In recent years, a series of major changes related China’s medical system reform have taken place, especially regarding continuous improvement of medical service quality.,  However, considering China’s vast population and its increasing health claims, the country is facing a certain systemic crisis, including an insufficient number of doctors and an imbalanced structure of supply-demand within health services. Inescapably, Chinese doctors are suffering the stressful work conditions characterised by excessive workloads, high occupational stress, effort-reward imbalances, potential health risks, tolerance of customer’s rude behaviour, and so on. Daily, they endure fatigue, frustration, and with patients while providing services ,which increases burnout. To make matters worse, tired doctors can easily trigger further negative outcomes,[2, 5]  such as deterioration of doctor-patient relationships and escalated violence in the health care sector Therefore, it is understandable that professional burnout among doctors has drawn continuous attention among academics and the public worldwide. Similarly, the various adverse effects resulting from doctor burnout also merit constant attention, which raises the question: given these deteriorating professional environments, how do doctors evaluate their own careers given that they are under tremendous stress and experiencing burnout? Particularly for doctors in highly challenging situations, ‘career calling’ can be regarded as a personal resource which provides their lives with meaning, increased resilience, and mechanisms for coping with challenges, further buffering the wider effects of burnout. However, the never-ending series of patient complaints and array of negative emotions triggered by job burnout are likely to reduce doctors’ job satisfaction, organizational commitment, and psychological attachment to the hospital setting, ultimately resulting in lower career expectations and less motivation to pursue a career in medicine. It is interesting to study how burnout affects doctors’ sense of career calling and whether psychological attachment plays a specific role in this relationship. However, the topic of the ‘career calling’ of doctors has received little international academic attention. This means that the more extensive adverse effects of doctor burnout are likely being ignored. Hence, the present study contributes to the literature by demonstrating the correlation between doctor burnout, psychological attachment, and career calling, as well as to verify possibly existing mechanism.
What is ‘Job Burnout’?
‘Job burnout’ is regarded as a psychological syndrome involving chronic emotional and interpersonal stressors referring to individuals’ experiences at work and their subsequent responses to their tasks, organizations, co-workers, clients, and themselves.[9, 10] In the past half century, symptoms of burnout have been confirmed to exist within a wide range of human service professionals, and related research on job burnout has been undertaken extensively by scholars in various fields., A well-known and widely-accepted burnout is Maslach’s three-dimensional model, which includes variables such as emotional exhaustion, depersonalisation, and reduced personal accomplishment. Of these, emotional exhaustion is the core variable and is regarded as a kind of ‘negative’ mindset. The Shirom-Melamed Burnout Measure is also popular among experts and serves as a well-known authority for explaining the issue of job burnout. Pine believes that job burnout is an amalgam of both physical and psychological fatigue caused by long-term emotional deprivation. Shirom and Melamed further define job burnout as a kind of mental state due to an exhaustion of physical, emotional, and cognitive energy. Known as a ‘job killer’, burnout is likely to threaten an individual’s health, obstruct an organization’s performance, and may even cause serious social problems. On the individual level, job burnout can cause serious problems such as headaches, insomnia, reduced work efficiency, impaired concentration, memory deterioration, poor immune system, and so forth. Furthermore, mental health symptoms commonly caused by burnout have been verified and include anxiety, depression, and feelings of inferiority which can lead to an employee’s poor quality of day-to-day working environment and family relationships as well as diminished self-image and happiness. At an organizational level, an individual’s burnout symptoms are prone to influencing their team members, resulting in an overall deterioration of organizational morale and reduced efficiency of organizational operations. A previous study has indicated that burnout may be linked to ‘escapism’ behaviour; for instance, job withdrawal and turnover may increase at significant cost to the organization. Many studies have confirmed that the high prevalence of job burnout is closely related to worsening occupational environments, which, in turn, causes a lack of harmony in interpersonal relationships and more occupational hazards. However, the adverse effects caused by doctor burnout are a growing concern worldwide, and are far broader in scope than the results of this study demonstrate. Hence, further research still needs to be conducted, especially in healthcare setting where the effects of job burnout are potentially life-threatening.
What happens when doctors experience job burnout?
