Abstract
Background
Empathy fatigue refers to the excessive empathy required of medical staff in the process of helping patients, which can produce traumatic experiences and emotional exhaustion. Severe empathy fatigue can even lead to medical disputes and errors, exacerbating increasingly tense doctor–patient relationships. Most studies on empathy fatigue focus on nurses, with few studies on physicians.
Methods
A cross-sectional questionnaire was used to assess empathy fatigue among physicians in public tertiary general hospitals in southwest China using convenience sampling.
Results
A total of 562 physicians participated in the survey; average empathy satisfaction scores were 32.1 ± 6.85, 28.2 ± 5.30, and 26.2 ± 6.04 for empathy satisfaction disorder, job burnout, and secondary traumatic stress domains, respectively. We identified 291 (51.8%) physicians with severe empathy fatigue. Working two or three night shifts per week was associated with severe empathy fatigue. In total, 424 (75.4%) physicians had thoughts of resigning. Weekly rest time, empathic satisfaction disorder, job burnout, and secondary traumatic stress disorder influenced thoughts of resigning.
Conclusions
The majority of hospital physicians experience empathy fatigue and have considered resigning; this study provides reference data that demonstrate the extent of this issue. Efforts are urgently needed to address empathy fatigue in physicians and, therefore, increase physician retention.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12888-024-06217-w.
Keywords: empathy fatigue, empathy satisfaction, job burnout, secondary stress trauma, hospital physicians
Background
Empathy fatigue refers to exhaustion and dysfunction caused by prolonged exposure to work-related and empathic stress [1–3]. As members of a caring profession, medical staff experience a high incidence of empathy fatigue. Studies have found that empathy fatigue can cause a variety of physical and mental health problems, reducing productivity and motivation. Severe empathy fatigue can even lead to medical disputes and errors, exacerbating increasingly strained doctor–patient relationships [4, 5].
Most studies on empathy fatigue have focused on nurses working in oncology, psychiatry, and emergency; few studies have explored empathy fatigue among physicians [6–8]. During the coronavirus disease 2019 (COVID-19) pandemic, healthcare professionals worked long hours at high intensities, and were frequently exposed to traumatic situations such patient death and the anxiety and pain of infected individuals [9]. They were also at a high risk of infection, creating a conflict between the performance of work duties and their personal health and safety [10, 11]. Although the end of the COVID-19 pandemic has been declared, the stress on ’physicians has not diminished [12–14]. Many medical staff report experiencing a lack of physical strength, energy, and empathy [12, 14]. Therefore, this study aimed to investigate empathy fatigue in clinicians in southwest China and provide empirical evidence for its prevention and treatment.
Methods
Study design
A survey of licensed clinicians working in public tertiary general hospitals in southwest China was conducted using convenience and snowball sampling between February 18 and March 31, 2024. We recruited doctors in Chongqing and Sichuan Province who had finished their undergraduate internship and completed standardized training for doctors, working in public tertiary general hospitals for more than 1 year. WeChat (2012 edition; Changsha Ranxing Information Technology Co., Ltd., Changsha, China) was used for data collection. This study was approved by the Affiliated Hospital of Southwest Jiaotong University.
Questionnaire design
The questionnaire comprised two sections, a self-compiled general situation questionnaire and a clinician empathy fatigue scale.
In the basic information section, a self-compiled general situation questionnaire included questions on sex, age, title, position, education, marital status, working years, department, weekly rest time, night shift frequency, and income. The empathy fatigue section included a version of the Professional Quality of Life Scale as revised by Stamm [15] and translated into Chinese by Chen and Wang [16]. The scale comprises three domains, empathy satisfaction, job burnout, and secondary traumatic stress, with 10 items in each domain for a total of 30 items. Items are scored using a 5-point Likert scale, which assigns points according to occurrence frequency from 1 point for “no” to 5 points for “always”; items 14, 15, 17, and 29 use this scale in reverse. The total possible score for each domain is 50 points, with critical values of < 37, > 27, and > 17 points for the empathy satisfaction, job burnout, and secondary traumatic stress domains, respectively. Scores that breached the critical value in one, two, or three domains were classified as mild, moderate, or severe empathy fatigue, respectively. In this study, the Cronbach α coefficient was between 0.836 and 0.931. A reliability evaluation revealed a reliability coefficient of 0.923 and a validity of 0.939.
