Rein Lepnurm

Bio: Rein Lepnurm is an academic researcher from University of Saskatchewan. The author has contributed to research in topics: Public health & Distress. The author has an hindex of 8, co-authored 24 publications receiving 224 citations.

Factors associated with career satisfaction among general practitioners in Canada.

Abstract: INTRODUCTION There are important differences in rural, regional and urban general practice environments. The purpose of this study was to articulate models that explain career satisfaction among general practitioners (GPs) in these practice environments. METHODS Of 4958 eligible physicians across Canada, 2810 (56.7%) completed a 12- page survey between January and March 2004, from whom a total of 256 GPs in rural, regional and urban communities were selected. Response bias was checked and found to be negligible. We used hierarchical regression analysis to record cumulative R2, standardized beta and significance levels as each predictor was entered. We applied weighting factors to reflect the actual physician population in Canada. RESULTS The models explained 88.5% of the variance in career satisfaction for GPs in small towns, 88.9% for GPs in regional communities and 86.3% for GPs in urban cities. The explanatory variables consisted of distress and coping, role in community activities, the quality of health care services and access to them, intrinsic and extrinsic rewards, workload and organizational structure. CONCLUSION Career satisfaction for small-town doctors is associated with being able to cope with stress in handling a wide variety of clinical conditions, largely on their own, but with effective collaboration from physicians in larger centres. Rural GPs also enjoy academic responsibilities. Satisfaction for GPs in regional communities also depends on coping with stress and the ability to maintain an efficiently operating set of secondary- level health services in their community. Satisfaction for urban GPs is associated with collegiality, which dampens stress, and access to a full range of health services, including community, hospital, mental health and rehabilitation services. Career satisfaction for all GPs is associated with equity, manageable workloads and effective practice management; however, all of these professional issues contribute, in small increments, to satisfaction.

Factors Explaining Career Satisfaction Among Psychiatrists and Surgeons in Canada

Abstract: was negligible. Hierarchical regression analysis was used to record cumulative R 2 , Standardized beta, and significance levels as each predictor was entered. We applied weighting factors to reflect the actual physician population in Canada. Results: The models explained 90.4% of the variance in career satisfaction for surgeons and 81.0% of the variance in career satisfaction for psychiatrists. The explanatory variables consisted of distress and coping, role in community activities, access to and quality of health care services, intrinsic and extrinsic rewards, workload, and organizational structure. Conclusions: The study demonstrated that variance associated with career satisfaction can be explained using various factors reported directly by physicians. The study also confirmed that relative differences in the importance of these factors do occur among specialties. Surgeons prefer to delegate more responsibility in the management of their practices on an informal basis, whereas psychiatrists prefer to be more involved in the management of their practices and use more formal structures.

A measure of daily distress in practising medicine.

