrero-marzo 2011. Arch Med 2011;7(2):1-7. https://doi.org/10.3823/072.
  15. Maslach C, Jackson SE, Leiter MP. Maslach burnout inventory manual. Palo Alto: Consulting Psychologists Press; 1996.
  16. Pantenburg B, Luppa M, Konig HH, Riedel-Heller SG. Burnout among young physicians and its association with physicians' wishes to leave: results of a survey in Saxony, Germany. J Occup Med Toxicol 2016;11:2. https://doi.org/10.1186/s12995-016-0091-z.
  17. Schaufeli WB, Leiter MP, Maslach C. Burnout: 35 years of research and practice. Career Dev Int 2009;14(3):204-20.. https://doi.org/10.1108/13620430910966406.
  18. Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Proc 2016 Nov 18. https://doi.org/10.1016/j.mayocp.2016.10.004 pii: S0025-6196(16)30625-5.
  19. Caballero P, Yagui M, Espinoza M, Castilla T, Granados A, Velasquez A, et al. Prioridades regionales y nacionales de investigacion en salud, Peru 2010-2014: un proceso con enfoque participativo y descentralista. Rev Peru Med Exp Salud Publica 2010;27:398-411.. https://doi.org/10.17843/rpmesp.2010.273.1498.
  20. Sotomayor R. Globalizacion y la responsabilidad de los paises en desarrollo: el caso de la migracion de los profesionales de la salud. Rev Peru Med Exp Salud Publica 2007;24:300-6. https://doi.org/10.17843/rpmesp.2007.243.1121.
  21. INEI, SUNASA. Encuesta nacional de satisfaccion de usuarios del aseguramiento universal en el Peru. Lima: Enero. 2014. Available from: http://portales.susalud.gob.pe/documents/11450/31127/01+INFORME+FINAL.pdf/79b9421f-fb3c-4683-a95e-acd644e97ce5.
  22. Grau Martin A, Flichtentrei D, Suner R, Prats M, Braga F. Influence of personal, professional and cross-national factors in burnout syndrome in Hispanic Americans and Spanish health workers (2007). Rev Esp Salud Publica 2009;83(2):215-30. https://doi.org/10.1590/S1135-57272009000200006.
  23. Maticorena-Quevedo J, Beas R, Anduaga-Beramendi A, Mayta-Tristan P. Prevalencia del sindrome de burnout en medicos y enfermeras del Peru, Ensusalud 2014. Rev Peru Med Exp Salud Publica 2016;33(2):1-7. https://doi.org/10.17843/rpmesp.2016.332.2170.
  24. Jennings BM. Advances in patient safety work stress and burnout among nurses: role of the work environment and working conditions. In: Hughes RG, editor. Patient safety and quality: an evidence-based handbook for nurses. Rockville (MD): Agency for Healthcare Research and Quality (US). 2008 [chapter 26]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK2668/.
  25. Gyorffy Z, Girasek E. Workload, work satisfaction and burnout among Hungarian female residents. Results of representative, online survey. Orv Hetil 2014;155(46):1831-40. https://doi.org/10.1556/OH.2014.30038.
  26. Moreno-Jimenez B, Galvez-Herrer M, Rodriguez-Carvajal R, Sanz Vergel AI. A study of physicians' intention to quit: the role of burnout, commitment and difficult doctor-patient interactions. Psicothema 2012;24(2):263-70. Available from: http://www.psicothema.com/PDF/4009.pdf.
  27. Zhang Y, Feng X. The relationship between job satisfaction, burnout, and turnover intention among physicians from urban state-owned medical institutions in Hubei, China: a cross-sectional study. BMC Health Serv Res 2011;11:235. https://doi.org/10.1186/1472-6963-11-235.
  28. El-Jardali F, Dimassi H, Dumit N, Jamal D, Mouro G. A national cross-sectional study on nurses' intent to leave and job satisfaction in Lebanon: implications for policy and practice. BMC Nurs 2009;8(1):1-13. https://doi.org/10.1186/1472-6955-8-3.
  29. Gurkova E, Soosova MS, Harokova S, Ziakova K, Serfelova R, Zamboriova M. Job satisfaction and leaving intentions of Slovak and Czech nurses. Int Nurs Rev 2013;60(1):112-21. https://doi.org/10.1111/j.1466-7657.2012.01030.x.
