Job Satisfaction and Chronic Stress of General Practitioners and Their Teams: Baseline Data of a Cluster-Randomised Trial (IMPROVEjob)

Work-Related Quality of Life among Physicians in Poland: A Cross-Sectional Study

BACKGROUND AND OBJECTIVES

Working in a healthcare setting is associated with high levels of stress and burnout syndrome. Work-related quality of life (WRQoL) remains insufficiently evaluated among physicians. The aim of this study is to assess the WRQoL among physicians of interventional, non-interventional, and diagnostic specialties in Poland.

MATERIALS AND METHODS

Standardized and anonymous WRQoL questionnaires have been filled in by 257 physicians working in Silesia, Poland. After the removal of missing data, 246 individuals were stratified in terms of specialties into the appropriate categories, including interventional, non-interventional, and diagnostics. These categories were compared using the following subscales: general well-being (GWB), home-work interface (HWI), job and career satisfaction (JCS), control at work (CAW), working conditions (WCS), and stress at work (SAW).

RESULTS

Out of 246 individuals, 132 were women (53.7%) and 112 (45.5%) were men. There were no differences in terms of WRQoL scores (p = 0.220) and subscales GWB (p = 0.148), HWI (p = 0.368), JCS (p = 0.117), CAW (p = 0.224), WCS (p = 0.609), SAW (p = 0.472) between interventional, non-interventional, and diagnostic specialties. The group of young doctors (age ≤ 30 years) had higher JCS scores than the older ones (mean score [SD], 22.7 [3.98] vs. 21 [4.6]; p = 0.013). Physicians who were not working in hospital had higher WRQoL score than respondents working in hospital (p = 0.061), with significant differences in terms of GWB (mean score [SD], 20.3 [4.93] vs. 22.8 [3.2], p = 0.014), HWI (mean score [SD], 9.1 [=2.65] vs. 10.6 [2.73], p = 0.011), and WCS (mean score [SD], 9.5 [2.61] vs. 10.8 [2.54], p = 0.035).

CONCLUSION

There were no differences considering overall WRQoL between analyzed groups stratified according to specialty. However, we disclosed a significant association between the respondent's WRQoL and age as well as place of work.

[Ensuring primary care in Germany-findings from a quantitative survey of general practitioners]

BACKGROUND

Given the risk of a shortage of general practitioners in private practice, the question arises as to which concepts can make an effective contribution. To date, there is a lack of studies that comprehensively shed light on how general practitioners, based on their professional experience, view different approaches to ensuring primary care in the long term.

OBJECTIVES

The aim of the study was to determine the positions, attitudes, and experiences of general practitioners with regard to ensuring primary care.

METHODS

Using an online survey, a total of 4176 general practitioners were surveyed between February and June 2023. In addition to the descriptive analysis, a t-test on independent samples was used to determine significant differences between two groups.

RESULTS

Of those surveyed, 42% reported a noticeable decline of general medical practices in their area. In addition, 53% saw a declining attractiveness of primary care for young doctors, which is attributed to three problem areas: 1) the position of primary care in the healthcare system, 2) requirements for training and further education, and 3) working conditions. In order to secure primary care, those surveyed were primarily in favor of the following approaches: establishing a primary care physician system (85%), increasing the promotion of interest and points of contact in training and further education (80%), strengthening multi-professional outpatient care centers (64%), restructuring curricula (56%) and admission criteria for medical studies (50%), and reforming general medical training (53%).

CONCLUSIONS

As the results show, general practitioners have their own suggestions and preferences that complement existing expert assessments. General practitioners should be more consistently involved in the planning, implementation, and evaluation of measures to stabilize primary care.

Psychosocial working conditions and mental health among medical assistants in Germany: a scoping review

BACKGROUND

Medical assistants (MA) constitute one of the largest professions in outpatient health care in Germany. The psychosocial working conditions of health care staff are generally believed to be challenging and to thereby increase the risk of poor mental health. A review of MA's psychosocial working conditions and mental health is lacking, however. We aimed to systematically identify and summarize existing research on psychosocial working conditions and mental health of MA by addressing (1) Which methods, concepts, and instruments have been used to capture the psychosocial working conditions and mental health among MA in Germany? (2) What findings are available? and (3) What are the research gaps?

