Reproductive health and burn-out among female physicians: nationwide, representative study from Hungary

BACKGROUND: There is a worldwide rising tendency of women deciding to become physicians; hence, one of the most remarkable fields of investigation is the wellbeing of female doctors. The aim of this study was to describe female physicians' reproductive health in Hungary and to explore the potential correlation between their reproductive disorders and burnout symptoms. Up to our present knowledge, there have not been any studies investigating the correlation between reproductive disorders and burnout of female physicians; therefore, our study represents a unique approach. METHODS: Data in this representative cross-sectional epidemiological study were obtained from online questionnaires completed by 3039 female physicians. Participants in a representative nationwide survey (Hungarostudy, 2013) served as controls (n = 1069). Differences between physicians and the control group were disclosed by chi-square test. Correlations between certain factors of reproductive health and the three dimensions of burnout were detected by Pearson correlations and X2 test. Binary logistic regression analysis was used to determine the association between burnout and reproductive health. RESULTS: Female physicians were more often characterised by time-to-pregnancy interval longer than one year (18.4% vs. 9.8%), were bearing more high-risk pregnancies (26.3% vs.16.3%), and were more likely to be undergoing infertility therapy (8.5% vs. 3.4%) and experiencing miscarriage (20.8% vs. 14.6%) during their reproductive years, compared with the general female population. With the exception of miscarriages, the difference remained significant in all comparisons with the professional control group. Both high-risk pregnancies and miscarriages of doctors were associated with depersonalisation (p = 0.028 and p = 0.012 respectively) and personal accomplishment (p = 0.016 and p = 0.008 respectively) dimensions of burnout. Results of the multivariate analysis showed that, beside traditional risk factors, depersonalisation acted as an important explanatory factor in case of high-risk pregnancies (OR = 1.086). CONCLUSIONS: There is a circulatory causality between burnout and the development of reproductive disorders. Burnout is an important risk factor for high-risk pregnancies and miscarriages, and it has a negative effect on the outcome of pregnancies. At the same time, women suffering from reproductive disorders are more likely to develop burnout syndrome. Improvement of working conditions and prevention of burnout in female doctors are equally important tasks

Work-load, burnout and mental health of dual-doctor couplesl: Depersonalization as a coping mechanism?

Background: In line with the feminization of medicine the rate of dual-doctor couples among physicians has increased. The aim of this study is to describe the impact of the special stress-load related to medical profession on the members of these couples. Methods: Data in this representative cross-sectional epidemiological study were obtained from online questionnaires completed by 5,607 Hungarian physicians. In the quantitative analysis data of those who lived in a partner relationship were processed: 1,549 physicians with a physician partner versus 3,095 physicians with a non-physician partner. In our descriptive analysis we compared the amount of work-load (number of working hours, workplaces and night shifts), leisure time, and time spent on housework in the two groups. We also analyzed certain indicators of mental health (sleep disorders, signs of depression, psychosomatic symptoms, and perceived stress) and the presence of burnout and role conflict. Results: There was no difference in the amount of workload between the two groups. No differences were detected in case of mental health indicators either; however, medium and high level of depersonalization and high level of role conflict was more prevalent among doctors with physician partner. Multivariate analysis demonstrated that having a physician partner was an important risk factor of depersonalization. Conclusions: Developing depersonalization might be a response on the 'double' emotional burden that affects doctors who live in a dual-career partner relationship. Higher prevalence of burnout among dual-physician couples draws the attention to the need for prevention and intervention

Császármetszés anyai kérésre – ahogyan a délkelet-magyarországi szülész-nőgyógyászok látják | Cesarean delivery on maternal request: survey among obstetricians/gynecologists in south-east Hungary