Statistical analysis
R software version 4.1.1 (The R Foundation for Statistical Computing, Vienna, Austria) was used for data processing and statistical analyses. Enumeration data are expressed as frequency and component ratios. Chi-squared or Fisher’s exact tests were used to compare the scores for empathy satisfaction (< 37 and ≥ 37 points), job burnout (< 27 and ≥ 27 points), and secondary traumatic stress (< 17 and ≥ 17 points) in clinicians categorized by sex, age, marital status, whether they raise children, education, professional title, duty, years of work, department, weekly rest time, night shift frequency, and income. The Wilcoxon rank-sum test was used to compare clinicians with different degrees of empathy fatigue (normal, mild, moderate, or severe). Multivariate binary logistic regression analysis was performed with clinician characteristics as independent variables and empathy satisfaction (< 37 points = 1; ≥ 37 points = 0), job burnout (< 27 points = 0; ≥ 27 points = 1), and secondary traumatic stress (< 17 points = 0; ≥ 17 points = 1) as dependent variables. Multivariate disordered logistic regression analysis was also performed with clinician characteristics as independent variables, and the degree of empathy fatigue (mild = 1; moderate = 2; severe = 3) and thoughts of resigning (rarely or never = 1; sometimes = 2; often or always = 3) as dependent variables. Independent variables were screened using backward stepwise regression, with a test level of α = 0.05.
Results
Clinician characteristics
A total of 562 physicians, with an average age of 37.3 ± 6.35 years, participated in the survey; 55.2% of participants were female, 85.4% were married, 30.6% were aged over 41 years, 27.6% had been working for more than 15 years, and 39.0% had two rest days a week (Table 1).
Table 1.
Clinician characteristics
| Characteristic | Category | n (%) |
|---|---|---|
| Sex | Female | 310 (55.2) |
| Male | 252 (44.8) | |
| Age(years) | 31 ~ 40 | 300 (53.4) |
| ≥ 41 | 172 (30.6) | |
| < 30 | 90 (16.0) | |
| Marital status | Unmarried | 82 (14.6) |
| Married | 480 (85.4) | |
| Raising children | Yes | 435 (77.4) |
| No | 127 (22.6) | |
| Education | Bachelor’s degree or below | 188 (33.5) |
| Masters | 319 (56.8) | |
| Doctorate | 55 (9.8) | |
| Professional title | Resident/attending physician | 110 (19.6) |
| Associate chief physician/chief physician | 452 (80.4) | |
| Duty | Director/deputy director | 108 (19.2) |
| Medical team leader | 104 (18.5) | |
| None | 350 (62.3) | |
| Years of work | < 5 | 109 (19.4) |
| 5–10 | 134 (23.8) | |
| 11–15 | 164 (29.2) | |
| > 15 | 155 (27.6) | |
| Department | Internal medicine | 391 (69.6) |
| Surgery | 86 (15.3) | |
| Other | 85 (15.1) | |
| Weekly rest time | 2 days | 219 (39.0) |
| 1 day | 230 (40.9) | |
| None | 113 (20.1) | |
| Night shift frequency | Once a month or less | 138 (24.6) |
| 2–3 times/month | 46 (8.2) | |
| Once a week | 246 (43.8) | |
| 2–3 times/week | 132 (23.5) | |
| Income(CNY) | < 5000 | 42 (7.5) |
| 5000–10,000 | 266 (47.3) | |
| 10,000–15,000 | 186 (33.1) | |
| > 15,000 | 68 (12.1) | |
| Thoughts of resigning | Never/rarely | 138 (24.5) |
| Sometimes | 254 (45.2) | |
| Often/always | 170 (30.3) |
Empathy satisfaction
The average empathy satisfaction score was 32.1 ± 6.85; in 562 physicians, 417 (74.20%) physicians had empathy satisfaction disorder. Sex, age, professional title, duty, years of work, night shift frequency, and income all influenced empathy fatigue. Logistic regression analysis identified weekly rest time as an influential factor for empathy fatigue (odds ratio [OR], 2.58; 95% confidence interval [CI], 1.33–5.15) (Table 2).
Table 2.