Abstract: Objective: Existing measures of stress either focus on burnout or frustration and fatigue factors, often referred to as job strain. The objectives of this study were to: establish a reliable measure of distress that is sensitive enough to identify job strain at lower levels of distress and risk of burnout at higher levels of distress; and document levels of distress among the major medical specialties and across varying patterns of clinical practice. Methods: A stratified cross-sectional survey of physicians in Canada was conducted in 2004. Among the eligible population, 2810 physicians (56.7%) responded. Response bias was negligible. Responding physicians completed a 13-item measure of distress. Confirmatory factor analysis was used to establish the measure. Scheffe tests were used to document differences in the levels of distress among specializations and by clinical practice profile. Results: Factor analysis revealed reliable dimensions of: fatigue (α = 0.75) and reaction (α = 0.73). The distress measure was reliable (α = 0.82). Emergency physicians (n = 4.51), surgeons (n = 4.35), and general practitioners (n = 4.33) reported the highest levels of distress, while administrative physicians (n = 3.30), community health (n = 3.35), and clinical specialists (n = 3.46) reported the lowest levels of distress. Physicians with clinical and administrative responsibilities reported the highest levels of distress (n = 4.40), compared with purely clinical physicians (n = 3.94) and clinician-academics (n = 3.98). Conclusions: Some specializations are associated with more distress than others. Administrative duties appear to add to distress for all physicians. Counterintuitively, adding academic as well as administrative responsibilities appears to add less distress than adding administrative duties alone. Academic duties are viewed as advancing medicine. Can J Psychiatry. 2009;54(3):170-180. Clinical Implications * Mentorship by senior colleagues may prevent physicians from becoming too absorbed in career responsibilities. * Community support is important to patients and physicians to ensure proper follow-up care. * Effective organization of clinical work and recognition of accomplishments by colleagues and administrators may provide psychological protection against excessive stress. Limitations * The study was cross-sectional. * The data were self-reported. * The number of specific specialists within each practice pattern was small. Key Words: daily stress, distress, strain, practice patterns, challenge Abbreviations used in this article GP general practitioner MBI Maslach Burnout Inventory MERCURi Maximizing Equitable Relationships by Collaborative University Research and insight PANAS Positive Affect Negative Affect Scale Physicians naturally act as patient advocates; however, they are encouraged to refrain from marginal uses of treatment resources for the sake of their colleagues with sicker patients, if not for reasons of controlling expenses.1 The classic attempts to document such stressful dilemmas were the demand and control studies of Karasek,2 which demonstrated that people experiencing high demands combined with lack of control suffered from high blood pressure and other cardiac problems. Subsequently, Maslach and Jackson3 developed a measure that identified people at high risk of burnout, while Cooper et al4 and others attempted to capture stress at lower levels. The latter group of studies have often been called studies of job strain.5 These studies catalogue the effects of various factors such as "coping with demanding patients, filling out excessive paperwork, interruptions in personal life etc"4' p 367 On the physician's professional and personal life. These factors are often called stressors,6 fatigue factors,7 or even hassles that physicians face on a day-to-day basis in their practice. …

Reconceptualizing determinants of health: barriers to improving the health status of First Nations peoples.

Abstract: Comparing the key determinants of health articulated by the Public Health Agency of Canada (the Agency) with the spiritual and cultural knowledge systems of First Nations peoples, as expressed by the Four Worlds International Institute for Human and Community Development (Four Worlds) and their 14 determinants of well-being and health, reveals differing philosophical perspectives. The key determinants of health can be interpreted as lacking a holistic and inclusive approach to public health services. As a result, many public health programs in Canada marginalize, ignore and suppress the needs of First Nations communities and people. Incorporating the Four Worlds guiding principles and its 14 health determinants model within the context of Canadian public health services geared towards First Nations populations provides the opportunity to develop a deeper understanding of social determinants of health. Therefore, when implementing public health initiatives to address the health status of First Nations people in Canada, it is important that the Agency incorporate the guiding principles of the Four Worlds: Development Comes from Within; No Vision, No Development; Individual and Community Transformations Must Go Hand in Hand; and Holistic Learning is the Key to Deep and Lasting Change. Reconceptualizing the key determinants of health to encompass the worldview expressed by the Four Worlds acknowledges the cultural wisdom of First Nations people and offers the potential to develop more inclusive public health services.

Using Multivariate Statistics

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Out of the Crisis

Abstract: According to W. Edwards Deming, American companies require nothing less than a transformation of management style and of governmental relations with industry. In Out of the Crisis, originally published in 1982, Deming offers a theory of management based on his famous 14 Points for Management. Management's failure to plan for the future, he claims, brings about loss of market, which brings about loss of jobs. Management must be judged not only by the quarterly dividend, but by innovative plans to stay in business, protect investment, ensure future dividends, and provide more jobs through improved product and service. In simple, direct language, he explains the principles of management transformation and how to apply them.

Quality of care.

Abstract: Editor – I am moved by Professor Allan's elegy to bygone NHS virtues of ‘calm caring and gentle pace of clinical life… and all the time in the world to deliver compassionate care' ( Clin Med October 2009 p 407). One's immediate instinct would be to say ‘Ah, but times have changed' – only

Burnout in palliative care: A systematic review

Abstract: Burnout is a phenomenon characterized by fatigue and frustration, usually related to work stress and dedication to a cause, a way of life that does not match the person’s expectations. Although it seems to be associated with risk factors stemming from a professional environment, this problem may affect any person. Palliative care is provided in a challenging environment, where professionals often have to make demanding ethical decisions and deal with death and dying. This article reports on the findings of a systematic review aimed at identifying described burnout levels in palliative care nurses and physicians, and the related risks and protective factors. The main findings indicate that burnout levels in palliative care, or in health care settings related to this field, do not seem to be higher than in other contexts.