Bevezetés: A császármetszés gyakoriságának növekedése hátterében az anyai kérésre végzett császármetszések szerepe is felmerült, annak ellenére, hogy nincs olyan hivatalos indikáció, amely alapján ilyen beavatkozás legálisan elvégezhető lenne. Ezért lehetetlen megbecsülni, hogy milyen mértékben járulnak hozzá az anyai kérésre végzett beavatkozások a császármetszés növekvő gyakoriságához. Célkitűzés: A szerzők a délkelet-magyarországi szülész-nőgyógyászok anyai kérésre végzett császármetszéssel kapcsolatos attitűdjének feltérképezését tűzték ki célul. Módszer: 2010 elején anonim kérdőíveket juttattak el a Bács-Kiskun, Békés és Csongrád megyei szülészeti intézményekben dolgozó 137 szülész-nőgyógyászhoz. A válaszadási arány 74,5% (n = 102) volt. Eredmények: A válaszadók több mint fele elutasította annak elméleti lehetőségét, hogy hazánkban legálissá váljon a megalapozott orvosi indikáció hiányában, pusztán az anya kérésére végzett császármetszés gyakorlata. Amennyiben azonban a törvényi szabályozás erre lehetőséget teremtene, 81 (79,4%) szülészorvos elvégezné a beavatkozást. Következtetések: A szülész-nőgyógyászok több mint felének elutasító véleménye ellentétben áll a feltételes hajlandósággal, amelyet többségük mutat a legális körülmények között elvégezhető, orvosi indikációval nem alátámasztott császármetszésekkel kapcsolatban. Orv. Hetil., 2013, 154, 1303–1311. | Introduction: increased frequency of maternal request for cesarean delivery may be a contributing factor to the rising cesarean section rate in Hungary, although there is no formal indication that would allow Hungarian obstetricians to perform this procedure legally. Thus, it is difficult to estimate the role of maternal request in the rising cesarean rate. Aim: The aim of the authors was to assess the attitudes of obstetricians toward this procedure. Method: In early 2010 anonymous questionnaires were distributed to each of the 137 obstetricians working in the maternity wards of counties Bács-Kiskun, Békés and Csongrád, with a response rate of 74.5% (n = 102). Results: More than half of the respondents refused the possibility of a legalized indication for this procedure in Hungary; however, in case it was legalized, 81 (79.4%) obstetricians would feel ready to perform it. Conclusions: The resistance of more than half of the obstetricians to an explicit indication for the procedure is in conflict with the theoretical willingness of the majority of them to perform it. Orv. Hetil., 2013, 154, 1303–1311

Non-medical determinants of cesarean section in a medically dominated maternity system

Objective: To assess the contribution of non-medical factors to actual mode of delivery in a setting with high cesarean rates. Design: Follow-up survey. Setting: University department of obstetrics and gynecology. Sample: Women with singleton pregnancies (n = 453) where there was no awareness of medical contradictions to vaginal delivery, attending for routine mid-pregnancy ultrasound examination in November 2011 to March 2012, and delivering between March and August 2012. Methods: Structured questionnaire completed in gestational weeks 18-22. Information on subsequent delivery was obtained from patient files and through personal contact. Main outcome measures: Contribution of childbirth preference, Wijma Delivery Expectancy/Experience Questionnaire A score, socio-demographic characteristics, attitudes toward birth issues and circumstances of pregnancy/delivery to mode of delivery. Results: The majority of respondents (410/453; 90.5%) preferred vaginal delivery; nevertheless, one-third (two-fifths of nulliparas) had a cesarean delivery. Among nulliparous respondents, a longer perceived interval from decision for pregnancy to conception, lower importance assigned to personal control, and the presence of an obstetrician with power to decide about cesarean delivery, were independent contributors to the binary logistic regression model explaining higher maternal cesarean risks. For parous respondents, corresponding factors were younger maternal age, perceived environmental influence towards cesarean section, the respondent's belief that cesarean is more beneficial than vaginal delivery and an older obstetrician attending the delivery. Conclusions: The results of this questionnaire survey contribute to the already existing evidence that against the background of high cesarean rates, non-medical factors, as much related to the obstetricians as to pregnant women's attitudes, play an important role. © 2014 Nordic Federation of Societies of Obstetrics and Gynecology