Single factor analysis of physician empathy satisfaction
| Factor | Category | < 37 points | ≥ 37 points | P-value |
|---|---|---|---|---|
| Sex | Female | 243 (58.3) | 67 (46.2) | 0.016 |
| Male | 174 (41.7) | 78 (53.8) | ||
| Age (years) | 31 ~ 40 | 237 (56.8) | 62 (42.8) | < 0.001 |
| ≥ 41 | 106 (25.4) | 66 (45.5) | ||
| ≤ 30 | 74 (17.7) | 17 (11.7) | ||
| Marital status | Unmarried | 66 (15.8) | 16 (11.0) | 0.203 |
| Married | 351 (84.2) | 129 (89.0) | ||
| Raising children | Yes | 317 (76.0) | 118 (81.4) | 0.225 |
| No | 100 (24.0) | 27 (18.6) | ||
| Education | Bachelor’s degree or below | 138 (33.1) | 50 (34.5) | 0.387 |
| Masters | 242 (58.0) | 77 (53.1) | ||
| Doctorate | 37 (8.9) | 18 (12.4) | ||
| Professional title | Resident/attending physician | 91 (21.8) | 19 (13.1) | 0.031 |
| Associate chief physician/chief physician | 326 (78.2) | 126 (86.9) | ||
| Duty | Director/deputy director | 64 (15.3) | 44 (30.3) | < 0.001 |
| Medical team leader | 72 (17.3) | 32 (22.1) | ||
| None | 281 (67.4) | 69 (47.6) | ||
| Years of work | < 5 | 91 (21.8) | 18 (12.4) | < 0.001 |
| 5–10 | 104 (24.9) | 30 (20.7) | ||
| 11–15 | 128 (30.7) | 36 (24.8) | ||
| > 15 | 94 (22.5) | 61 (42.1) | ||
| Department | Internal medicine | 292 (70.0) | 99 (68.3) | 0.508 |
| Surgery | 66 (15.8) | 20 (13.8) | ||
| Other | 59 (14.1) | 26 (17.9) | ||
| Weekly rest time | 2 days | 152 (36.5) | 67 (46.2) | 0.105 |
| 1 day | 176 (42.2) | 54 (37.2) | ||
| None | 89 (21.3) | 24 (16.6) | ||
| Night shift frequency | Once a month or less | 83 (19.9) | 55 (37.9) | < 0.001 |
| 2–3 times/month | 28 (6.7) | 18 (12.4) | ||
| Once a week | 191 (45.8) | 55 (37.9) | ||
| 2–3 times/week | 115 (27.6) | 17 (11.7) | ||
| Income (CNY)) | < 5000 | 33 (7.9) | 9 (6.2) | < 0.001 |
| 5000–10,000 | 215 (51.6) | 51 (35.2) | ||
| 10,000–15,000 | 134 (32.1) | 52 (35.9) | ||
| > 15,000 | 35 (8.4) | 33 (22.8) |
Data are expressed as number (percentage)
Job burnout
The average job burnout score was 28.2 ± 5.30; of the 562 physicians surveyed, 319 (56.8%) clinicians had job burnout. Age, duty, weekly rest time, night shift frequency, and income all influenced job burnout. Logistic regression analysis identified a lack of weekly rest time (OR, 3.6; 95% CI, 2.03–6.57) and working two or three night shifts per week (OR, 2.16; 95% CI, 1.22–3.85) as influential factors for job burnout (Table 3).
Table 3.