METHODS

We systematically searched Medline, Scopus, CCMed and Google Scholar. Using the Population Concept Context (PCC)-framework, we applied the following eligibility criteria: (a) Language: English or German, (b) publication between 2002-2022, (c) original study, (d) study population: mainly MA (i.e., ≥ 50% of the study population), (e) concept: psychosocial working conditions and/or mental health, and (f) context: Germany. Two reviewers extracted data independently, results were compared for accuracy and completeness.

RESULTS

Eight hundred twenty-seven sources were identified. We included 30 publications (19 quantitative, 10 qualitative, and one mixed methods study). Quantitative studies consistently reported high job satisfaction among MA. Quantitative and mixed methods studies frequently reported aspects related to job control as favorable working conditions, and aspects related to job rewards as moderate to unfavorable. Qualitative studies reported low job control in specific work areas, high demands in terms of workload, time pressure and job intensity, and a desire for greater recognition. Social interactions seemed to be important resources for MA. Few studies (n = 8) captured mental health, these reported inconspicuous mean values but high prevalences of anxiety, burnout, depression, and stress among MA. Studies suggested poorer psychosocial working conditions and mental health among MA during the COVID-19 pandemic.

CONCLUSIONS

Quantitative studies tend to suggest more favorable psychosocial working conditions among MA than qualitative studies. We suggest mixed methods to reconcile this alleged inconsistency. Future research should examine discrepancies between job satisfaction and unfavorable working conditions and if psychosocial working conditions and mental health remain changed after the COVID-19 pandemic.

Associations between COVID-19 Pandemic-Related Overtime, Perceived Chronic Stress and Burnout Symptoms in German General Practitioners and Practice Personnel-A Prospective Study

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.

The Predominance of the Health-Promoting Patterns of Work Behavior and Experience in General Practice Teams-Results of the IMPROVEjob Study

This study aims to identify the distribution of the "Work-related behavior and experience patterns" (Arbeitsbezogenes Verhaltens-und Erlebnismuster, AVEM) in general practitioners and their teams by using baseline data of the IMPROVEjob study. Members of 60 general practices with 84 physicians in a leadership position, 28 employed physicians, and 254 practice assistants participated in a survey in 2019 and 2020. In this analysis, we focused on AVEM variables. Age, practice years, work experience, and working time were used as control variables in the Spearman Rho correlations and analysis of variance. The majority of the participants (72.1%) revealed a health-promoting pattern (G or S). Three of eleven AVEM dimensions were above the norm for the professional group "employed physicians". The AVEM dimensions "striving for perfection" (p < 0.001), "experience of success at work" (p < 0.001), "satisfaction with life" (p = 0.003), and "experience of social support" (p = 0.019) differed significantly between the groups' practice owners and practice assistants, with the practice owners achieving the higher values, except for experience of social support. Practice affiliation had no effect on almost all AVEM dimensions. We found a high prevalence of AVEM health-promoting patterns in our sample. Nearly half of the participants in all professional groups showed an unambitious pattern (S). Adapted interventions for the represented AVEM patterns are possible and should be utilized for maintaining mental health among general practice teams.

Remote Communications between Patients and General Practitioners: Do Patients Choose the Most Effective Communication Routes?

