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Christiansen F, Gynning BE, Lashari A, Johansson G, Brulin E. Associations between effort-reward imbalance and risk of burnout among Swedish physicians. Occup Med (Lond) 2024; 74:355-363. [PMID: 38970463 DOI: 10.1093/occmed/kqae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2024] Open
Abstract
BACKGROUND The high prevalence of burnout among Swedish physicians may have several possible effects on individuals and society. However, further investigations of work-related factors associated with the risk of burnout among Swedish physicians are needed. AIMS We aimed to study the associations between psychosocial work factors, based on the effort-reward imbalance (ERI) model, and the risk of burnout among Swedish physicians. METHODS A representative sample of 7200 Swedish physicians was invited in 2021. Data were gathered through questionnaires, with a response rate of 41%. Logistic regression models were used to study the associations between exposure to ERI and the risk of burnout. RESULTS Approximately 62% of Swedish physicians were exposed to a high ERI. Exposure to a high ERI was associated with 11 times increased risk (95% confidence interval 6.5-20.0) of burnout in adjusted models. Large variations in the prevalence of ERI and risk of burnout across sociodemographic and occupational factors were identified, particularly across different clinical specialties. CONCLUSIONS A majority of Swedish physicians were exposed to high levels of work-related stress, strongly associated with an increased risk of burnout. This population-based cross-sectional study underlines the need to further study variations of work-related stress across clinical specialties and to monitor occupational health among physicians longitudinally.
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Affiliation(s)
- F Christiansen
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - B E Gynning
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - A Lashari
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - G Johansson
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - E Brulin
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
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Miljeteig I, Førde R, Rø KI, Bååthe F, Bringedal BH. Moral distress among physicians in Norway: a longitudinal study. BMJ Open 2024; 14:e080380. [PMID: 38803245 PMCID: PMC11129035 DOI: 10.1136/bmjopen-2023-080380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 05/10/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVES To explore and compare physicians' reported moral distress in 2004 and 2021 and identify factors that could be related to these responses. DESIGN Longitudinal survey. SETTING Data were gathered from the Norwegian Physician Panel Study, a representative sample of Norwegian physicians, conducted in 2004 and 2021. PARTICIPANTS 1499 physicians in 2004 and 2316 physicians in 2021. MAIN OUTCOME MEASURES The same survey instrument was used to measure change in moral distress from 2004 to 2021. Logistic regression analyses examined the role of gender, age and place of work. RESULTS Response rates were 67% (1004/1499) in 2004 and 71% (1639/2316) in 2021. That patient care is deprived due to time constraints is the most severe dimension of moral distress among physicians, and it has increased as 68.3% reported this 'somewhat' or 'very morally distressing' in 2004 compared with 75.1% in 2021. Moral distress also increased concerning that patients who 'cry the loudest' get better and faster treatment than others. Moral distress was reduced on statements about long waiting times, treatment not provided due to economic limitations, deprioritisation of older patients and acting against one's conscience. Women reported higher moral distress than men at both time points, and there were significant gender differences for six statements in 2021 and one in 2004. Age and workplace influenced reported moral distress, though not consistently for all statements. CONCLUSION In 2004 and 2021 physicians' moral distress related to scarcity of time or unfair distribution of resources was high. Moral distress associated with resource scarcity and acting against one's conscience decreased, which might indicate improvements in the healthcare system. On the other hand, it might suggest that physicians have reduced their ideals or expectations or are morally fatigued.
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Affiliation(s)
- Ingrid Miljeteig
- Bergen Centre for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department for Research and Development, Bergen Hospital Trust, Bergen, Norway
| | - Reidun Førde
- Center for Medical Ethics, University of Oslo Faculty of Medicine, Oslo, Norway
- Institute for Studies of the Medical Profession, Oslo, Norway
| | | | - Fredrik Bååthe
- Institute for Studies of the Medical Profession, Oslo, Norway
- Institute of Stress Medicine, Gothenburg, Sweden
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Oftung B, Tyssen R. Occupational stress among Norwegian physicians: A literature review of long-term prospective studies 2007-2019. Scand J Public Health 2024:14034948241243164. [PMID: 38600437 DOI: 10.1177/14034948241243164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
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.
