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

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.

Association of part-time clinical work with well-being and mental health in General Internal Medicine: A survey among Swiss hospitalists

INTRODUCTION

Burnout and low job satisfaction are increasing among the General Internal Medicine (GIM) workforce. Whether part-time compared to full-time clinical employment is associated with better wellbeing, job satisfaction and health among hospitalists remains unclear.

MATERIALS AND METHODS

We conducted an anonymized cross-sectional survey among board-certified general internists (i.e. hospitalists) from GIM departments in 14 Swiss hospitals. Part-time clinical work was defined as employment of <100% as a clinician. The primary outcome was well-being, as measured by the extended Physician Well-Being Index (ePWBI), an ePWBI ≥3 indicating poor wellbeing. Secondary outcomes included depressive symptoms, mental and physical health, and job satisfaction. We compared outcomes in part-time and full time workers using propensity score-adjusted multivariate regression models.

RESULTS

Of 199 hospitalists invited, 137 (69%) responded to the survey, and 124 were eligible for analysis (57 full-time and 67 part-time clinicians). Full-time clinicians were more likely to have poor wellbeing compared to part-time clinicians (ePWBI ≥3 54% vs. 31%, p = 0.012). Part-time compared to full-time clinical work was associated with a lower risk of poor well-being in adjusted analyses (odds ratio 0.20, 95% confidence interval 0.07-0.59, p = 0.004). Compared to full-time clinicians, there were fewer depressive symptoms (3% vs. 18%, p = 0.006), and mental health was better (mean SF-8 Mental Component Summary score 47.2 vs. 43.2, p = 0.028) in part-time clinicians, without significant differences in physical health and job satisfaction.

CONCLUSIONS

Full-time clinical hospitalists in GIM have a high risk of poor well-being. Part-time compared to full-time clinical work is associated with better well-being and mental health, and fewer depressive symptoms.

Predictors of job satisfaction among teachers in Germany during the SARS-CoV-2 pandemic: cross-sectional results of a nationwide online questionnaire

Introduction

During the SARS-CoV-2 pandemic teaching was changed several times to distance learning. To consider the associated stresses and challenges for teachers a nationwide cross-sectional study was performed in March 2021 in which N = 31,089 teachers from Germany participated.

Methods

A multiple linear regression model with stepwise inclusion of thematically sorted variables (sociodemographic, SARS-CoV-2- and work-related variables) was used to identify relevant predictors of job satisfaction.

Results

The analysis revealed that work-related variables were significant predictors of job satisfaction. In the third regression model, when all variables are included the adjusted R² was 0.364. Overall, the results showed that, e.g., work predictability (b = 0.097), influence at work (b = 0.118), and meaning of work (b = 0.212) increased job satisfaction. In contrast, increased emotional exhaustion (b = -0.016), feelings of unfair treatment (b = -0.048), and work family conflicts (b = -0.154) deteriorated job satisfaction.

Discussion

The results indicate that future research should focus especially the work-related topics in more detail and that job satisfaction is a useful concept for analyzing working conditions from a public health point of view.

Burnout and work-privacy conflict - are there differences between full-time and part-time physicians?

Background

Changes in everyday work with regard to working time models have reached the medical profession. The number of physicians working part-time is steadily increasing. At the same time, however, the population's need for care is also rising. This can reinforce the impending shortage of doctors in the future. The aim was to investigate differences in work-privacy conflict and burnout among physicians working full-time or part-time.

Method

The present study includes data from a baseline survey of the long-term study of physicians with different medical backgrounds. The analysis focused on a sub-sample of 598 physicians (not self-employed). The two main outcomes under investigation—burnout and work-privacy conflict—were measured using the Copenhagen Burnout Inventory adapted for health care professionals, as well as the associated subscale of the Copenhagen Psychosocial Questionnaire (COPSOQ). Data analyses included descriptive statistics followed by regression models.

Results

Descriptive analyses show, that 31.8% of physicians are working part-time, whereas 68.2% are working full-time. The part-time subsample is significantly older, and female physicians are more likely to work part-time. With regard to workload and work-privacy conflict, significant differences between part-time and full-time physicians were only observed in terms of work-privacy-conflict. However, regression analysis underline the importance of possible confounding variables (such as medical setting) within the relationship between job size and job-related well-being.

Discussion

Differences in working hour arrangements (full-time or part-time work) are only accompanied by less work-privacy conflict. No differences with regard to burnout (patient-related, work-related or personal) could be obtained. Rather, the data suggests that other job-related variables may play a role and should be further investigated.