cardioКардиологияKardiologiia0022-90402412-5660Kardiomag10.18087/cardio.2021.6.n1538cardio-1538Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИRESEARCH ARTICLESОсобенности профессионального выгорания, психологического статуса и качества жизни врачей терапевтического профиля амбулаторно-поликлинического звена здравоохраненияOccupational Burnout, Psychological Status and Quality of Life in Primary Care Physicians Working in Outpatient Settingshttps://orcid.org/0000-0002-4165-804XПогосоваН. В.PogosovaN. V.

Заместитель генерального директора по научно-аналитической работе и профилактической кардиологии, профессор, д.м.н.

Deputy General Director for Scientific and Analytical Work and Preventive Cardiology, Professor, MD,PhD

nanapogosova@gmail.comИсаковаС. С.IsakovaS. S.

врач

therapeutic

svetnaklene@mail.ruСоколоваО. Ю.SokolovaO. Y.

старший научный сотрудник, к.м.н.

Leading researcher, Ph.D.

birdname@gmail.comhttps://orcid.org/0000-0001-9794-7484АушеваА. К.AushevaA. K.

ведущий научный сотрудник, к.м.н.

Leading researcher, Ph.D.

azaausheva3011@gmail.comЖетишеваР. А.ZhetishevaR. A.

Младший научный сотрудник

Research assistant

merowa@bk.ruhttps://orcid.org/0000-0003-1577-3623АрутюновА. А.ArutyunovA. A.

Младший научный сотрудник

Research assistant

arutyunov.md@gmail.comФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, МоскваРоссияNational Medical Research Center of Cardiology, MoscowRussian FederationООО «МСЧ 14», МоскваРоссияOOO «MSCH 14», MoscowRussian Federation2021010720216166978Copyright © Kardiomag, 20212021KardiomagKardiomaghttps://cardio.elpub.ru/jour/about/submissions#copyrightNoticehttps://cardio.elpub.ru/jour/article/view/1538

Цель    Изучить особенности психологического статуса, синдрома профессионального выгорания (СПВ) и качества жизни (КЖ) у врачей терапевтического профиля, работающих в амбулаторно-поликлиническом звене здравоохранения.

Материал и методы  Проведено поперечное исследование на базе 16 отобранных случайным образом городских поликлиник Москвы, в которое включались врачи терапевтического профиля (участковые врачи, врачи общей практики, кардиологи). После подписания информированного согласия участниками заполнялась индивидуальная регистрационная карта, включающая основные социально-демографические (пол, возраст, образование, занимаемая должность) и профессиональные характеристики (специализация, стаж работы, наличие квалификационной категории), а также опросники. Степень профессионального выгорания оценивалась с помощью Опросника выгорания Маслач (MBI-HSS), наличие тревожной и депрессивной симптоматики оценивалось с помощью Госпитальной шкалы тревоги и депрессии (HADS). Для оценки уровня стресса использовалась визуальная аналоговая шкала (ВАШ) с диапазоном значений от 0 до 10 баллов. Для изучения КЖ врачей использовался Краткий опросник Всемирной организации здравоохранения для оценки качества жизни (WHOQOL-BREF).

Результаты   В исследование включены 108 врачей из 16 городских поликлиник в возрасте от 24 до 70 лет (средний возраст 44,0±13,1 года), преимущественно женщины (87,0 %). Из компонентов СПВ высокий уровень эмоционального истощения выявлен у 50,0 % врачей, высокий уровень деперсонализации – у 34,1 %, высокий уровень редукции личных достижений – у 37,5 %. Высокий уровень стресса (≥7 баллов по ВАШ) был обнаружен у 66,3 % врачей; тревожная и депрессивная симптоматика любой степени выраженности (≥8 баллов по подшкалам HADS-A и HADS-D) выявлена у 23,8 и 22,7 % участников соответственно. Доля врачей, оценивших свое КЖ ниже, чем «хорошо», составила 42,0 %; доля врачей, которые оценили свое состояние здоровья ниже, чем «хорошо», – 41,6 %. Большинство изученных факторов не имели достоверных различий в зависимости от пола и стажа работы участников, за исключением эмоционального истощения (у 55,3 % женщин и 16,7 % мужчин; p=0,0086) и высокого уровня стресса (у 72,2 % женщин и 28,6 % мужчин; р=0,002).