Single factor analysis of job burnout
| Factor | Category | > 27 points | ≤ 27 points | P-value |
|---|---|---|---|---|
| Sex | Female | 176 (55.2) | 134 (55.1) | 1 |
| Male | 143 (44.8) | 109 (44.9) | ||
| Age | 31 ~ 40 years | 181 (56.7) | 118 (48.6) | 0.026 |
| > 40 years | 83 (26.0) | 89 (36.6) | ||
| ≤ 30 years | 55 (17.2) | 36 (14.8) | ||
| Marital status | Unmarried | 49 (15.4) | 33 (13.6) | 0.637 |
| Married | 270 (84.6) | 210 (86.4) | ||
| Raising children | Yes | 242 (75.9) | 193 (79.4) | 0.369 |
| No | 77 (24.1) | 50 (20.6) | ||
| Education | Bachelor’s degree or below | 113 (35.4) | 75 (30.9) | 0.488 |
| Masters | 177 (55.5) | 142 (58.4) | ||
| Doctorate | 29 (9.1) | 26 (10.7) | ||
| Professional title | Resident/attending physician | 72 (22.6) | 38 (15.6) | 0.052 |
| Associate chief physician/chief physician | 247 (77.4) | 205 (84.4) | ||
| Duty | Director/deputy director | 53 (16.6) | 55 (22.6) | 0.04 |
| Medical team leader | 53 (16.6) | 51 (21.0) | ||
| None | 213 (66.8) | 137 (56.4) | ||
| Years of work | < 5 | 65 (20.4) | 44 (18.1) | 0.127 |
| 5–10 | 83 (26.0) | 51 (21.0) | ||
| 11–15 | 95 (29.8) | 69 (28.4) | ||
| > 15 | 76 (23.8) | 79 (32.5) | ||
| Department | Internal medicine | 228 (71.5) | 163 (67.1) | 0.496 |
| Surgery | 47 (14.7) | 39 (16.0) | ||
| Other | 44 (13.8) | 41 (16.9) | ||
| Weekly rest time | 2 days | 99 (31.0) | 120 (49.4) | < 0.001 |
| 1 day | 129 (40.4) | 101 (41.6) | ||
| None | 91 (28.5) | 22 (9.1) | ||
| Night shift frequency | Once a month or less | 59 (18.5) | 79 (32.5) | < 0.001 |
| 2–3 times/month | 19 (6.0) | 27 (11.1) | ||
| Once a week | 143 (44.8) | 103 (42.4) | ||
| 2–3 times/week | 98 (30.7) | 34 (14.0) | ||
| Income(CNY) | < 5000 | 29 (9.1) | 13 (5.3) | 0.041 |
| 5000–10,000 | 160 (50.2) | 106 (43.6) | ||
| 10,000–15,000 | 99 (31.0) | 87 (35.8) | ||
| > 15,000 | 31 (9.7) | 37 (15.2) |
Data are expressed as number (percentage)
Secondary traumatic stress
The mean secondary traumatic stress score was 26.2 ± 6.04; Of the 562 physicians surveyed, 507 (90.2%) clinicians had traumatic stress disorder. Age, raising children, professional title, duty, years of work, weekly rest time, and income were all associated with stress trauma. Married physicians (OR, 2.76; 95% CI, 1.00–7.28) were more likely to experience secondary traumatic stress (Table 4).
Table 4.
Single factor analysis of secondary stress trauma
| Factor | Category | > 17 points | ≤ 17 points | P-value |
|---|---|---|---|---|
| Sex | Female | 270 (53.3) | 40 (72.7) | 0.009 |
| Male | 237 (46.7) | 15 (27.3) | ||
| Age | 31 ~ 40 years | 265 (52.3) | 34 (61.8) | 0.005 |
| > 40 years | 165 (32.5) | 7 (12.7) | ||
| ≤ 30 years | 77 (15.2) | 14 (25.5) | ||
| Marital status | Unmarried | 71 (14.0) | 11 (20.0) | 0.32 |
| Married | 436 (86.0) | 44 (80.0) | ||
| Raising children | Yes | 399 (78.7) | 36 (65.5) | 0.039 |
| No | 108 (21.3) | 19 (34.5) | ||
| Education | Bachelor’s degree or below | 169 (33.3) | 19 (34.5) | 0.521 |
| Masters | 286 (56.4) | 33 (60.0) | ||
| Doctorate | 52 (10.3) | 3 (5.5) | ||
| Professional title | Resident/attending physician | 90 (17.8) | 20 (36.4) | 0.002 |
| Associate chief physician/chief physician | 417 (82.2) | 35 (63.6) | ||
| Duty | Director/deputy director | 105 (20.7) | 3 (5.5) | 0.002 |
| Medical team leader | 98 (19.3) | 6 (10.9) | ||
| None | 304 (60.0) | 46 (83.6) | ||
| Years of work | < 5 | 93 (18.3) | 16 (29.1) | 0.02 |
| 5–10 | 118 (23.3) | 16 (29.1) | ||
| 11–15 | 147 (29.0) | 17 (30.9) | ||
| > 15 | 149 (29.4) | 6 (10.9) | ||
| Department | Internal medicine | 353 (69.6) | 38 (69.1) | 0.45 |
| Surgery | 75 (14.8) | 11 (20.0) | ||
| Other | 79 (15.6) | 6 (10.9) | ||
| Weekly rest time | 2 days | 202 (39.8) | 17 (30.9) | 0.046 |
| 1 day | 210 (41.4) | 20 (36.4) | ||
| None | 95 (18.7) | 18 (32.7) | ||
| Night shift frequency | Once a month or less | 134 (26.4) | 4 (7.3) | 0.001 |
| 2–3 times/month | 43 (8.5) | 3 (5.5) | ||
| Once a week | 221 (43.6) | 25 (45.5) | ||
| 2–3 times/week | 109 (21.5) | 23 (41.8) | ||
| Income(CNY) | < 5000 | 32 (6.3) | 10 (18.2) | 0.005 |
| 5000–10,000 | 238 (46.9) | 28 (50.9) | ||
| 10,000–15,000 | 172 (33.9) | 14 (25.5) | ||
| > 15,000 | 65 (12.8) | 3 (5.5) |
Data are expressed as number (percentage)
Factors influencing the degree of empathy fatigue
Mild, moderate, and severe empathy fatigue was experienced by 118, 132, and 291 physicians, respectively. Sex, age, raising children, education, professional title, duty, years of work, department, weekly rest time, night shift frequency, and income all influenced the degree of empathy fatigue. Multivariate logistic regression analysis suggested that working two or three night shifts per week was associated with severe compassion fatigue (OR, 3.10; 95% CI, 1.47–6.50) (Table 5).
