Edmond Girasek

Mobility of health professionals pre and post 2004 and 2007 EU enlargements: Evidence from the EU project PROMeTHEUS

BACKGROUND EU enlargement has facilitated the mobility of EU citizens, including health professionals, from the 2004 and 2007 EU accession states. Fears have been raised about a mass exodus of health professionals and the consequences for the operation of health systems. However, to date a systematic analysis of the EU enlargements effects on the mobility of health professionals has been lacking. The aim of this article is to shed light on the changes in the scale of movement, trends and directions of flows pre and post 2004 and 2007 EU enlargements. METHODS The study follows a pan-European secondary data analysis to (i) quantitatively and (ii) qualitatively analyse mobility before and after the EU enlargement. (i) The secondary data analysis covers 34 countries (including all EU Member States). (ii) Data were triangulated with the findings of 17 country case studies to qualitatively assess the effects of enlargement on health workforce mobility. RESULTS The stock of health professionals from the new (EU-12) into the old EU Member States (EU-15) have increased following EU accession. The stock of medical doctors from the EU-12 in the EU-15 countries has more than doubled between 2003 and 2007. The available data suggest the same trend for dentists. The extremely limited data for nurses show that the stock of nurses has, in contrast, only slightly increased. However, while no reliable data is available evidence suggests that the number of undocumented or self-employed migrant nurses in the home-care sector has significantly increased. Health professionals trained in the EU-12 are becoming increasingly important in providing sufficient health care in some destination countries and regions facing staff shortages. CONCLUSION A mass exodus of health professionals has not taken place after the 2004 and 2007 EU enlargements. The estimated annual outflows from the EU-12 countries have rarely exceeded 3% of the domestic workforce. This is partly due to labour market restrictions in the destination countries, but also to improvements in salaries and working conditions in some source countries. The overall mobility of health professionals is hence relatively moderate and in line with the overall movement of citizens within the EU. However, for some countries even losing small numbers of health professionals can have impacts in underserved regions.

The medical career choice motivations — Results from a Hungarian study

Some decades ago being a medical doctor was characterized unambiguously as a profession that offers help and serves the patients’ needs during medical treatment. In today’s society, this image of the medical profession has been substantially changed. The present paper aims to examine medical career choice motivations and preferences of choosing speciality, in the light of current social and economic changes in Hungary. The study was carried out by using a voluntary, self-administrated, questionnaire among first-year medical students and resident doctors in four medical faculties in Hungary. The career choice motivations of the first-year medical students and resident doctors are similar and match to the traditional health profession career choice motivations. Nevertheless the first-year students consider high income as one of the most important factors. They appear more conscious and more ambitious regarding their future speciality choice. The Hungarian health care system and medical education must be prepared for the presence of students that are aware of the high market value of a medical diploma, have excellent language skills, and consider migration as one main factor in their motivation when choosing a medical profession.

Workload, mental health and burnout indicators among female physicians

BackgroundFemale doctors in Hungary have worse indicators of physical and mental health compared with other professional women. We aimed to cast light on possible indicators of mental health, workload, and burnout of female physicians.MethodsTwo time-points (T) were compared, in 2003 (T1 n = 408) and 2013 (T2 n = 2414), based on two nationally representative surveys of female doctors, and comparison made with data from other professional control groups. Independent samples t test or chi-squared test was used both for the two time-point comparison and the comparison between the index and the control groups. The background factors of sleep disorders and burnout were assessed by binary logistic regression analysis.ResultsNo significant differences in the rates of depressive symptoms and suicidal thoughts and attempts were detected between the 2003 and 2013 cohorts, but the prevalence of sleep disorders increased. The workload increased, and there was less job satisfaction in 2013 than in 2003, coupled to more stressful or difficult work-related situations. The personal accomplishment component of burnout significantly decreased in line with the declining work-related satisfaction. Compared to the professional control groups, the prevalence of depressive symptoms, suicide attempts, and sleep disorders was higher among female physicians at both time-points. The number of workplaces, frequency of work-related stressful situations, and intensive role conflict was associated with sleep disorders and decreased personal accomplishment.ConclusionsIn comparison with the other professional groups, female doctors had worse mental health indicators with regard to depression, suicidal ideas, and sleep disorders both in 2003 and 2013 while within professional strata the changes seemed to be less. Increasing workload had a clear impact on sleep disorders and the personal accomplishment dimension of burnout.

Women's antenatal preferences for delivery route in a setting with high cesarean section rates and a medically dominated maternity system

To assess birth preferences in a sample of Hungarian pregnant women and identify determinants of ambivalence or clear choices for cesarean section throughout pregnancy.

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

BackgroundThere 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.MethodsData 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.ResultsFemale 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).ConclusionsThere 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.

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

To assess the contribution of non‐medical factors to actual mode of delivery in a setting with high cesarean rates.

