Associations between confidentiality requirements, support seeking and burnout among university hospital physicians in Norway, Sweden, Iceland and Italy (the HOUPE study)

Occupational stress among Norwegian physicians: A literature review of long-term prospective studies 2007-2019

AIMS

There are signs of increased stress at work among Norwegian physicians over the last decades, not least among general practitioners (GPs). In this review, we identify trends in both occupational stress and adverse work-related predictors of such stress and burnout in Norwegian physicians.

METHODS

We performed an extensive literature search using MEDLINE, Embase and PsycINFO. We included prospective and repeated cross-sectional studies of work stress among Norwegian physicians published in 2007-2019.

RESULTS

Nine studies with observation periods of 1-20 years were included. Occupational stress (global measure) among all doctors decreased gradually from medical school to 20 years later. The prevalence of an effort-reward imbalance increased fourfold among GPs during the period 2010-2019. Five studies reported higher levels of occupational stress among female physicians than among their male colleagues. Work-home conflict levels increased after graduation until 10 years after leaving medical school and plateaued thereafter. Physicians who graduated in a later cohort reported lower levels of work-home conflict and less workplace violence. Work-home conflict, low colleague support, number of work hours and workload/low autonomy were all independent predictors of occupational stress.

CONCLUSIONS

The reduction in occupational stress during the years after leaving medical school may result from increased competency in clinical work and decreased on-call work. The Co-ordination Act implemented in 2012 may explain the increase in occupational stress among GPs. These findings suggest that both reducing work-home conflict and increasing colleague support are important for doctors' well-being.

Exploring Satisfaction and Migration Intentions of Physicians in Three University Hospitals in Poland

Introduction: University hospitals constitute a unique group of health care organizations which traditionally link three functions: (1) providing highly specialized services, (2) teaching activities, and (3) conducting research. Objectives: To assess the level of carrier satisfaction among physicians working in three university hospitals in Poland (1); to assess whether the physicians have the intention to migrate and what the main reasons for migration are (2); and to identify the actions that might be taken at the hospital level to mitigate physicians’ intentions to migrate (3). Methods: Cross-sectional study with both quantitative and qualitative components. In the quantitative part, an online questionnaire was distributed among physicians working in three university hospitals. A total number of 396 questionnaires were analyzed. In the qualitative part, in-depth interviews with six hospital managers were conducted and analyzed using thematic analysis. Results: On a scale from one “very dissatisfied” to six “very satisfied”, the mean career satisfaction of physicians was 4.0 (SD = 0.74). The item with the lowest mean concerned salary level (2.8, SD = 1.41). In the sample, 34% of physicians declared intentions to migrate from Poland. The main reasons for the intention to migrate were: Better working conditions abroad, higher earnings, the ability to maintain better work-life balance, better training opportunities abroad, and problems due to a stressful current workplace. Hospital managers considered the actions that can be taken at the hospital level to mitigate physicians’ migration to be specific to those focused on the working environment. Conclusions: Career development opportunities and features related to the working environment are the main factors influencing physicians’ satisfaction and migration intentions that can be modified at the university hospital level.

Burnout and perceived social support: The mediating role of secondary traumatization in nurses vs. physicians

AIMS

The study aimed to examine differences between paediatric nurses and physicians regarding burnout syndrome, secondary traumatic stress (STS) and perceived social support (PSS).

BACKGROUND

Paediatric nurses and physicians encounter cumulative effects of treating sick and injured children and helping their families, in situations that might promote burnout and STS.

DESIGN

Cross-sectional design.

METHOD

Nurses (n = 158) and physicians (N = 76) completed self-report questionnaires on STS, PSS and burnout.

RESULTS

Nurses and physicians had similar rates of STS and burnout but showed significant differences in PSS. Furthermore, STS mediated the association between PSS and burnout for both groups; however, the effect was stronger for nurses in comparison to physicians.

CONCLUSION

Paediatric nurses and physicians would benefit from participating in interventions geared towards reducing STS, thus minimizing burnout. Moreover, advocating social support within the organization is needed to bolster the ability for coping with sources of stress.

IMPACT STATEMENT

Nurses' and physicians' involvement in the physical, physiological and mental needs of their paediatric patients might lead to burnout and secondary traumatic stress (STS). However, research on social support in the context of burnout and STS among nurses and physicians is scant. Secondary traumatic stress and burnout were similar for nurses and physicians, though perceived social support (PSS) was higher for nurses. Secondary traumatic stress plays a mediating role in the association between PSS and burnout among nurses and physicians. However, the mediation effect was stronger for nurses. Policy makers would be wise to advocate institutional stress management interventions to reduce secondary traumatic and to reinforce organizational support for nurses and physicians.

Potential correlates of burnout among general practitioners and residents in Hungary: the significant role of gender, age, dependant care and experience

BACKGROUND

Burnout is increasingly prevalent among general practitioners (GPs) in Hungary, which may lead to functional impairment and, subsequently, to poor quality of patient care. However, little is known about potential predictors of burnout among GPs. The aim of this study was to explore psychosocial correlates of burnout among GPs and residents in Hungary.