Table 5.
Univariate analysis of factors influencing the degree of empathy fatigue
| Factor | Category | Normal (n = 21) | Mild (n = 118) | Moderate (n = 132) |
Severe (n = 291) | P-value |
|---|---|---|---|---|---|---|
| Sex | Female | 11 (52.4%) | 57 (48.3%) | 78 (59.1%) | 164 (56.4%) | 0.008 |
| Male | 10 (47.6%) | 61 (51.7%) | 54 (40.9%) | 127 (43.6%) | ||
| Age (years) mean ± SD | 38.8 ± 6.54 | 39.3 ± 7.42 | 37.0 ± 6.16 | 36.4 ± 5.74 | < 0.001 | |
| Marital status | Unmarried | 2 (9.5%) | 17 (14.4%) | 18 (13.6%) | 45 (15.5%) | 0.008 |
| Married | 19 (90.5%) | 101 (85.6%) | 114 (86.4%) | 246 (84.5%) | ||
| Raising children | Yes | 19 (90.5%) | 91 (77.1%) | 105 (79.5%) | 220 (75.6%) | 0.014 |
| No | 2 (9.5%) | 27 (22.9%) | 27 (20.5%) | 71 (24.4%) | ||
| Education | Bachelor’s degree or below | 8 (38.1%) | 33 (28.0%) | 49 (37.1%) | 98 (33.7%) | < 0.001 |
| Masters | 10 (47.6%) | 74 (62.7%) | 66 (50.0%) | 169 (58.1%) | ||
| Doctorate | 3 (14.3%) | 11 (9.3%) | 17 (12.9%) | 24 (8.2%) | ||
| Professional title | Resident/attending physician | 3 (14.3%) | 15 (12.7%) | 25 (18.9%) | 67 (23.0%) | 0.008 |
| Associate chief physician/chief physician | 18 (85.7%) | 103 (87.3%) | 107 (81.1%) | 224 (77.0%) | ||
| Duty | Director/deputy director | 4 (19.0%) | 32 (27.1%) | 30 (22.7%) | 42 (14.4%) | 0.003 |
| Medical team leader | 4 (19.0%) | 27 (22.9%) | 23 (17.4%) | 50 (17.2%) | ||
| None | 13 (61.9%) | 59 (50.0%) | 79 (59.8%) | 199 (68.4%) | ||
| Years of work | < 5 | 3 (14.3%) | 19 (16.1%) | 25 (18.9%) | 62 (21.3%) | < 0.001 |
| 5–10 | 4 (19.0%) | 24 (20.3%) | 31 (23.5%) | 75 (25.8%) | ||
| 11–15 | 6 (28.6%) | 30 (25.4%) | 38 (28.8%) | 90 (30.9%) | ||
| > 15 | 8 (38.1%) | 45 (38.1%) | 38 (28.8%) | 64 (22.0%) | ||
| Department | Internal medicine | 13 (61.9%) | 80 (67.8%) | 93 (70.5%) | 205 (70.4%) | < 0.001 |
| Surgery | 5 (23.8%) | 14 (11.9%) | 22 (16.7%) | 45 (15.5%) | ||
| Other | 3 (14.3%) | 24 (20.3%) | 17 (12.9%) | 41 (14.1%) | ||
| Weekly rest time | 2 days | 13 (61.9%) | 53 (44.9%) | 62 (47.0%) | 91 (31.3%) | 0.004 |
| 1 day | 8 (38.1%) | 49 (41.5%) | 52 (39.4%) | 121 (41.6%) | ||
| None | 0 (0%) | 16 (13.6%) | 18 (13.6%) | 79 (27.1%) | ||
| Night shift frequency | Once a month or less | 11 (52.4%) | 39 (33.1%) | 37 (28.0%) | 51 (17.5%) | < 0.001 |
| 2–3 times/month | 1 (4.8%) | 17 (14.4%) | 11 (8.3%) | 17 (5.8%) | ||
| Once a week | 6 (28.6%) | 47 (39.8%) | 64 (48.5%) | 129 (44.3%) | ||
| 2–3 times/week | 3 (14.3%) | 15 (12.7%) | 20 (15.2%) | 94 (32.3%) | ||
| Income(CNY) | 5000–10,000 | 7 (33.3%) | 48 (40.7%) | 60 (45.5%) | 151 (51.9%) | 0.001 |
| 10,000–15,000 | 8 (38.1%) | 42 (35.6%) | 45 (34.1%) | 91 (31.3%) | ||
| > 15,000 | 6 (28.6%) | 21 (17.8%) | 18 (13.6%) | 23 (7.9%) | ||
| < 5000 | 0 (0%) | 7 (5.9%) | 9 (6.8%) | 26 (8.9%) |
Data are expressed as number (percentage) unless otherwise stated. SD, standard deviation
Thoughts of resigning are related to empathy fatigue