Заключение     Выявлена высокая распространенность персональных факторов, потенциально неблагоприятно влияющих на работу врачей амбулаторно-поликлинического звена здравоохранения: высокого уровня стресса, тревожной и депрессивной симптоматики, профессионального выгорания, неудовлетворительного КЖ и низкой удовлетворенности состоянием собственного здоровья. Необходимо принятие управленческих решений и мер по созданию оптимального для врачей психологического климата на рабочем месте, разработке новых стратегий профилактики и коррекции психологического состояния врачей, а также внедрению комплексных программ, направленных на оздоровление профессиональной среды с целью сохранения и укрепления психического здоровья и повышения профессионального престижа врачебной специальности.

Aim      To study features of the psychological status, job burnout syndrome (JBS)m and quality of life (QoL) in outpatient physicians.

Material and methods  This cross-sectional study was performed at 16 randomly selected municipal outpatient hospitals of Moscow and included physicians (district physicians, primary care physicians, and cardiologists). The participants signed an informed consent form and then filled out a registration card that included major social and demographic (sex, age, education, position) and professional characteristics (specialization, work experience, qualification category), and questionnaires. The degree of job burnout was evaluated with the Maslach Burnout Inventory (MBI-HSS), and the presence of anxio-depressive symptoms was evaluated with the Hospital Anxiety and Depression Scale (HADS). The level of stress was assessed with a visual analogue scale (VAS) in a score range from 0 to 10. The QoL of physicians was assessed with the short version of the World Health Organization Quality of Life (HOQOL-BREF) questionnaire.

Results This study included 108 physicians from 16 municipal outpatient clinics aged 24 to 70 years (mean age, 44.0±13.1 years), mostly women (87.0 %). Among JBS components, a high level of emotional exhaustion was observed in 50.0 % of physicians, a high level of depersonalization in 34.1 %, and a severe reduction of personal accomplishment in 37.5 %. A high level of stress (VAS score ≥7) was observed in 66.3 % of physicians; symptoms of anxiety and depression of any degree (HADS-A and HADS-D subscale score ≥ 8) were found in 23.8 and 22.7 % of participants, respectively. 42.0% of physicians evaluated their QoL lower than “good” and 41.6% of physicians evaluated their health condition lower than “good”. Most of the studied factors did not significantly depend on the gender and the duration of work, except for emotional exhaustion (55.3 % of women and 16.7 % of men; p=0.0086) and a high level of stress (72.2 % of women and 28.6 % of men; р=0.002).

Conclusion      The study showed a high prevalence of personal factors that potentially adversely affect the work of outpatient physicians. These factors included high degrees of stress, anxio-depressive symptoms, job burnout, unsatisfactory QoL, and low satisfaction with own health. Management decisions and actions are required to create the optimum psychological climate at the workplace of physicians, to develop new strategies for prophylaxis and correction of their psychological condition, and to implement comprehensive programs for improving the professional environment to maintain and enhance the mental health and to increase the professional prestige of the medical speciality.