Burnout among Hungarian physicians. Who are the most at risk

A kieges a XXI. szazad orvoslasanak egyik legnagyobb kihivast jelentő kerdese. Celkitűzes: A szerzők celul tűztek ki a magyarorszagi orvosok (n = 4784) kiegesmutatoinak felmereset, valamint e mutatok es a munkavegzes korulmenyeit erintő legmeghatarozobb aspektusok (munkaorak, ugyeleti munkavegzes, tobb munkahelyen valo helytallas) osszefuggeseinek elemzeset. Modszer: Orvosok koreben vegzett orszagos, reprezentativ, online kvantitativ felmeres eredmenyeinek deskriptiv elemzese. Eredmenyek: A vizsgalat azt mutatta, hogy hazai orvosok koreben a teljesitmenyvesztes dimenzioja a legmagasabb aranyu, ezt koveti az emocionalis kimerules, majd a deperszonalizacio faktora. A fi atal eletkor (<35 ev), a fekvőbeteg-ellatasban valo munkavegzes, az ugyeleti munka, valamint a tobb munkahelyen valo egyidejű helytallas a kieges mindharom dimenziojanak meghatarozo kockazati tenyezője. Az orvos partner meglete a deperszonalizaciot noveli, mig a gyerekszam protektiv mindharom aspektus eseteben. Ugyanakkor a munka–csalad konfl iktus a kiegest egyertelműen novelő tenyező. Kovetkeztetesek: A betegellatasra, a lakossag egesz- segi allapotanak alakulasara nezve jelentős hatasu a kieges. Az eredmenyek fenyeben a prevencio es az intervencio kulcsszerepű. Orv. Hetil., 2015, 156 (14), 564–570.

Burnout among Hungarian physicians. Who are the most jeopardized

A kieges a XXI. szazad orvoslasanak egyik legnagyobb kihivast jelentő kerdese. Celkitűzes: A szerzők celul tűztek ki a magyarorszagi orvosok (n = 4784) kiegesmutatoinak felmereset, valamint e mutatok es a munkavegzes korulmenyeit erintő legmeghatarozobb aspektusok (munkaorak, ugyeleti munkavegzes, tobb munkahelyen valo helytallas) osszefuggeseinek elemzeset. Modszer: Orvosok koreben vegzett orszagos, reprezentativ, online kvantitativ felmeres eredmenyeinek deskriptiv elemzese. Eredmenyek: A vizsgalat azt mutatta, hogy hazai orvosok koreben a teljesitmenyvesztes dimenzioja a legmagasabb aranyu, ezt koveti az emocionalis kimerules, majd a deperszonalizacio faktora. A fi atal eletkor (<35 ev), a fekvőbeteg-ellatasban valo munkavegzes, az ugyeleti munka, valamint a tobb munkahelyen valo egyidejű helytallas a kieges mindharom dimenziojanak meghatarozo kockazati tenyezője. Az orvos partner meglete a deperszonalizaciot noveli, mig a gyerekszam protektiv mindharom aspektus eseteben. Ugyanakkor a munka–csalad konfl iktus a kiegest egyertelműen novelő tenyező. Kovetkeztetesek: A betegellatasra, a lakossag egesz- segi allapotanak alakulasara nezve jelentős hatasu a kieges. Az eredmenyek fenyeben a prevencio es az intervencio kulcsszerepű. Orv. Hetil., 2015, 156 (14), 564–570.

Willingness to migrate—a potential effect of burnout? A survey of Hungarian physicians

BackgroundBurnout worldwide and migration of caregivers are among the most important challenges of the twenty-first century health care.MethodsQuantitative, online survey of Hungarian physicians (n = 4 784) was performed in 2013. A link to an anonymous, self-administered questionnaire was sent to all potential participants, namely to the registered members of the Hungarian Medical Chamber with a valid e-mail address. Linear regression analysis was used to determine the risk factors of burnout. The association between physicians’ burnout and their willingness to migrate was determined by binary logistic regression analysis.ResultsModerate/mild level of personal accomplishment was detected in 65% of respondents, whereas moderate/severe level of emotional exhaustion and depersonalization was detected in 49% and 46%, respectively. Single male physicians younger than 35 composed the cohort with the highest risk for developing burnout. Higher daily working hours and multiple workplaces contribute to the risk of developing burnout.According to logistic regression analysis, the intention to work abroad was affected by the emotional exhaustion dimension of burnout (OR = 1.432) and depersonalization had a tendency to have an impact on the willingness to migrate.ConclusionsWe assume that there is a circular causality between burnout and the willingness to migrate. Burnout increases the willingness to work abroad, whereas contemplating migration might evoke a certain degree of depersonalization in caregivers who are in a dilemma.

Mit gondolnak a családorvos-rezidensek a hálapénzről?

Semmelweis Egyetem, Általános Orvostudományi Kar, 1Magatartástudományi Intézet, 2Családorvosi Tanszék, Budapest 3Szegedi Tudományegyetem, Általános Orvostudományi Kar, Családorvosi Intézet és Rendelő, Szeged 4Debreceni Egyetem, Népegészségügyi Kar, Családorvosi és Foglalkozás-egészségügyi Tanszék, Debrecen 5Pécsi Tudományegyetem, Orvostudományi Kar, Alapellátási Intézet, Pécs 6Semmelweis Egyetem, Egészségügyi Közszolgálati Kar, Egészségügyi Menedzserképző Központ, Budapest