METHODS

We collected socio-demographic and work-related data with self-administered questionnaires in a cross-sectional study among GPs (N = 196) and residents (N = 154). We assessed burnout with the Maslach Burnout Inventory Human Services Survey (MBI-HSS) and calculated the mean level of burnout and the proportion of physicians suffering from low, intermediate and high degree of burnout. To identify potential socio-demographic and work-related correlates of burnout among physicians, we determined Spearman's and Mann-Whitney U correlation coefficients and conducted stepwise linear regression analyses. We deployed Mann-Whitney U test to explore gender disparity in the level of burnout between female and male physicians and between general practitioners and residents.

RESULTS

The prevalence of moderate to high level emotional exhaustion, depersonalisation, and impaired personal accomplishment was 34.7, 33.5 and 67.8% as well as 41.0, 43.1, and 71.1% among GPs and residents, respectively. Residents reported significantly lower level of personal accomplishment vs GPs. We identified a significantly higher level of depersonalization among male physicians compared to female physicians. Age correlated negatively with emotional exhaustion and depersonalization and positively with personal accomplishment among GPs. Dependant care was positively associated with burnout among female GPs. Female residents were more likely to report depersonalization. High workload was positively correlated with depersonalization among female GPs. Younger age emerged as the strongest predictor of emotional exhaustion. Male gender and fewer years of experience predicted depersonalization best, and male gender showed a significant predictive relationship with low personal accomplishment.

CONCLUSION

We identified specific socio-demographic and work-related correlates of burnout, which may guide the development of specific and effective organizational decisions to attenuate occupational stress and subsequent burnout as well as functional impairment among GPs, and thus, may improve the quality of patient care.

A saúde física e mental do profissional médico: uma revisão sistemática

RESUMO O objetivo desta revisão sistemática da literatura foi de identificar as principais doenças que acometem os médicos em todo o mundo, mediante uma pesquisa eletrônica na base de dados Biblioteca Virtual em Saúde (BVS) baseada na metodologia Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Prisma). Foram analisados 57 dos 374 artigos científicos encontrados sobre o tema em inglês, português e espanhol, publicados entre 2005 e 2015. Os resultados encontrados apontaram que os acometimentos mentais prevaleceram, destacando-se o esgotamento profissional (síndrome de burnout). Entre as doenças físicas, predominaram os acometimentos musculoesqueléticos.

Job Stress and Job Satisfaction among Health-Care Workers of Endoscopy Units in Korea

Background/Aims:

The management of job-related stress among health-care workers is critical for the improvement of healthcare services; however, there is no existing research on endoscopy unit workers as a team. Korea has a unique health-care system for endoscopy unit workers. In this study, we aimed to estimate job stress and job satisfaction among health-care providers in endoscopy units in Korea.

Methods:

We performed a cross-sectional survey of health-care providers in the endoscopy units of three university-affiliated hospitals in Korea. We analyzed the job stress levels by using the Korean occupational stress scale, contributing factors, and job satisfaction.

Results:

Fifty-nine workers completed the self-administered questionnaires. The job stress scores for the endoscopy unit workers (46.39±7.81) were relatively lower compared to those of the national sample of Korean workers (51.23±8.83). Job stress differed across job positions, with nurses showing significantly higher levels of stress (48.92±7.97) compared to doctors (42.59±6.37). Job stress and job satisfaction were negatively correlated with each other (R²=0.340, p<0.001).

Conclusions:

An endoscopy unit is composed of a heterogeneous group of health-care professionals (i.e., nurses, fellows, and professors), and job stress and job satisfaction significantly differ according to job positions. Job demand, insufficient job control, and job insecurity are the most important stressors in the endoscopy unit.

University hospitals as drivers of career success: an empirical study of the duration of promotion and promotion success of hospital physicians

BACKGROUND

German hospitals have a well-defined career structure for clinicians. In this hierarchical career system university hospital are stepping stones for career advancement. This longitudinal study investigates the impact of working in university hospitals on the career success of junior physicians and senior physicians.

METHODS

Consideration of the career trajectories of 324 hospital physicians. Discrete-time event history analysis is used to study the influence of working in university hospitals on the chance of promotion from junior physician to senior physician and senior physician to chief physician. A comparison of medians provides information about the impact of working in university hospitals on the duration of promotion to senior and chief physician positions.

RESULTS

Working in university hospitals has a negative impact for advancement to a senior physician position in terms of promotion duration (p = 0.005) and also in terms of promotion success, where a short time span of just 1-2 years in university hospitals has a negative effect (OR = 0.38, p < 0.01), while working there for a medium or long term has no significant effect. However, working in universities has a positive effect on the duration of promotion to a chief physician position (p = 0.079), and working in university hospitals for 3-4 years increases the chance of promotion to a chief physician position (OR = 4.02, p < 0.05), while working there > =7 years decreases this chance (OR = 0.27, p < 0.05). In addition, physicians have a higher chance of promotion to a chief physician position through career mobility when they come to the position from a university hospital.

CONCLUSION

Working at university hospitals has a career-enhancing effect for a senior physician with ambitions to become a chief physician. For junior physicians on the trajectory to a senior physician position, however, university hospitals are not drivers of career success.