Первичное звено здравоохраненияпрофессиональное выгораниетревожностьдепрессиястрессPrimary health carejob burnoutanxietydepressionstressКонфликт интересов не заявлен.No conflict of interest is reported.ReferencesRotenstein LS, Torre M, Ramos MA, Rosales RC, Guille C, Sen S et al. Prevalence of Burnout Among Physicians: A Systematic Review. JAMA. 2018;320(11):1131–50. DOI: 10.1001/jama.2018.12777Rotenstein LS, Torre M, Ramos MA, Rosales RC, Guille C, Sen S et al. Prevalence of Burnout Among Physicians: A Systematic Review. JAMA. 2018;320(11):1131–50. DOI: 10.1001/jama.2018.12777Kim MH, Mazenga AC, Simon K, Yu X, Ahmed S, Nyasulu P et al. Burnout and self-reported suboptimal patient care amongst health care workers providing HIV care in Malawi. PLOS ONE. 2018;13(2):e0192983. DOI: 10.1371/journal.pone.0192983Kim MH, Mazenga AC, Simon K, Yu X, Ahmed S, Nyasulu P et al. Burnout and self-reported suboptimal patient care amongst health care workers providing HIV care in Malawi. PLOS ONE. 2018;13(2):e0192983. DOI: 10.1371/journal.pone.0192983Saijo Y, Chiba S, Yoshioka E, Kawanishi Y, Nakagi Y, Ito T et al. Job stress and burnout among urban and rural hospital physicians in Japan. Australian Journal of Rural Health. 2013;21(4):225–31. DOI: 10.1111/ajr.12040Saijo Y, Chiba S, Yoshioka E, Kawanishi Y, Nakagi Y, Ito T et al. Job stress and burnout among urban and rural hospital physicians in Japan. Australian Journal of Rural Health. 2013;21(4):225–31. DOI: 10.1111/ajr.12040Freudenberger HJ. Staff Burn-Out. Journal of Social Issues. 1974;30(1):159–65. DOI: 10.1111/j.1540-4560.1974.tb00706.xFreudenberger HJ. Staff Burn-Out. Journal of Social Issues. 1974;30(1):159–65. DOI: 10.1111/j.1540-4560.1974.tb00706.xMaslach C, Schaufeli WB, Leiter MP. Job Burnout. Annual Review of Psychology. 2001;52(1):397–422. DOI: 10.1146/annurev.psych.52.1.397Maslach C, Schaufeli WB, Leiter MP. Job Burnout. Annual Review of Psychology. 2001;52(1):397–422. DOI: 10.1146/annurev.psych.52.1.397Kumar S. Burnout and Doctors: Prevalence, Prevention and Intervention. Healthcare. 2016;4(3):37–46. DOI: 10.3390/healthcare4030037Kumar S. Burnout and Doctors: Prevalence, Prevention and Intervention. Healthcare. 2016;4(3):37–46. DOI: 10.3390/healthcare4030037West CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: a systematic review and metaanalysis. The Lancet. 2016;388(10057):2272–81. DOI: 10.1016/S0140-6736(16)31279-XWest CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: a systematic review and metaanalysis. The Lancet. 2016;388(10057):2272–81. DOI: 10.1016/S0140-6736(16)31279-XShanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D et al. Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population. Archives of Internal Medicine. 2012;172(18):1377–85. DOI: 10.1001/archinternmed.2012.3199Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D et al. Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population. Archives of Internal Medicine. 2012;172(18):1377–85. DOI: 10.1001/archinternmed.2012.3199Shanafelt T, Goh J, Sinsky C. The Business Case for Investing in Physician Well-being. JAMA Internal Medicine. 2017;177(12):1826–32. DOI: 10.1001/jamainternmed.2017.4340Shanafelt T, Goh J, Sinsky C. The Business Case for Investing in Physician Well-being. JAMA Internal Medicine. 2017;177(12):1826–32. DOI: 10.1001/jamainternmed.2017.4340Shanafelt TD, Hasan O, Dyrbye LN, Sinsky C, Satele D, Sloan J et al. Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. Mayo Clinic Proceedings. 2015;90(12):1600–13. DOI: 10.1016/j.mayocp.2015.08.023Shanafelt TD, Hasan O, Dyrbye LN, Sinsky C, Satele D, Sloan J et al. Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. Mayo Clinic Proceedings. 