The use of remote communication between patients and general practitioners has greatly increased worldwide, especially following the COVID-19 outbreak. Yet, it is important to evaluate the impact of this shift on healthcare quality. This study aimed at evaluating remote healthcare quality by comparing four remote patient-to-physician communication modes used in Israel. The research methodology entailed criteria-based analysis conducted by healthcare quality experts and a subjective patient-perception questionnaire regarding the healthcare quality attributed to each mode and the extent to which each mode was used. Our findings indicate that the extent to which each mode is used was found to be inversely related to its rated quality. As such, the common assumption whereby patients tend to choose the mode of communication that will most likely ensure high service quality is refuted. Our findings also indicate that remote services often hinder the physician's understanding of the patient's clinical issues, as patients encounter difficulties in correctly articulating and conveying them; such services also hinder the patient's understanding of the recommended course of treatment. These findings should be addressed by policymakers for improving remote communication services to ensure optimal healthcare service quality.

180° view on general practitioners' leadership skills: practice-level comparisons of leader and staff assessments using data from the cluster-randomised controlled IMPROVEjob study

OBJECTIVES

Strong primary care leaders are needed to assure high quality services for patient populations. This study analysed general practitioners' (GP) leadership skills comparing practice-level self and staff assessments based on the full range of leadership model and the leader-member exchange (LMX).

SETTING

The questionnaire survey was conducted among German general practice leaders and their staff participating in the IMPROVEjob trial.

PARTICIPANTS

The study population comprised 60 German general practices with 366 participants: 84 GP practice leaders and 282 employees (28 physicians and 254 practice assistants).

PRIMARY AND SECONDARY OUTCOME MEASURES

Leadership skills of the practice leaders were measured using the Integrative Leadership Questionnaire (German Fragebogen für integrative Führung) and the LMX-7 questionnaire. Leaders rated themselves and practice staff rated their leaders. The data was analysed by paired mean comparisons on the practice level.

RESULTS

For most leadership dimensions, practice leaders rated themselves higher than their employees rated them. Differences were found for transformational leadership (p<0.001, d=0.41), especially for the dimensions 'innovation' (p<0.001, d=0.69) and 'individuality focus' (p<0.001, d=0.50). For transactional leadership, the dimension 'goal setting' differed significantly (p<0.01, d=0.30) but not the other dimensions. Scores for negative leadership were low and showed no differences between leaders and employees. Interestingly, employed physicians' rated their practice leaders higher on the two transformational ('performance development', 'providing a vision') and all transactional dimensions. The LMX-7 scale showed high quality relationships between leaders and employees.

CONCLUSIONS

This 180° analysis of GPs' leadership skills with self and employee ratings indicated good relationships. There is a potential to improve leadership regarding goal-setting, innovation and focusing on individual team members. These results allow for the development of targeted interventions.

TRIAL REGISTRATION NUMBER

German Clinical Trials Register, DRKS00012677. Registered 16 October 2019.

Exploring Transfer Potentials of the IMPROVEjob Intervention for Strengthening Workplace Health Management in Micro-, Small-, and Medium-Sized Enterprises in Germany: A Qualitative Study

Micro- and small-sized enterprises (MSE), and small- and medium-sized enterprises (SME) in Germany are often burdened with high levels of psychosocial stressors at work. The IMPROVEjob intervention was originally developed for general practice teams, and aims to promote job satisfaction and reduce psychosocial stressors in the context of workplace health management (WHM). This qualitative study identified challenges and transfer options regarding the transfer of the IMPROVEjob intervention to other MSE/SME settings. Based on previous study results, a comprehensive, qualitative inter- and transdisciplinary approach was developed and conducted between July 2020 and June 2021, also including single interviews and focus group discussion with eleven experts from MSE/SME settings. Data analysis was carried out using a rapid analysis approach. The experts discussed psychosocial topics and didactic formats of the original IMPROVEjob intervention. A lack of access to information on managing work-related psychosocial stressors and inadequate recognition of the importance of psychosocial stressors in the workplace among managers and employees, seemed to be the highest barriers regarding the transfer of the intervention into other MSE/SME settings. The transfer of the IMPROVEjob intervention to other MSE/SME settings requires an adapted intervention format, comprising targeted offers with easy access to information on managing work-related psychosocial stressors and improving WHM in MSE/SME settings.