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Affiliation(s)
- Bendik Oftung
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Reidar Tyssen
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
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Küppers L, Göbel J, Aretz B, Rieger MA, Weltermann B. Associations between COVID-19 Pandemic-Related Overtime, Perceived Chronic Stress and Burnout Symptoms in German General Practitioners and Practice Personnel-A Prospective Study. Healthcare (Basel) 2024; 12:479. [PMID: 38391854 PMCID: PMC10888352 DOI: 10.3390/healthcare12040479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The mental burdens of general practitioners (GPs) and practice assistants (PrAs) during the COVID-19 pandemic are well investigated. Work-related conditions like overtime are known to contribute to perceived chronic stress and burnout symptoms. However, there is limited evidence regarding the specific mechanisms, which link pandemic-related overtime, chronic stress and burnout symptoms. This study used data from the IMPROVEjob trial to improve psychological well-being in general practice personnel. METHODS This prospective study with 226 German GPs and PrAs used the baseline (pre-pandemic: October 2019 to March 2020) and follow-up data (pandemic: October 2020 to April 2021) of the IMPROVEjob trial. Overtime was self-reported as hours above the regular work time. Perceived chronic stress was assessed using the Trier Inventory for the Assessment of Chronic Stress Screening Scale (TICS-SSCS), while burnout symptoms were evaluated using a short version of the Maslach Burnout Inventory (MBI). A mediation analysis investigated the differences of the three main variables between pre-pandemic and pandemic periods. RESULTS Burnout symptoms increased significantly from baseline to follow-up (p = 0.003). Overtime correlated positively with burnout symptoms (Total Effect: 0.13; 95% CI: 0.03, 0.23). Decomposition of the total effect revealed a significant indirect effect over perceived chronic stress (0.11; 95% CI: 0.06, 0.18) and no significant direct effect (0.02; 95% CI: -0.08, 0.12), indicating a full mediation. CONCLUSION In this large longitudinal study, pandemic-related overtime led to significantly higher levels of burnout symptoms, linked by a pathway through perceived chronic stress. Future prevention strategies need to aim at reducing the likelihood of overtime to ensure the mental well-being of practice personnel.
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Affiliation(s)
- Lucas Küppers
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Julian Göbel
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Benjamin Aretz
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Monika A Rieger
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, 72074 Tuebingen, Germany
| | - Birgitta Weltermann
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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Voltmer E, Rosta J, Köslich-Strumann S, Goetz K. Job satisfaction and work stress among physicians in Norway and Germany-A cross-sectional study. PLoS One 2024; 19:e0296703. [PMID: 38181025 PMCID: PMC10769063 DOI: 10.1371/journal.pone.0296703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 12/17/2023] [Indexed: 01/07/2024] Open
Abstract
PURPOSE Physicians' health and wellbeing are important albeit often neglected quality indicators of health care systems. The aims of the study were to compare job satisfaction and work stress among doctors in Germany and Norway, and to identify predictors for job satisfaction. METHODS All active physicians in Schleswig-Holstein, Germany (N = 13,304) and a nationwide sample of Norwegian physicians (N = 2,316) were surveyed in a cross-sectional design in 2021. Response rates of German and Norwegian physicians were n = 4,385 (33%) and n = 1,639 (70.8%), respectively. In addition to age, sex, and work-hours, the main outcome measures were the validated Job Satisfaction Scale (JSS) and the short form of the Effort-Reward Imbalance Questionnaire (ERI). RESULTS There were significant differences between Norwegian and German physicians in job satisfaction but with small effect sizes. All effort scores of German physicians were significantly higher and four of seven reward scores significantly lower than for their Norwegian colleagues. The proportion of German physicians in the state of a gratification crisis was significantly higher (67%) than in their Norwegian colleagues (53%). In both countries, physicians with a gratification crisis scored significantly lower on all items of job satisfaction. There were only minor gender differences in job satisfaction and effort-reward balance. Age, effort, and reward accounted for 46% of the explained variance of job satisfaction. CONCLUSIONS Lower job satisfaction and reward in some areas and higher perceived effort of physicians in Germany than in Norway are still in favor of Norwegian working conditions, but the differences seem to diminish. The high proportions of gratification crises in both countries warrants appropriate measures for prevention and health promotion.