The term ‘burnout’ has taken on a broad meaning that goes far beyond what is understood about it as a diagnosis or syndrome. Therefore, how do we approach the issue of physician burnout in the medical profession? Burnout among doctors is an extensive problem, and their symptoms may not only threaten their health and sleep quality , but also the quality of the medical services that they provide and the well being of their patients, even their very lives, which restricts the advancement of China’s healthcare system reforms. Numerous studies have found that doctor burnout is associated with a higher frequency of medical errors, lower patient satisfaction, longer post-discharge recovery times, and decrease in professional drive, lapses in professionalism, impeded learning, problematic alcohol use, and low job satisfaction. Burnout tends to worsen and change over time, and the issue of doctor burnout is exhibiting an obvious increasing trend. Today, there are still some problems in China’s health care system. To counterbalance what may be seen as dissatisfying reward for their efforts, some doctors are emphasising economic benefit rather than . Even worse, there is a widespread sense that the career calling of doctors is gradually weakening, and the formerly trusting relationships between doctors and patients have been broken, which will be difficult to mend in the short term.[1, 20] An increase in doctors’ unprofessional and unethical behaviour induced by burnout could likely lead to more occurrences of violence towards doctors, which also poses additional difficulties to reforming the healthcare system. The present study continues to focus on the current situation regarding burnout among physicians and its adverse results in the Chinese context in order to make a significant contribution to understanding the phenomenon of doctor burnout.
What is the relationship between career calling, psychological attachment, and doctor burnout?
Career calling is defined as an approach to one’s work in which one is inspired by an ‘external summons’ and provided with a means through which one is able to derive meaning and fulfil positive social functions. Specifically, career calling is related to so-called ‘career spirit; that is, providing services for people, promoting physical and mental harmony, and improving people’s quality of life. Vital research has found that career calling is linked to work effort, dedication, and well-being. A sense of career calling is particularly important for doctors in highly challenging situations. Consequently, a correct and profound understanding of the medical profession is a necessary component of a career calling for any doctor.[10, 23] While there has already been much scholarly discussion about career calling, these studies have mostly focused on understanding its core concepts. There has been little research into the association between the career calling and burnout of doctors. In China, where these issues are particularly problematic, questions of falling career calling and increased burnout are grossly neglected by academics and not reflected in systemic health care reforms. There is no doubt that it is essential to monitor these issues as they unfold and explore the relationship between doctors’ career calling and burnout in depth.
Doctors exhibit reduced enthusiasm for their work due to emotional exhaustion, a decline in professional meaningfulness, job satisfaction, and organizational identification. When doctors are treated unfairly, their enthusiasm diminishes with in-role weakening and extra-role decreasing, resulting a loss of psychological attachment to their organization. ‘That special attachment’, as Hirschman calls the loyalty psychologists term ‘effective commitment—is an ‘employee’s emotional attachment to, identification with, and involvement in the organization.[28, 29] Doctors with high levels of attachment are prone to identifying with their career goals and values as well as a sense of pride regarding their profession; thus, they tend to undertake behaviour which extend beyond the job’s in-role requirements. Therefore, we can assume that, if the degree of a doctor’s psychological attachment decreases, his or her acceptance of and emotional dependence on his or her sense of career calling (i.e., the reason he or she became a doctor in the first place) would diminish. However, previous studies have revealed that attachment plays a mediating role in many relationships. Only a few studies have explored the notion that psychological attachment may mediate the relationship between job burnout and career calling among doctors. To remedy this gap in the literature, in this study, we examined psychological attachment using a function mechanism to test the mediating effect of psychological attachment. More importantly, the findings of this study contribute to new evidence increasingly revealing the adverse effects caused by the job burnout of Chinese doctors, specifically, negative effects on psychological attachment and career calling.
What are the objectives of this study?
This study comprehensively investigated the following research questions: (1) how prevalent is burnout syndrome among doctors, and what differences in demographic factors can be established? (2) What is the relationship between job burnout, psychological attachment, and career calling? (3) How does job burnout threaten doctors’ career calling and does psychological attachment play a specific role in the relationship between burnout and career calling?