Association of psychological symptoms with job burnout and occupational stress among coal miners in Xinjiang, China: A cross-sectional study

Objective

The study aimed to investigate the influencing factors of psychological symptoms in relation to job burnout and occupational stress among coal miners in Xinjiang, so as to provide data support for enterprises in an effort to help them identify internal psychological risk factors and improve the mental health of coal miners.

Methods

A cross-sectional study was carried out. A total of 12 coal mines were selected using the stratified cluster random sampling method and 4,109 coal miners were investigated by means of online electronic questionnaires. The Symptoms Check List-90 (SCL-90), Chinese Maslach Burnout Inventory (CMBI), and Job Demand-Control (JDC) model were respectively used to measure the status of psychological symptoms, job burnout, and occupational stress among coal miners. The mediation analysis was performed through structural equation modeling (SEM) by using Analysis of Moment Structure (AMOS).

Results

The prevalence of psychological symptoms was higher in the occupational stress group than in the non-occupational stress group, and increased with job burnout (P < 0.05). The multivariate logistic regression analysis results showed that mild (OR = 1.401, 95% CL: 1.165, 1.685), moderate (OR = 2.190, 95% CL: 1.795, 2.672), or severe levels of burnout (OR = 6.102, 95% CL: 3.481, 10.694) and occupational stress (OR = 1.462, 95% CL: 1.272, 1.679) were risk factors for psychological symptoms in coal miners. The results of structural equation modeling indicated that occupational stress (β = 0.11, P = 0.002) and job burnout (β = 0.46, P = 0.002) had significant positive direct effects on psychological symptoms, and job burnout was an intermediate variable between occupational stress and psychological symptoms.

Conclusion

High levels of job burnout and occupational stress were risk factors for psychological symptoms. Both occupational stress and job burnout had direct effects on psychological symptoms, and occupational stress could also have an indirect effect on coal miners' psychological symptoms through the intermediate variable of job burnout.

Satisfaction of family physician team members in the context of contract system: A cross-sectional survey from Shandong Province, China

Background

Family physicians play a key role in responding to the growing demand for primary healthcare due to aging. The work attitude of family physician team members (FPTMs) impacts their work efficiency and quality. Knowing how satisfied they are with their jobs can help identify potential directions and entry points for incentives. The purpose of this study is to analyze the job satisfaction status and influencing factors of grassroots health service personnel after the implementation of the family physician contract system in China.

Methods

The study conducted a cross-sectional survey with 570 FPTMs in three prefecture-level cities in the Shandong Province. Satisfaction was measured using 30 items across seven dimensions. Responses were recorded on a 5-point Likert scale. Descriptive statistical analysis was used to analyze the general information and satisfaction of FPTMs. Multiple linear regression analysis was used to analyze the factors influencing job satisfaction.

Results

The overall job satisfaction among FPTMs was not high. Among the seven dimensions, interpersonal relationships had the highest satisfaction (4.10 ± 0.78), while workload had the lowest satisfaction (3.08 ± 0.56). The satisfaction levels of the three sample regions were different, and the results were opposite to their regional economic development levels. The results of the multifactor analysis showed that gender, income level, educational background, working years, daily working hours, number of training sessions per year and the proportion of performance pay had significant impact on overall job satisfaction.

Conclusions

The development of a family physician contract system has increased the workload of FPTMs. In addition to the implementation of the new policy, attention should be paid to the workload and working attitude of family physicians. The fundamental measures should focus on attracting more personnel to work at the grassroots level by accelerating education and training to solve the problem of insufficient health personnel at the grassroots level. Simultaneously, attention should be paid to the improvement of the medical staff's salary level and the need for self-promotion, such as training.