Of the physicians who participated in the survey, 254 (45.2%) sometimes and 170 (30.2%) often/always had thoughts of resigning. Sex, age, professional title, duty, years of work, weekly rest time, and night shift frequency all influenced thoughts of resigning. Multiple regression analysis suggested that weekly rest time (OR, 2.91; 95% CI, 1.32–6.43), empathic satisfaction disorder (OR, 0.25; 95% CI, 0.12–0.54), job burnout (OR, 0.19; 95% CI, 0.09–0.36), and secondary traumatic stress disorder (OR, 0.04; 95% CI, 0.01–0.36) influence thoughts of resigning (Table 6).
Table 6.
Univariate analysis of factors influencing thoughts of resigning
| Factor | Category | Never/rarely (n = 138) | Sometimes (n = 254) | Often/always (n = 170) | P-value |
|---|---|---|---|---|---|
| Sex | Female | 60 (43.5) | 129 (50.8) | 121 (71.2) | < 0.001 |
| Male | 78 (56.5) | 125 (49.2) | 49 (28.8) | ||
| Age (years) mean (SD) | 39.28 (6.88) | 37.33 (6.10) | 35.50 (5.75) | < 0.001 | |
| Marital status | Unmarried | 16 (11.6) | 36 (14.2) | 30 (17.6) | 0.316 |
| Married | 122 (88.4) | 218 (85.8) | 140 (82.4) | ||
| Raising children | Yes | 115 (83.3) | 197 (77.6) | 123 (72.4) | 0.072 |
| No | 23 (16.7) | 57 (22.4) | 47 (27.6) | ||
| Education | Bachelor’s degree or below | 43 (31.2) | 92 (36.2) | 53 (31.2) | 0.645 |
| Masters | 82 (59.4) | 135 (53.1) | 102 (60.0) | ||
| Doctorate | 13 (9.4) | 27 (10.6) | 15 (8.8) | ||
| Professional title | Resident/attending physician | 21 (15.2) | 42 (16.5) | 47 (27.6) | 0.006 |
| Associate chief physician/chief physician | 117 (84.8) | 212 (83.5) | 123 (72.4) | ||
| Duty | Director/deputy director | 39 (28.3) | 50 (19.7) | 19 (11.2) | < 0.001 |
| Medical team leader | 28 (20.3) | 52 (20.5) | 24 (14.1) | ||
| None | 71 (51.4) | 152 (59.8) | 127 (74.7) | ||
| Years of work | < 5 | 17 (12.3) | 49 (19.3) | 43 (25.3) | 0.009 |
| 5–10 | 31 (22.5) | 59 (23.2) | 44 (25.9) | ||
| 11–15 | 39 (28.3) | 73 (28.7) | 52 (30.6) | ||
| > 15 | 51 (37.0) | 73 (28.7) | 31 (18.2) | ||
| Department | Internal medicine | 96 (69.6) | 170 (66.9) | 125 (73.5) | 0.192 |
| Surgery | 16 (11.6) | 43 (16.9) | 27 (15.9) | ||
| Other | 26 (18.8) | 41 (16.1) | 18 (10.6) | ||
| Weekly rest time | 2 days | 67 (48.6) | 102 (40.2) | 50 (29.4) | 0.001 |
| 1 day | 51 (37.0) | 109 (42.9) | 70 (41.2) | ||
| None | 20 (14.5) | 43 (16.9) | 50 (29.4) | ||
| Night shift frequency | Once a month or less | 50 (36.2) | 65 (25.6) | 23 (13.5) | < 0.001 |
| 2–3 times/month | 14 (10.1) | 24 (9.4) | 8 (4.7) | ||
| Once a week | 50 (36.2) | 119 (46.9) | 77 (45.3) | ||
| 2–3 times/week | 24 (17.4) | 46 (18.1) | 62 (36.5) | ||
| Income(CNY) | < 5000 | 10 (7.2) | 13 (5.1) | 19 (11.2) | < 0.001 |
| 5000–10,000 | 47 (34.1) | 124 (48.8) | 95 (55.9) | ||
| 10,000–15,000 | 56 (40.6) | 85 (33.5) | 45 (26.5) | ||
| > 15,000 | 25 (18.1) | 32 (12.6) | 11 (6.5) | ||
| Empathic satisfaction disorder | Yes | 65 (47.1) | 196 (77.2) | 156 (91.8) | < 0.001 |
| No | 73 (52.9) | 58 (22.8) | 14 (8.2) | ||
