Need for recovery amongst emergency physicians in the UK and Ireland: a cross-sectional survey

Abstract

Objectives: To determine the need for recovery (NFR) among emergency physicians and to identify demographic and occupational characteristics associated with higher NFR scores.

Design: Cross-sectional electronic survey.

Setting: Emergency departments (EDs) (n=112) in the UK and Ireland.

Participants: Emergency physicians, defined as any registered physician working principally within the ED, responding between June and July 2019.

Main outcome measure: NFR Scale, an 11-item self-administered questionnaire that assesses how work demands affect intershift recovery.

Results: The median NFR Score for all 4247 eligible, consented participants with a valid NFR Score was 70.0 (95% CI: 65.5 to 74.5), with an IQR of 45.5-90.0. A linear regression model indicated statistically significant associations between gender, health conditions, type of ED, clinical grade, access to annual and study leave, and time spent working out-of-hours. Groups including male physicians, consultants, general practitioners (GPs) within the ED, those working in paediatric EDs and those with no long-term health condition or disability had a lower NFR Score. After adjusting for these characteristics, the NFR Score increased by 3.7 (95% CI: 0.3 to 7.1) and 6.43 (95% CI: 2.0 to 10.8) for those with difficulty accessing annual and study leave, respectively. Increased percentage of out-of-hours work increased NFR Score almost linearly: 26%-50% out-of-hours work=5.7 (95% CI: 3.1 to 8.4); 51%-75% out-of-hours work=10.3 (95% CI: 7.6 to 13.0); 76%-100% out-of-hours work=14.5 (95% CI: 11.0 to 17.9).

Conclusion: Higher NFR scores were observed among emergency physicians than reported in any other profession or population to date. While out-of-hours working is unavoidable, the linear relationship observed suggests that any reduction may result in NFR improvement. Evidence-based strategies to improve well-being such as proportional out-of-hours working and improved access to annual and study leave should be carefully considered and implemented where feasible.

Keywords: accident & emergency medicine; health services administration & management; human resource management; occupational & industrial medicine; organisation of health services.

Figure 1

Box plots of Need for Recovery (NFR) Score by participant demographic characteristics, excluding any participants who did not respond to the question (ie, missing). Plot (A) age group in years; (B) gender; (C) clinical grade; (D) any long-term health condition or disability. ST1-ST2, specialist training year 1–2 (this included physicians training in anaesthetics, emergency medicine (EM), acute medicine and general practice); SASG, EM staff grade, associate specialist and specialty grade physician; GP, general practitioner working within the emergency department (ED).

Figure 2

Box plot of Need for Recovery (NFR) Score by participant’s occupational characteristics, excluding any participants who does not respond to the question (ie, missing). Plot (A) ability to obtain study leave when requested; (B) ability to obtain annual leave when requested; (C) proportion of time working out-of-hours; (D) working in paediatrics emergency departments (ED) only.