Leadership program with skills training for general practitioners was highly accepted without improving job satisfaction: the cluster randomized IMPROVEjob study

Leadership has become an increasingly important issue in medicine as leadership skills, job satisfaction and patient outcomes correlate positively. Various leadership training and physician psychological well-being programmes have been developed internationally, yet no standard is established in primary care. The IMPROVEjob leadership program was developed to improve job satisfaction among German general practitioners and practice personnel. Its acceptance and effectiveness were evaluated. The IMPROVEjob intervention is a participatory, interdisciplinary and multimodal leadership intervention that targets leadership, workflows and communication in general practices using three elements: (1) two leadership workshops with skills training; (2) a toolbox with printed and online material, and (3) a 9-month implementation phase supported by facilitators. A cluster-randomised trial with a waiting-list control evaluated the effectiveness on the primary outcome job satisfaction assessed by the Copenhagen Psychosocial Questionnaire (range 0-100). A mixed-methods approach with questionnaires and participant interviews evaluated the acceptance of the intervention and factors influencing the implementation of intervention content. Statistical analyses respected the clustered data structure. The COVID-19 pandemic necessitated intervention adjustments: online instead of on-site workshops, online material instead of facilitator practice visits. Overall, 52 of 60 practices completed the study, with altogether 70 practice leaders, 16 employed physicians, and 182 practice assistants. According to an intention-to-treat analysis, job satisfaction decreased between baseline and follow-up (not significantly) in the total study population and in both study arms, while the subgroup of practice leaders showed a non-significant increase. A mixed multilevel regression model showed no effect of the intervention on job satisfaction (b = - 0.36, p > 0.86), which was influenced significantly by a greater sense of community (b = 0.14, p < 0.05). The acceptance of the IMPROVEjob workshops was high, especially among practice leaders compared to assistants (1 = best to 5 = worst): skills training 1.78 vs. 2.46, discussions within the practice team 1.87 vs. 2.28, group discussions 1.96 vs. 2.21. The process evaluation revealed that the COVID-19 pandemic complicated change processes and delayed the implementation of intervention content in practice routines. The workshops within the participatory IMPROVEjob intervention were rated very positively but the multimodal intervention did not improve job satisfaction 9 months into the pandemic. Qualitative data showed an impairment of implementation processes by the unforeseeable COVID pandemic.Trial registration Registration number: DRKS00012677 on 16/10/2019.

Satisfaction of outpatient oncologists with their work

Job satisfaction is a fundamental ingredient in the life quality of a modern person; for a health care worker, it determines to a large extent the quality and accessibility of health care services they provide. Our aim is identification of key reasons for low job satisfaction among outpatient oncologists at cancer care centres (CCC) and identification of the best ways to address them. 110 oncologists working in outpatient CCC in Moscow, Moscow region and Ivanovo region participated in this research. Respondents' job satisfaction was assessed using V.A. Rozanova's Job Satisfaction Assessment Questionnaire. Virtually a quarter (23.6%) of oncologists were dissatisfied with their work; male respondents and surgical employees reported significantly higher levels of dissatisfaction. Wage levels and equity, working hours, teamwork and coordination in carrying out collective tasks and managerial style were the main areas of dissatisfaction. Measures to improve the work process included enhancing the resource outfit, fair consideration of each employee's achievements when distributing incentives, clear allocation of responsibility for collective project tasks, creating opportunities for paid part-time work and arranging regular meals at the expense of the health care organisation. Raising managers' awareness of the results can contribute to improvements in oncologists' performance, work process satisfaction, productivity and performance, quality of care and access to it, as well as public satisfaction and confidence in the health-care system as a whole.

Occupational stress and associated factors among general practitioners in China: a national cross-sectional study

BACKGROUND

Occupational stress among general practitioners (GPs) is a public health concern. This study aimed to investigate the prevalence and factors associated with occupational stress among GPs in China.

METHODS

A cross-sectional design was used. Data were collected from 3,236 GPs in eastern, central, and western China (response rate, 99.75%) between October 2017 and February 2018 using a structured self-administered questionnaire. An ordinal logistic regression model was used to identify the factors associated with occupational stress among GPs.