| Job burnout | Yes | 44 (31.9) | 131 (51.6) | 144 (84.7) | < 0.001 |
| No | 94 (68.1) | 123 (48.4) | 26 (15.3) | ||
| Secondary traumatic stress | Yes | 112 (81.2) | 238 (93.7) | 169 (99.4) | < 0.001 |
| No | 26 (18.8) | 16 (6.3) | 1 (0.6) |
Data are expressed as number (percentage) unless otherwise stated. SD, standard deviation
Discussion
Our study identified 291 physicians with severe empathy fatigue; 75.4% of the participating physicians had thought about resigning. Working weekends and two or three night shifts per week were factors associated with empathy fatigue; working two or three night shifts per week was also associated with severe empathy fatigue. In turn, empathy fatigue was associated with thoughts of resigning.
Few studies have been performed on empathy fatigue in physicians. Research in oncologists suggested that a quarter experience high levels of compassion satisfaction, with a quarter at risk of compassion fatigue [17]. A separate study found that oncologists reported high levels of secondary traumatic stress and compassion satisfaction [18]. Secondary traumatic stress scores were 17.18 (SD = 7.02, range = 3–39). Similarly, job burnout levels were high, with an average score of 26.74 (SD = 6.76, range = 4–41). In a study of 914 junior doctors conducted by Markwell et al., 54% experienced empathy fatigue [19]. Our study found a higher proportion of doctors with empathy fatigue than that reported in previous studies, which may be related to the COVID-19 pandemic. During the pandemic, doctors experienced sustained high-intensity work pressure and mental stress, which have not improved since the end of the pandemic [20]. This may also be related to the high workload of physicians in China, who, according to a 2017 white paper, work more than 50 h per week on average, far exceeding the legal full-time work week of 40 h. These long working hours are compounded by an inability to take vacation time, with only 24% of physicians taking their full allotment of annual leave, 48% taking less, and 23.6% forgoing vacation altogether [21]. Approximately 40% of physicians sleep less than six hours per day [22]. Our study found that 51.8% of physicians had severe empathy fatigue, which is consistent with the findings of previous studies. A survey of 174 psychiatric nurses in 12 public hospitals in Greece revealed that 44.8% were at a high risk of empathy fatigue [23]. Cho et al. found that 72% of 171 oncology nurses had moderate-to-high levels of empathy fatigue [24]. We found the phenomenon of empathy fatigue among physicians is relatively serious. Studies have shown that serious empathy fatigue among medical staff affects the quality and safety of medical services, not only affecting the quality of diagnosis and treatment of patients but also the physical and mental health of medical staff [4, 5, 25, 26]. We call on the global society to acknowledge and address empathy fatigue in doctors to avoid more serious consequences.
