It was a victory to receive the completed questionnaires since the topic deals with a very delicate and personal issue for physicians.
After collecting the return data their specific results will be shown below.
The first question formulated was “In which of the following medical areas do you work?”.
In Brazil, 54 specialties were standardized by CFM Resolution No. 2,149. They are included in clinical, surgical, diagnostic, and other areas (such as Hospital Administration and Auditing). Medical areas with clinical and surgical specialties represent almost the total return of the questionnaire sent, as presented in Figure 1.
The second question formulated was “How many years have passed since your graduation?”. As shown in Figure 2, more than 80% of physicians have more than 10 years of medical degrees, data similar to the survey of the national Medical Census.
Regarding stress factors, the third question was “If tiredness and/or fatigue due to precarious working conditions (which can lead to stress) have been present at some point in your professional life, did these factors interfere with your ethical practices?”. According to Figure 3, positive results were observed in 57.3% of physicians.
The fourth question was “If precarious physical, human, or support structures for the practice of medicine were present at some point in your professional life, did they interfere with your ethical practices?”.
Considering the various challenges imposed by working environments, we can infer that insufficient QWL (such as lack of sleep) can cause distortions in bioethics. Lack of QWL is evident in excessive daily working hours and uninterrupted work. It is estimated that, in Brazil, “89.6% of medical professionals work over 45 hours per week, and 16.65% work more than 80 hours per week”. Similar data were found in Portugal, where “89.7% of physicians who answered the questionnaires work more than 45 hours per week”. Medical decisions require deep attention and careful reasoning. This pressure can lead medical professionals to experience burnout syndrome. Other studies found that about 40 to 60% of physicians have high levels of burnout in any given of their professional career and emergency physicians are most affected, presenting values between 46 and 93%, according to values obtained in several studies phase.
Similar studies found that “47.8% of professionals had a high burnout score”. These findings are consistent with the nation’s largest survey of physicians. An alarming proportion (25%) of physicians up to 35 years of age work more than 80 hours a week, and with 48.5% also working more than three consecutive shifts a week. In addition, only 21.7% of those who work on 24-hour shifts have the next day off. The medical class has an exclusive dedication of 83.7% to medical activities.
Bulgarian healthcare suffers similar challenges. More than 50% of our responding physicians and nurses show moderate-to-high and very-high degree of burnout. Social and economic aspects of the burnout syndrome among medical professionals are reflected in reduced performance, low self-estimation, decreased quality of patient care, and in some cases, lower medical treatment effect. As Mosadeghrad reports in research, stress compromises QWL.
For this study results are presented in Figure 4. Positive results observed in 56% of physicians.
The 2015 Medical Census profiled medical professionals. Analysis of the results showed that physicians’ work was far from ideal. The organizations to which physicians belong “Do not offer an environment that brings to the individual comfort, respect, safety, and well-being, among others. In other words, the organization must provide an environment that is conducive to the use of their capabilities”. Work directly affects the physicians’ lives from a biopsychosocial perspective.
This work aims at presenting the factors that influence quality of working life in organizations. In this way, factors such as equal opportunities, task identity, fair remuneration, feedback, among others, are perceived as important.
In the services area, as the behavioral factor has an important role in several services, quality becomes even more critical. Approaches for HR management, human growth management, motivation, empowerment, endomarketing, among others, are items that must be included in the discussion agenda about service management.
As in other countries, QWL among Brazil’s medical professionals has decreased substantially. Medical events held in Brazil have addressed the theme of burnout syndrome. Among these is the Ordinary General Assembly of the Ibero-American and Caribbean Medical Confederation (Assembleia Geral Ordinária da Confederação Médica Latina-Íbero-Americana e Caribe - Confemel) in Brasilia (Distrito Federal). Arthur Hengerer, Chair of the Federation of State Medical Boards [FSMB] of the United States of America (Conselhos Médicos dos Estados Unidos da América), emphasized and reaffirmed that this phenomenon does not occur only in Brazil. Physicians work increasingly under an enormous bureaucracy. They lack control of their environment which, traditionally, is already chaotic, as found by the Federal Council of Medicine (CFM). There is a lack of respect and equity and many conflicts of values. All this leaves the professionals very exposed, and the stress prevents them from deciding what is best for the patient.
It has been reported that a total of 45.8% of physicians complain of burnout syndrome. Although physicians know the factors that lead to stress in their workplaces, as well as the prevention mechanisms, they are susceptible and, paradoxically, cannot prevent their physical and mental exhaustion. Burnout is especially problematic for individuals who are at the frontline of their professions. The impact of this chronic condition on physicians is particularly important given that their actions are linked to the mortality and morbidity of patients. The medical profession is acutely aware of this problem and many interventions have been developed to ameliorate the antecedents and consequences of burnout.
Physicians’ responsibility for medical care in Brazil became more imposing after the ratification of the 1988 Constitution. The state’s obligation to the population’s health is in Article 196 of the Brazilian Constitution. Accordingly, the commitment to QWL became a critical point in the national health sector.
Regarding the fifth question the text was “If precariousness or lack of administrative action in health services were present at some point in your professional life, did it interfere with your ethical practices?”. The results are presented in Figure 5. Positive results were observed in 55.7% of physicians.
Physicians are continually making significant investments in their professional lives. They face biological risks daily and are constantly subjected to stress and poor working conditions. In addition, their work practice usually disregards the standard of most Brazilian workers' labor laws that respect a 26-hour rest period after 12 hours of uninterrupted work. On November 9, 2009 during the Global Forum of Health Leaders in Taipei, Taiwan, World Medical Association President Dana Hanson spoke about a “silent desperation” among some physicians. “Physicians,” he said, “should not have to choose between saving themselves and serving their patients,” adding that “many physicians were inwardly burning”.
In related research between the provider (physicians) and the Environmental Factors, such as health systems, HR and facilities, indicate that these are fundamentals for obtaining the quality of medical services provided. Physicians seek to overcome organizational shortcomings that interfere with the quality of their care, which are conceptually structured in the physician-patient relationship.
It is evident that there is a direct relationship between good human resource management practices and medical professionals. The most recent (and largest) survey conducted in Brazil, published in the Medical Demography of Brazil 2018, confirmed this notion with the statements of “82% of Brazilian physicians” who agreed that the main health problem in Brazil is poor management of medical services. The QWL of medical professionals influences and determines the quality of physician-patient relationships. “Quality of life” has also been taken over by organizations in general. This concept of quality in service management is also shared by Baathe. Its fundamental idea is that people are more productive when they are satisfied with and involved in their work.
As a reference in this context that does not occur only in Brazil, we mention that even the United States, the largest nation in the world, problems with health management are present, causing many to have no access, and even quality medicine.
Certainly, the lack of quality in the management of medical services compromises and directly affects the quality of the services provided.
Improving QWL by avoiding wear, anxiety, and stress among medical workers can increase productivity in service provision. “We also address why health systems should routinely measure physician wellness as an indicator of health-system quality in view of the growing recognition that suboptimum physician wellness adversely affects system performance”.