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Affiliation(s)
- Edgar Voltmer
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Judith Rosta
- Institute for Studies of the Medical Profession, Oslo, Norway
| | | | - Katja Goetz
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Lübeck, Germany
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Rosta J, Rø KI. Changes in weekly working hours, proportion of doctors with hours above the limitations of European Working Time Directive (EWTD) and time spent on direct patient care for doctors in Norway from 2016 to 2019: a study based on repeated surveys. BMJ Open 2023; 13:e069331. [PMID: 37349097 PMCID: PMC10314479 DOI: 10.1136/bmjopen-2022-069331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 05/01/2023] [Indexed: 06/24/2023] Open
Abstract
OBJECTIVES To compare the total weekly working hours, proportions with work hours above the limitations of European working time directive (EWTD) and time spent on direct patient care in 2016 and 2019 for doctors working in different job positions in Norway. DESIGN Repeated postal surveys in 2016 and 2019. SETTING Norway. PARTICIPANTS Representative samples of doctors; the response rates were 73.1% (1604/2195) in 2016 and 72.5% (1511/2084) in 2019. MAIN OUTCOME MEASURES Self-reported weekly working hours, proportions with hours above the limitations of EWTD defined as >48 hours/week and time spent on direct patient care. ANALYSES Linear mixed models with estimated marginal means and proportions. RESULTS From 2016 to 2019, the weekly working hours increased significantly for male general practitioners (GPs) (48.7 hours to 50.9 hours) and male hospital doctors in leading positions (48.2 hours to 50.5 hours), and significantly decreased for female specialists in private practice (48.6 hours to 44.9 hours). The proportion of time spent on direct patient care was noted to be similar between genders and over time. In 2019, it was higher for specialists in private practice (66.4%) and GPs (65.5%) than for doctors in other positions, such as senior hospital consultants (43.5%), specialty registrars (39.8%) and hospital doctors in leading positions (34.3%). Working >48 hours/week increased significantly for both male and female GPs (m: 45.2% to 57.7%; f: 27.8% to 47.0%) and hospital doctors in leading positions (m: 34.4% to 57.1%; f: 17.4% to 46.4%), while it significantly decreased for female specialty registrars (13.2% to 6.9%). CONCLUSIONS Working hours increased significantly for GPs and hospital doctors in leading positions from 2016 to 2019, resulting in increased proportions of doctors with work hours above the EWTD. As work hours above the EWTD can be harmful for health personnel and for safety at work, initiatives to reduce long working weeks are needed.
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Affiliation(s)
- Judith Rosta
- Institute for Studies of the Medical Profession, Oslo, Norway
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Bååthe F, von Knorring M, Isaksson-Rø K. How hospital top managers reason about the central leadership task of balancing quality of patient care, economy and professionals' engagement: an interview study. Leadersh Health Serv (Bradf Engl) 2022; ahead-of-print:261-274. [PMID: 36573612 PMCID: PMC10427974 DOI: 10.1108/lhs-02-2022-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/27/2022] [Accepted: 10/04/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE This study aims to deepen the understanding of how top managers reason about handling the relationships between quality of patient care, economy and professionals' engagement. DESIGN/METHODOLOGY/APPROACH Qualitative design. Individual in-depth interviews with all members of the executive management team at an emergency hospital in Norway were analysed using reflexive thematic method. FINDINGS The top managers had the intention to balance between quality of patient care, economy and professionals' engagement. This became increasingly difficult in times of high internal or external pressures. Then top management acted as if economy was the most important focus. PRACTICAL IMPLICATIONS For health-care top managers to lead the pursuit towards increased sustainability in health care, there is a need to balance between quality of patient care, economy and professionals' engagement. This study shows that this balancing act is not an anomaly top-managers can eradicate. Instead, they need to recognize, accept and deliberately act with that in mind, which can create virtuous development spirals where managers and health-professional communicate and collaborate, benefitting quality of patient care, economy and professionals' engagement. However, this study builds on a limited number of participants. More research is needed. ORIGINALITY/VALUE Sustainable health care needs to balance quality of patient care and economy while at the same time ensure professionals' engagement. Even though this is a central leadership task for managers at all levels, there is limited knowledge about how top managers reason about this.
