Exploring the impact of rural health system factors on physician burnout: a mixed-methods study in Northern Canada

Abstract

Background Burnout among physicians is a consequence of chronic occupational stresses and emotionally intense work demands. However, much of the evidence exploring burnout is derived from urban settings and may not reflect the work and social contexts of physicians in Indigenous communities or in rural and resource-constrained areas. We sought to characterize health system factors that influence burnout among physicians practicing in the three northern territories of Canada. Methods We conducted a mixed-methods study that included an online survey and qualitative interviews with physicians practicing in Nunavut, Northwest Territories, or Yukon in 2019. The survey adapted content from the Maslach Burnout Inventory. Results were analyzed with logistic regression to assess the association between health system factors and burnout. We conducted in-depth interviews with 14 physicians. Qualitative data was coded and analyzed for themes using the ATLAS.ti software. Results Thirty-nine percent of survey respondents (n = 22/57) showed features associated with burnout. Factors associated with burnout included use of electronic medical records (β = − 0.7, p < .05), inadequate financial remuneration (β = − 1.0, p < .05), and cross-cultural issues (β = − 1.1, p < .05). Qualitative analysis further identified physician perceptions of lack of influence over health system policies, systemic failures in cultural safety, discontinuity of care, administrative burden, and physician turnover as important drivers of burnout. Conclusions Physicians practicing in northern regions in Canada experience stress and burnout related to health system factors and cross-cultural issues. The relationship between cross-cultural issues and burnout has not previously been reported. This work may have implications for physician wellbeing and workforce attrition in other resource-constrained or culturally diverse clinical settings.

WITHDRAWN: Addressing social determinants of health is a priority for managing COVID-19 in Arctic Indigenous communities: results of a scoping review

“…Hansen N, et al, (53) 2021 -Yukon, NWT, and Nunavut -57 physicians -Mixed method using a crosssectional survey and semi-structured interview -Positive experiences among the participants were directly associated with love of work and coworkers' support, and inversely associated with using electronic medical record, insu cient remuneration, and cultural issues.…”

Predictors of compassion satisfaction and compassion fatigue in health care workers providing health and rehabilitation services in rural and remote locations: A scoping review

“…These barriers have been reported previously by practitioners with burnout as having a significant and negative impact on rural health practitioners' mental health, longevity in their role and quality‐of‐service provision for clients. They are therefore of interest as possible predictors of compassion fatigue 39 …”

“…They are therefore of interest as possible predictors of compassion fatigue. 39 By not limiting the search strategy to any type of health care profession, care provision or system, we anticipated the findings would capture the impact of providing rehabilitation health care in schemes such as disability management (including the NDIS), workers' compensation and life insurance case management. 40 However, none of the studies included in this review provided information about health care professionals working in rehabilitation settings in rural and remote locations.…”

Structural determinants of health workforce burnout

“…An exception is a recent study from Northern Canada that link physician burnout to health system and cross-cultural issues. 15…”

“…An exception is a recent study from Northern Canada that link physician burnout to health system and cross-cultural issues. 15 The focus of burnout studies on service-level factors obfuscates potential causal system-level structural determinants that may underlie occupational wellness. A case in point is the current focus in the health sector on the impact of information technology on provider burnout.…”