title: The effects of fatigue and dissatisfaction on how physicians perceive their social responsibilities.
abstract: OBJECTIVE
  To examine how fatigue and dissatisfaction with practicing medicine relate to US physicians' perceptions of their professional responsibilities in a time of upheaval in health care.
  
  
  METHODS
  From May 30, 2012, through September 1, 2012, we mailed an 8-page paper survey, including measures of perceived social responsibility, fatigue, and satisfaction, to a random sample of 3897 physicians selected from the American Medical Association Physician Masterfile. We performed bivariate tests and multivariable logistic regression to examine associations between key predictors (fatigue and satisfaction) and 3 dependent variables: obligations to care for the uninsured and underinsured, obligations to address policy issues, and agreement with cost-containment.
  
  
  RESULTS
  A total of 2556 physicians (65.6%) responded to the survey. Nearly half of physicians (1160 [45.4%]) reported high levels of fatigue, whereas most (1810 [70.8%]) expressed satisfaction with practicing medicine. Dissatisfaction in practicing medicine proved to be a significant predictor in how physicians perceive their professional responsibilities and in medical decision-making. Overall, physicians who rated themselves as very dissatisfied had a significantly reduced likelihood of favoring limiting reimbursement to expand basic coverage (odds ratio, 0.5; 95% CI, 0.3-0.7), recognizing an obligation to care for the uninsured (odds ratio, 0.5; 95% CI, 0.3-0.7), and addressing societal health policy issues (OR, 0.7; 95% CI, 0.5-0.9).
  
  
  CONCLUSIONS
  Although fatigue and satisfaction are strongly associated, only satisfaction appears to correlate with physicians' perceived social responsibilities. Physicians who are dissatisfied with their profession may be less inclined to address health policy issues, embrace charity care, or practice cost containment.
authors: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors: Erin P
authors: EP
authors: O'Donnell
authors: Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN.
authors: Katherine M
authors: KM
authors: Humeniuk
authors: Division of General Internal Medicine, Mayo Clinic, Rochester, MN; Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
authors: Colin P
authors: CP
authors: West
authors: Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN; Division of General Internal Medicine, Mayo Clinic, Rochester, MN; Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN. Electronic address: Tilburt.jon@mayo.edu.
authors: Jon C
authors: JC
authors: Tilburt
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D005221:Fatigue / Q000523:psychology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000523:psychology*; D012941:Social Responsibility; D014481:United States