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Affiliation(s)
- Fredrik Bååthe
- Institute for Studies of the Medical Profession, LEFO, Oslo, Norway; Institute of Stress Medicine at Region Västra Götaland, Gothenburg, Sweden and Institute of Health and Care Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Mia von Knorring
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Karin Isaksson-Rø
- Institute for Studies of the Medical Profession, LEFO, Oslo, Norway and Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Medical Faculty, University of Oslo, Oslo, Norway
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Deilkås ET, Rosta J, Baathe F, Søfteland E, Lexberg ÅS, Røise O, Rø KI. Physician participation in quality improvement work- interest and opportunity: a cross-sectional survey. BMC PRIMARY CARE 2022; 23:267. [PMID: 36284296 PMCID: PMC9594954 DOI: 10.1186/s12875-022-01878-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Lack of physician involvement in quality improvement threatens the success and sustainability of quality improvement measures. It is therefore important to assess physicians´ interests and opportunities to be involved in quality improvement and their experiences of such participation, both in hospital and general practice. METHODS A cross-sectional postal survey was conducted on a representative sample of physicians in different job positions in Norway in 2019. RESULTS The response rate was 72.6% (1513 of 2085). A large proportion (85.7%) of the physicians wanted to participate in quality improvement, and 68.6% had actively done so in the last year. Physicians' interest in quality improvement and their active participation was significantly related to the designated time for quality improvement in their work-hour schedule (p < 0.001). Only 16.7% reported time designated for quality improvement in their own work hours. When time was designated, 86.6% of the physicians reported participation in quality improvement, compared to 63.7% when time was not specially designated. CONCLUSIONS This study shows that physicians want to participate in quality improvement, but only a few have designated time to allow continuous involvement. Physicians with designated time participate significantly more. Future quality programs should involve physicians more actively by explicitly designating their time to participate in quality improvement work. We need further studies to explore why managers do not facilitate physicians´ participation in quality improvement.
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Affiliation(s)
- Ellen Tveter Deilkås
- grid.411279.80000 0000 9637 455XHealth Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Judith Rosta
- Institute for Studies of the Medical Profession (LEFO), Oslo, Norway
| | - Fredrik Baathe
- Institute for Studies of the Medical Profession (LEFO), Oslo, Norway ,The Institute of Stress Medicine, Region Västra Götaland, Gothenburg, Sweden ,grid.8761.80000 0000 9919 9582Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Eirik Søfteland
- grid.7914.b0000 0004 1936 7443Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Åse Stavland Lexberg
- grid.459157.b0000 0004 0389 7802Quality Department, Vestre Viken Hospital Trust, Drammen, Norway
| | - Olav Røise
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway ,grid.18883.3a0000 0001 2299 9255Faculty of Health Sciences, SHARE – Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway
| | - Karin Isaksson Rø
- Institute for Studies of the Medical Profession (LEFO), Oslo, Norway
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Johnsen TM, Norberg BL, Krogh FH, Vonen HD, Getz LO, Austad B. The impact of clinical experience on working tasks and job-related stress: a survey among 1032 Norwegian GPs. BMC PRIMARY CARE 2022; 23:216. [PMID: 36030207 PMCID: PMC9419378 DOI: 10.1186/s12875-022-01810-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 07/20/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND General practice is a generalist discipline fraught with complexity. For inexperienced physicians, it may be demanding to get to grips with the clinical challenges. The purpose of this article is to describe possible differences in the range of tasks between inexperienced and experienced general practitioners (GPs), and the extent to which clinical experience affects the way in which GPs perceive their daily work. METHODS An online questionnaire was sent to all regular GPs in Norway (N = 4784) in 2018. The study sought to document the tasks performed during a typical working day and how the GPs perceived their working situation. In this study, we compare the tasks, working situation and occurrence of potentially conflictual consultations among 'less experienced physicians' (≤ 5 years of experience in general practice) versus 'more experienced physicians' (> 5 years of experience). The findings are discussed in light of theories on development of expertise. RESULTS We received responses from 1032 GPs; 296 (29%) were less experienced and 735 (71%) more experienced. The two groups reported virtually the same number of consultations (19.2 vs. 20.5) and clinical problems handled (40.4 vs. 44.2) during the study day. The less experienced physicians reported a higher proportion of challenging and/or conflictual consultations, involving prescriptions for potentially addictive medication (5.7% vs. 3.1%), sickness certification (4.1% vs. 2.4%) and referral for medical investigations on weak clinical indication (8.1% vs. 5.6%). For other clinical issues there were minor or no differences. Both GP groups reported high levels of work-related stress with negative effect on self-perceived health (61.6% vs 64.6%). GPs who felt that high job demands harmed their health tended to handle a slightly higher number of medical issues per consultation and more consultations with elements of conflict. CONCLUSIONS AND IMPLICATIONS Inexperienced GPs in Norway handle a workload comparable to that of experienced GPs, but they perceive more conflictual consultations. These findings have relevance for training and guidance of future GP specialists. Irrespective of experience, the GPs report such high levels of negative work-related stress as to indicate an acute need for organisational changes that imply a reduced workload.