  30. Lansiquot BA, Tullai-McGuinness S, Madigan E. Turnover intention among hospital-based registered nurses in the Eastern Caribbean. J Nurs Scholarsh 2012 Jun;44 [2016]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22486803.
  31. Arroyo J. Los sistemas descentrados de recursos humanos en salud: el caso del Peru, 1990-2005. Cien Saude Colet 2006;11:1063-72. https://doi.org/10.1590/S1413-81232006000400027.
  32. Ancalli-Calizaya F, Cohaila G, Maquera-Afaray J. Agresiones contra el trabajador de salud en Tacna, Peru. Rev Peru Med Exp Salud Publica 2012;29:415-6. https://doi.org/10.1590/S1726-46342012000300022
  33. Tuya-Figueroa X, Mezones-Holguin E. Violencia contra medicos: un problema por considerar en la investigacion de recursos humanos en salud. Rev Peru Med Exp Salud Publica 2012;29:164-5. https://doi.org/10.1590/S1726-46342012000100034
  34. Heponiemi T, Kouvonen A, Virtanen M, Vanska J, Elovainio M. The prospective effects of workplace violence on physicians’ job satisfaction and turnover intentions: the buffering effect of job control. BMC Health Serv Res 2014;14:19. https://doi.org/10.1186/1472-6963-14-19
  35. George G, Atujuna M, Gow J. Migration of South African health workers: the extent to which financial considerations influence internal flows and external movements. BMC Health Serv Res 2013;13 [2016]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3765273/.
  36. Lee RT, Seo B, Hladkyj S, Lovell BL, Schwartzmann L. Correlates of physician burnout across regions and specialties: a meta-analysis. Hum Resour Health 2013;11 [2016]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3849515/.
  37. Goodman EA, Boss RW. Burnout dimensions and voluntary and involuntary turnover in a health care setting. J Health Hum Serv Admin 1999;21(4):462-71. Available from: http://www.jstor.org/stable/25780924.
  38. Topcu I, Turkmen E, Badir A, Goktepe N, Miral M, Albayrak S, et al. Relationship between nurses' practice environments and nursing outcomes in Turkey. Int Nurs Rev 2016. https://doi.org/10.1111/inr.12247.
  39. Hendel T, Kagan I. Professional image and intention to emigrate among Israeli nurses and nursing students. Nurse Educ Today 2011;31(3):259-62. https://doi.org/10.1016/j.nedt.2010.11.008.
  40. De Silva AP, Liyanage IK, De Silva STGR, Jayawardana MB, Liyanage CK, Karunathilake IM. Migration of Sri Lankan medical specialists. Hum Resour Health 2013;11:21. https://doi.org/10.1186/1478-4491-11-21.
  41. Huaman M, Kamimura K, Medina J, Bustios C, Mini E, Benito M, et al. Caracteristicas laborales del medico joven egresado de la Facultad de Medicina San Fernando. An Fac Med 2007;68(1). https://doi.org/10.15381/anales.v68i1.1235.
  42. Mayta-Tristan P, Dulanto-Pizzorni A. Prevalencia y factores asociados con la intencion de Emigracion en internos de medicina de una universidad publica, Lima 2007. Rev Per Med Exp Salud Publica 2008;25:274-8. https://doi.org/10.17843/rpmesp.2008.253.1276.
  43. Vanasse A, Scott S, Courteau J, Orzanco MG. Canadian family physicians' intentions to migrate Associated factors. Can Fam Physician 2009;55(4):396-397.e6. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2669015/.
  44. Silva SC, Nunes MA, Santana VR, Reis FP, Machado Neto J, Lima SO. Burnout syndrome in professionals of the primary healthcare network in Aracaju, Brazil. Cien Saude Colet 2015;20(10):3011-20. https://doi.org/10.1590/1413-812320152010.19912014.
  45. Eyal N, Hurst SA. Physician brain drain: can nothing be done? Public Health Ethics 2008;1(2):180-92. https://doi.org/10.1093/phe/phn026.
  46. Mayta-Tristan P, Dulanto-Pizzorni A, Miranda JJ. Low wages and brain drain: an alert from Peru. Lancet 2008;371(9624):1577. https://doi.org/10.1016/S0140-6736(08)60685-6.

Cited by

  1. Predictors of Burnout and Depression in Surgeons Practicing in East, Central, and Southern Africa vol.255, 2020, https://doi.org/10.1016/j.jss.2020.04.038