2015;90(12):1600–13. DOI: 10.1016/j.mayocp.2015.08.023West CP, Dyrbye LN, Sinsky C, Trockel M, Tutty M, Nedelec L et al. Resilience and Burnout Among Physicians and the General US Working Population. JAMA Network Open. 2020;3(7):e209385. DOI: 10.1001/jamanetworkopen.2020.9385West CP, Dyrbye LN, Sinsky C, Trockel M, Tutty M, Nedelec L et al. Resilience and Burnout Among Physicians and the General US Working Population. JAMA Network Open. 2020;3(7):e209385. DOI: 10.1001/jamanetworkopen.2020.9385Jager AJ, Tutty MA, Kao AC. Association Between Physician Burnout and Identification With Medicine as a Calling. Mayo Clinic Proceedings. 2017;92(3):415–22. DOI: 10.1016/j.mayocp.2016.11.012Jager AJ, Tutty MA, Kao AC. Association Between Physician Burnout and Identification With Medicine as a Calling. Mayo Clinic Proceedings. 2017;92(3):415–22. DOI: 10.1016/j.mayocp.2016.11.012Shanafelt TD, Mungo M, Schmitgen J, Storz KA, Reeves D, Hayes SN et al. Longitudinal Study Evaluating the Association Between Physician Burnout and Changes in Professional Work Effort. Mayo Clinic Proceedings. 2016;91(4):422–31. DOI: 10.1016/j.mayocp.2016.02.001Shanafelt TD, Mungo M, Schmitgen J, Storz KA, Reeves D, Hayes SN et al. Longitudinal Study Evaluating the Association Between Physician Burnout and Changes in Professional Work Effort. Mayo Clinic Proceedings. 2016;91(4):422–31. DOI: 10.1016/j.mayocp.2016.02.001Кобякова О.С., Деев И.А., Куликов Е.С., Пименов И.Д., Хомяков К.В. Эмоциональное выгорание у врачей и медицинские ошибки. Есть ли связь? Социальные аспекты здоровья населения. 2016;1(47):1-5. DOI: 10.21045/2071-5021-2016-47-1-5Kobyakova O.S., Deev I.A., Kulikov E.S., Pimenov I.D., Khomyakov K.V. Burnout in doctors and medical errors. Is there a connection? Social Aspects of Population Health. 2016;1(47):1–5. DOI: 10.21045/2071-5021-2016-47-1-5Aiken LH, Sermeus W, Van den Heede K, Sloane DM, Busse R, McKee M et al. Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ. 2012;344:e1717. DOI: 10.1136/bmj.e1717Aiken LH, Sermeus W, Van den Heede K, Sloane DM, Busse R, McKee M et al. Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ. 2012;344:e1717. DOI: 10.1136/bmj.e1717Salyers MP, Bonfils KA, Luther L, Firmin RL, White DA, Adams EL et al. The Relationship Between Professional Burnout and Quality and Safety in Healthcare: A Meta-Analysis. Journal of General Internal Medicine. 2017;32(4):475–82. DOI: 10.1007/s11606-016-3886-9Salyers MP, Bonfils KA, Luther L, Firmin RL, White DA, Adams EL et al. The Relationship Between Professional Burnout and Quality and Safety in Healthcare: A Meta-Analysis. Journal of General Internal Medicine. 2017;32(4):475–82. DOI: 10.1007/s11606-016-3886-9Ahola K, Väänänen A, Koskinen A, Kouvonen A, Shirom A. Burnout as a predictor of all-cause mortality among industrial employees: A 10-year prospective register-linkage study. Journal of Psychosomatic Research. 2010;69(1):51–7. DOI: 10.1016/j.jpsychores.2010.01.002Ahola K, Väänänen A, Koskinen A, Kouvonen A, Shirom A. Burnout as a predictor of all-cause mortality among industrial employees: A 10-year prospective register-linkage study. Journal of Psychosomatic Research. 2010;69(1):51–7. DOI: 10.1016/j.jpsychores.2010.01.002Oreskovich MR, Kaups KL, Balch CM, Hanks JB, Satele D, Sloan J et al. Prevalence of Alcohol Use Disorders Among American Surgeons. Archives of Surgery. 2012;147(2):168–74. DOI: 10.1001/archsurg.2011.1481Oreskovich MR, Kaups KL, Balch CM, Hanks JB, Satele D, Sloan J et al. Prevalence of Alcohol Use Disorders Among American Surgeons. Archives of Surgery. 2012;147(2):168–74. DOI: 10.1001/archsurg.2011.1481Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C et al. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA. 2016;316(21):2214–36. DOI: 10.1001/jama.2016.17324Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C et al. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA. 2016;316(21):2214–36. DOI: 10.1001/jama.2016.17324Mata DA, Ramos MA, Bansal N, Khan R, Guille C, Di Angelantonio E et al. Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis. JAMA. 2015;314(22):2373–83. DOI: 10.1001/jama.2015.15845Mata DA, Ramos MA, Bansal N, Khan R, Guille C, Di Angelantonio E et al. Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis. JAMA. 2015;314(22):2373–83. DOI: 10.1001/jama.2015.15845Pereira-Lima K, Mata DA, Loureiro SR, Crippa JA, Bolsoni LM, Sen S. Association Between Physician Depressive Symptoms and Medical Errors: A Systematic Review and Meta-analysis. JAMA Network Open. 2019;2(11):e1916097. DOI: 10.1001/jamanetworkopen.2019.16097Pereira-Lima K, Mata DA, Loureiro SR, Crippa JA, Bolsoni LM, Sen S. Association Between Physician Depressive Symptoms and Medical Errors: A Systematic Review and Meta-analysis. JAMA Network Open. 2019;2(11):e1916097. DOI: 10.1001/jamanetworkopen.2019.16097Petrie K, Crawford J, Baker STE, Dean K, Robinson J, Veness BG et al. Interventions to reduce symptoms of common mental disorders and suicidal ideation in physicians: a systematic review and meta-analysis. The Lancet Psychiatry. 2019;6(3):225–34. DOI: 10.1016/S2215-0366(18)30509-1Petrie K, Crawford J, Baker STE, Dean K, Robinson J, Veness BG et al. Interventions to reduce symptoms of common mental disorders and suicidal ideation in physicians: a systematic review and meta-analysis. The Lancet Psychiatry. 2019;6(3):225–34. DOI: 10.1016/S2215-0366(18)30509-1Жевелик О.Д., Дзюман Е.М., Михеева Г.Ф. Эмоциональное «выгорание» среди медицинских работников сферы психического здоровья. Здравоохранение Югры: опыт и инновации. 2017;1(10):34-7Zhevelik O.D., Dzyuman E.M., Mikheeva G.F. Emotional burnout among mental health professionals. Ugra health care: experience and innovations. 2017;1(10):34–7.Panagioti M, Geraghty K, Johnson J, Zhou A, Panagopoulou E, ChewGraham C et al. Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction: A Systematic Review and Meta-analysis. JAMA Internal Medicine. 2018;178(10):1317–31. DOI: 10.1001/jamainternmed.2018.3713Panagioti M, Geraghty K, Johnson J, Zhou A, Panagopoulou E, ChewGraham C et al. Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction: A Systematic Review and Meta-analysis. JAMA Internal Medicine. 2018;178(10):1317–31. DOI: 10.1001/jamainternmed.2018.3713Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory (MBI). 4th editon. [Internet] Available at: https://www.mindgarden.com/maslach-burnout-inventory-mbi/685-mbi-manual.htmlMaslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory (MBI). 4th editon. [Internet] Available at: https://www.mindgarden.com/maslach-burnout-inventory-mbi/685-mbi-manual.htmlZigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica. 1983;67(6):361–70. PMID: 6880820Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica. 1983;67(6):361–70. PMID: 6880820World Health Organization. WHOQOL-BREF : introduction, administration, scoring and generic version of the assessment: field trial version, December 1996. [Internet] Available at: https://www.who.int/publications-detail-redirect/WHOQOL-BREFWorld Health Organization. WHOQOL-BREF : introduction, administration, scoring and generic version of the assessment: field trial version, December 1996. [Internet] Available at: https://www.who.int/publications-detail-redirect/WHOQOL-BREFЦветкова Л.А., Яковлев Г.М. Актуальные проблемы клинической психологии и психофизиологии: материалы науч.-практ. конф. ‘Ананьев. чтения – 2004’, 26–28 окт. 2004 г. (С.189–190).–СПб.: Изд-во С.-Петерб. ун-та, 2004. – 304с. ISBN 5-288-03534-2Tsvetkova L.A., Yakovlev G.N. Current problems of clinical psychology and psychophysiology: materials of the scientific and practical conference ‘Ananyev. readings-2004’, October 26-28, 2004. (P. 189-190). -SPb.: Publishing House of St. Petersburg University;2004. – 304 p. ISBN 5-288-03534-2de Oliveira GS, Chang R, Fitzgerald PC, Almeida MD, CastroAlves LS, Ahmad S et al. The Prevalence of Burnout and Depression and Their Association with Adherence to Safety and Practice Standards: A Survey of United States Anesthesiology Trainees. Anesthesia & Analgesia. 