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Affiliation(s)
- Tor Magne Johnsen
- Norwegian Centre for E-Health Research (NSE), Tromsø, Norway
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), General Practice, Research Unit, Trondheim, Norway
- Midtbyen Medical Centre Trondheim, Trondheim, Norway
| | - Børge Lønnebakke Norberg
- Norwegian Centre for E-Health Research (NSE), Tromsø, Norway
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), General Practice, Research Unit, Trondheim, Norway
| | - Frode Helgetun Krogh
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), General Practice, Research Unit, Trondheim, Norway
| | - Hanne Dahl Vonen
- Medical Student Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Linn Okkenhaug Getz
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), General Practice, Research Unit, Trondheim, Norway
| | - Bjarne Austad
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), General Practice, Research Unit, Trondheim, Norway
- Øya Medical Centre, Trondheim General Practice Research Unit, Trondheim, Norway
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Johnsson L, Nordgren L. The voice of the self: a typology of general practitioners' emotional responses to situational and contextual stressors. Scand J Prim Health Care 2022; 40:289-304. [PMID: 35822622 PMCID: PMC9397474 DOI: 10.1080/02813432.2022.2097616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To develop a comprehensive typology of emotional reactions associated with stress among general practitioners (GPs), grounded in their own experiences. DESIGN Data was generated using observations and unstructured interviews, using Straussian grounded theory as the overarching methodology. The typology was built using multidimensional property supplementation. SETTING Eleven health care centres in urban and rural communities in four Swedish regions. SUBJECTS Sixteen GPs and GP residents. MAIN OUTCOME MEASURES Characteristics of GPs' emotional reactions in everyday work situations. RESULTS Accounts of negative emotions connected to stress revealed four principal personal needs of the GP: trust, efficacy, understanding, and knowledge. Simultaneous threats to more than one of these needs invariably increased the level of tension. From these more complex accounts, six second-order needs could be identified: integrity, judgment, pursuit, authority, autonomy, and competence. The most extreme encounters, in which all four principal needs were threatened, were characterised by the experience of being reduced into an assistant. CONCLUSION The considerable resilience of GPs may belie some of the pressures that they are facing while being far from a fail-safe defence against being diverted from purposeful and morally responsible action. Our typology distinguishes between different forms of stress that may affect how GPs carry out their work, and connects to the vast literature on GP wellness. The results of this study could be used to develop tools for self-reflection with the aim of countering the effects of stress, and are potentially relevant to future research into its causes and consequences.Key pointsWhat is known•Stress among GPs may have severe consequences for themselves and their patients, and levels of stress appear to be increasing.What this article adds•Stressful situations threaten at least one of four principal needs of the GP: trust, efficacy, understanding, and knowledge.•More complex threats increase the level of tension and bring out second-order needs: integrity, judgment, pursuit, authority, autonomy, and competence.•The wealth of literature on GP stress can be clearly understood through the lens of our four-dimensional typology.
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Affiliation(s)
- Linus Johnsson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- CONTACT Linus Johnsson Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Lena Nordgren
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Centre for Clinical Research Sörmland/Uppsala University, Eskilstuna, Sweden
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