Studies have shown that empathy fatigue is influenced by factors including sex, age, marital status, years of work, shift pattern, and leave [27–29]. Jasperse et al. showed that job-related factors such as years of work, work department, shift pattern, and workload, as well as hospital characteristics, were significantly correlated with empathy fatigue and job burnout [30]. Oktay et al. pointed out that almost all nurses experience a low-to-moderate degree of empathy fatigue, which was affected by factors including age, years of work, marital status, and hospital type [31]. Our finding that working weekends and two or three night shifts per week was significantly associated with empathy fatigue is consistent with the results of a previous study, which showed that working more than 60 h and two or more night shifts per week was associated with anxiety or depressive symptoms [32]. When doctors work long hours and night shifts, their sense of accomplishment and emotional engagement are affected. It is therefore necessary to ensure that doctors have sufficient rest time to increase their energy and enthusiasm for their work [33].
We found that the majority of physicians had thought of resigning, which is consistent with a previous survey of 1414 residents that classified nearly half (47.87%) into ‘high’ and ‘very high’ turnover intention level; 11.46% ‘often’ thought about quitting [34]. Our findings are also similar to the reported proportion of rural health workers from 11 western provinces in China (29.1%) [35] and one teaching hospital in central China (37.8%) [36] who have thought about resigning. Internationally, the percentage was also similar to that among general surgery residents in Canada (32.0%) [37] and also higher than that reported in the USA (20.0%) [38] and general internal medicine residents in Switzerland (21.0%) [39]. Similarly, consistent with previous studies, our study found that job burnout can significantly affect thoughts of resigning. Longer years of work and longer weekly working hours were associated with greater job burnout, a diminished sense of belonging, and increased thoughts of resigning [30–32, 40–42].
Our study found that a large proportion of physicians have empathy fatigue, with some having severe empathy fatigue. Empathy fatigue among physicians was associated with thoughts of resigning. This study provides evidence for hospital administrators showing the importance of addressing empathy fatigue in physicians and not only in nurses in specific departments, as addressed in prior studies. It is hoped that hospital managers undertake corresponding measures to improve empathy fatigue in physicians to prevent the continued loss of medical staff. Our study also had some limitations. Our analyses primarily focus on correlations rather than causal inference, hence our findings may be susceptible to confounding bias. The sample size of the present survey was not small, further describing the current situation of empathy fatigue among physicians in China. However, because we used convenience and snowball sampling, there is a lack of generalizability in the present study. In the future, there needs to be a larger sample size for Empathy fatigue among physicians in China.
Conclusions
This survey of hospital physicians in Southwest China shows that the majority are experiencing severe empathy fatigue and have considered resigning, thus providing reference data that demonstrate the extent of this issue. Efforts are needed to address empathy fatigue in physicians and therefore increase physician retention. This may involve ensuring enough rest time and altering shift patterns, both factors identified here as being associated with empathy fatigue. We call on global societies and governments to address empathy fatigue among physicians. We hope that health authorities can take effective measures to intervene, considering the most effective intervention measures without increasing the burden on physicians.
Electronic Supplementary Material
Below is the link to the electronic supplementary material.
Acknowledgements
We thank all the clincians for their cooperation.
Abbreviations
- CI
Confidence interval
- OR
Odds ratio
Author contributions
Qing Ye, Xuemin Zhong and Gongbo Li were responsible for the study conception and design. Qingye, Xuemin Zhong and Qiang Zhou were responsible for the data collection and the first draft of the paper.Qingye, Xuemin Zhong and Hua Liu were responsible for the final manuscript and data analysis. All authors have read and approved the final manuscript for publication.
Funding
None.
Data availability
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
This study was approved by the Medical and Health Research Ethics Committee of the Affiliated Hospital of Southwest Jiaotong University. Informed consent was obtained from all the participants, and confidentiality was guaranteed. All methods were carried out in accordance with relevant guidelines and regulations.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Contributor Information
Hua Liu, Email: hxliumedidoctor@163.com.
Gongbo Li, Email: ligongbo@hospital.cqmu.edu.cn.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.