RESULTS

Among these respondents, 313 (9.67%), 1,028 (31.77%), and 1,895 (58.56%) of GPs had a low, medium, and high level of occupational stress, respectively. GPs from central China, with temporary work contracts, without management responsibility, receiving a moderate level of income, and with moderate occupational development opportunities had a lower level of occupational stress. GPs with greater than 40 working hours per week and those who worked overtime occasionally or frequently had a higher level of occupational stress.

CONCLUSIONS

The prevalence of occupational stress among GPs is high in China. Substantial regional variation in determinants of occupational stress among GPs was observed. These findings should inform the design of policies to reduce the occupational stress of GPs.

Higher Work-Privacy Conflict and Lower Job Satisfaction in GP Leaders and Practice Assistants Working Full-Time Compared to Part-Time: Results of the IMPROVEjob Study

Background: Work-privacy conflict (WPC) has become an important issue for medical professionals. The cluster-randomized controlled IMPROVEjob study aimed at improving job satisfaction (primary outcome), with additional outcomes such as examining the work-privacy conflict in German general practice personnel. Using baseline data of this study, the relationship between work-privacy conflict and job satisfaction (JS) was analyzed. In addition, factors associated with higher WPC were identified. Methods: At baseline, 366 participants (general practitioners (GPs) in leadership positions, employed general practitioners, and practice assistants) from 60 German practices completed a questionnaire addressing socio-demographic data and job characteristics. Standardized scales from the German version of the COPSOQ III requested data concerning job satisfaction and work-privacy conflict. Both scores range from 0 (lowest) to 100 (highest). Multilevel analysis accounted for the clustered data. Statistical analyses were performed using IBM SPSS and RStudio software, with a significance level set at p < 0.05. Results: Job satisfaction was 77.16 (mean value; SD = 14.30) among GPs in leadership positions (n = 84), 79.61 (SD = 12.85) in employed GPs (n = 28), and 72.58 (SD = 14.42) in practice assistants (n = 254). Mean values for the WPC-scale were higher for professionals with more responsibilities: GPs in leadership positions scored highest with 64.03 (SD = 29.96), followed by employed physicians (M = 45.54, SD =30.28), and practice assistants (M = 32.67, SD = 27.41). General practitioners and practice assistants working full-time reported significantly higher work-privacy conflict than those working part-time (p < 0.05). In a multilevel analysis, work-privacy conflict was significantly associated with job satisfaction (p < 0.001). A multiple regression analysis identified working hours, as well as and being a practice owner or an employed physician as factors significantly influencing WPC. Discussion: WPC was high among general practice leaders and practice personnel working full-time. Future interventions to support practice personnel should focus on reducing WPC, as there is good evidence of its effects on job satisfaction.

Does the Number of Reasons for Seeking Care and Self-Rated Health Predict Sick Leave during the Following 12 Months? A Prospective, Longitudinal Study in Swedish Primary Health Care

BACKGROUND

Sick leave has major social and economic consequences for both individuals and society. Primary Health Care (PHC) meets people who seek care before they risk going on sick leave. This study examined the impact of self-perceived health on sick leave within 12 months for workers seeking care in PHC.

METHODS

The study had a prospective longitudinal design with 271 employed, non-sick-listed patients aged 18-64 years seeking care for physical and/or mental symptoms at PHC. In a logistic regression, an estimation of the odds ratio (OR) for belonging to the group workers with >14 days of sick-leave (W-SL) was made.

RESULTS

A high number of reasons when seeking care, with an OR of 1.33 (confidence interval 1.14 to 1.56), and lower self-rated health, with an OR of 1.45 (confidence interval 1.10 to 1.91), were determinants for sick leave at 12 months after adjusting for covariates and confounders. Mental symptoms constituted the main reason for seeking care, followed by musculoskeletal pain, and significant differences in proportions regarding most symptoms were shown between the groups with and without sick-leave >14 days.

CONCLUSION

Health care professionals in PHC need to be aware of the risk of future sick leave at comorbidity and low self-perceived health. Preventive rehabilitation interventions should be offered to improve health and prevent sick leave for this group.