2013;117(1):182–93. DOI: 10.1213/ANE.0b013e3182917da9de Oliveira GS, Chang R, Fitzgerald PC, Almeida MD, CastroAlves LS, Ahmad S et al. The Prevalence of Burnout and Depression and Their Association with Adherence to Safety and Practice Standards: A Survey of United States Anesthesiology Trainees. Anesthesia & Analgesia. 2013;117(1):182–93. DOI: 10.1213/ANE.0b013e3182917da9Fahrenkopf AM, Sectish TC, Barger LK, Sharek PJ, Lewin D, Chiang VW et al. Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ. 2008;336(7642):488–91. DOI: 10.1136/bmj.39469.763218.BEFahrenkopf AM, Sectish TC, Barger LK, Sharek PJ, Lewin D, Chiang VW et al. Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ. 2008;336(7642):488–91. DOI: 10.1136/bmj.39469.763218.BESonneck G, Etzersdorfer E, Nagel-Kuess S. Imitative suicide on the Viennese subway. Social Science & Medicine. 1994;38(3):453–7. DOI: 10.1016/0277-9536(94)90447-2Sonneck G, Etzersdorfer E, Nagel-Kuess S. Imitative suicide on the Viennese subway. Social Science & Medicine. 1994;38(3):453–7. DOI: 10.1016/0277-9536(94)90447-2Soler JK, Yaman H, Esteva M, Dobbs F, Asenova RS, Katic M et al. Burnout in European family doctors: the EGPRN study. Family Practice. 2008;25(4):245–65. DOI: 10.1093/fampra/cmn038Soler JK, Yaman H, Esteva M, Dobbs F, Asenova RS, Katic M et al. Burnout in European family doctors: the EGPRN study. Family Practice. 2008;25(4):245–65. DOI: 10.1093/fampra/cmn038Ogus ED, Grenglass ER, Burke RJ. Gender-role differences, work stress and depersonalization. Journal of Social Behavior and Personality. 1990;5(5):387–98Ogus ED, Grenglass ER, Burke RJ. Gender-role differences, work stress and depersonalization. Journal of Social Behavior and Personality. 1990;5(5):387–98Евдокимов В.И., Есауленко И.Э., Губин А.И., Попов В.И. Оценка профессионального выгорания у медицинских работников. Методические Рекомендации. –СПб.: Политехника, 2009. - 82с. ISBN 978-5-904031-08-4Evdokimov V.I., Esaulenko I.E., Gubin A.I., Popov V.I. Assessment of professional burnout in healthcare workers. Methodological Recommendations. -SPb.: Polytechnic;2009. - 82 p. ISBN 978-5-904031-08-4Логутова Е.В. Гендерные особенности проявления синдрома профессионального выгорания у медицинских работников. Азимут Научных Исследований: педагогика и психология. 2017;6(2):268-71Logutova E.V. Gender features of the professional burnout syndrome in medical workers. Azimuth of Scientific Research: pedagogy and psychology. 2017;6(2):268–71.Водопьянова Н.Е., Старченкова Е.С. Синдром выгорания: диагностика и профилактика. - М.: Питер, 2005. - 336с. ISBN 978-5-469-00289-5Vodopyanova N.E., Starchenkova E.S. Burnout syndrome: diagnosis and prevention. -M.: Piter;2005. - 336 p. ISBN 978-5-469-00289-5Волобаев В.М. К вопросу о клиническом подходе к диагностике синдрома эмоционального выгорания. Психотерапия. 2008:6;23-4]Volobaev V.M. On the question of the clinical approach to the diagnosis of burnout syndrome. Psychotherapy. 2008;6:23–4.del Carmen MG, Herman J, Rao S, Hidrue MK, Ting D, Lehrhoff SR et al. Trends and Factors Associated With Physician Burnout at a Multispecialty Academic Faculty Practice Organization. JAMA Network Open. 2019;2(3):e190554. DOI: 10.1001/jamanetworkopen.2019.0554del Carmen MG, Herman J, Rao S, Hidrue MK, Ting D, Lehrhoff SR et al. Trends and Factors Associated With Physician Burnout at a Multispecialty Academic Faculty Practice Organization. JAMA Network Open. 2019;2(3):e190554. DOI: 10.1001/jamanetworkopen.2019.0554

The authors declare that there are no conflicts of interest present.