Job satisfaction and work stress among physicians in Norway and Germany-A cross-sectional study

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.

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

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.

Physician participation in quality improvement work- interest and opportunity: a cross-sectional survey

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.

Changes in work stress among doctors in Norway from 2010 to 2019: a study based on repeated surveys

OBJECTIVES

To explore and discuss the changes in the levels of work stress for Norwegian doctors in different job positions (hospital doctors, general practitioners (GPs), private practice specialists, doctors in academia) from 2010 to 2019.

DESIGN

Repeated questionnaire surveys in 2010, 2016 and 2019, where samples were partly overlapping.

SETTING

Norway.

PARTICIPANTS

A representative sample of 1500-2200 doctors in different job positions. Response rates were 66.7% (1014/1520) in 2010, 73.1% (1604/2195) in 2016 and 72.5% (1511/2084) in 2019.

MAIN OUTCOME MEASURE

Validated 9-item short form of the 'Effort-Reward Imbalance' questionnaire. A risky level of work stress was defined as an effort/reward ratio above 1.0.

ANALYSES

Linear mixed models with estimated marginal means of job positions controlled for gender and age. Proportions with 95% CIs.

RESULTS

From 2010 to 2016 and further to 2019, GPs reported a significant increase in levels on the effort scale (ES: 2.96, 3.25, 3.51) and significant decrease in levels on the reward scale (RS: 4.27, 4.05, 3.67). No significant changes were reported by hospital doctors (ES: 3.13, 3.10, 3.14; RS: 4.09, 3.98, 4.04), private practice specialists (ES: 2.58, 2.61, 2.59; RS: 4.32, 4.32, 4.30) and doctors in academia (ES: 2.63, 2.51, 2.52; RS: 4.09, 4.11, 4.14). The proportion of doctors with risky levels of work stress increased significantly for GPs (10.3%, 27.7%, 40.1%), but did not significantly change for hospital doctors (23.0%, 27.3%, 26.9%), private practice specialists (8.2%, 12.7%, 9.4%) and doctors in academia (11.9%, 19.0%, 16.4%).

CONCLUSION

During a 9-year period, the proportion of risky levels of work stress increased significantly for GPs but did not significantly change for other job positions. This may be partly due to changes in expectations of younger GPs and several healthcare reforms and regulations.

Why are doctors opting out of general practice?

BACKGROUND

There has been a sustained focus on the lack of recruitment to general practice in Norwegian politics, media and research. We have little knowledge of the reasons that have been prominent for doctors who have actively opted out of general practice. We therefore wished to investigate what types of doctors choose not to work in general practice and why.

MATERIAL AND METHOD

The data are based on a questionnaire that was sent to the 2 195 members of the Medical Panel in 2016/17. The response rate was 73.1 %. We used graphics and descriptive analyses to study inter-group differences between those who had considered general practice but made another choice, and those who had quit general practice.

RESULTS

Of the 1 153 doctors who were not general practitioners, 44.1 % had not considered this as an option. 39.9 % had considered it, but chosen differently, and 16.0 % had previously worked as GPs, but quit. The administrative burden and small professional community were the main reasons for doctors to opt out of general practice.

INTERPRETATION

The administrative burden and small professional community were key reasons why doctors opted out of general practice or quit the specialty. A number of other factors also played a role, and the efforts to recruit and retain GPs should therefore be seen in a wider and more overarching context.

Changes in work stress among doctors in Norway from 2010 to 2019: a study based on repeated surveys

Background

Changes in the organization of health care can influence the doctors` working conditions, which may in turn impact on doctors` perception of work stress. Since high levels of work stress can affect both the doctors’ own health and the quality of patient care, it is of importance for public health. We studied changes in work stress among Norwegian doctors from 2010 to 2018-19, and the associations of high work stress with job positions, self-rated health and sickness absence in 2018-19.

Methods

The study populations consisted of representative samples of 1,500 to 2,200 doctors working as hospital doctors, general practitioners (GPs), private practice specialists and doctors in academia. Data were drawn from nationwide repeated postal surveys in 2010, 2016 and 2018-19 in Norway. Response rates were between 67%-73%. The main outcome measure was perception of work stress as measured by the validated short form of the Effort-Reward Imbalance Questionnaire (ERI). Linear mixed models, proportions with 95% confidence intervals and logistic regression model were used in the analyses.

Results

From 2010 to 2018-19, the scores on the effort items (time pressure, responsibility, demands) increased significantly and the scores on the reward items (recognition, job stability, promotion prospects, prestige) decreased significantly for GPs, but remained stable for doctors in other positions. The proportion of doctors with high levels of work stress increased significantly for GPs. In 2018-19, high levels of work stress were associated with being a GP as compared with other job positions, younger age groups, average or poor health vs. very good or good health, but not with sickness absence or gender.

Conclusions

During a nine-year-period, work stress increased significantly for GPs, but remained stable for other job positions. This may be partly due to several health care reforms. Less work stress may improve both the doctors` own health and the quality of health care.

Key messages

From 2010 to 2018-19 in Norway, the proportion of GPs with high levels of work stress increased, while it remained stable for doctors in other job positions. This study supports previous findings on the association between high levels of work stress and health.

Changes in job satisfaction among doctors in Norway from 2010 to 2017: a study based on repeated surveys

OBJECTIVE

To assess job satisfaction for different categories of Norwegian doctors from 2010 to 2016-2017.

DESIGN

Cross-sectional surveys in 2010, 2012, 2014 and 2016-2017 of partly overlapping samples.

SETTING

Norway from 2010 to 2016-2017.

PARTICIPANTS

Doctors working in different job positions (hospital doctors, general practitioners (GPs), private practice specialists, doctors in academia). Response rates were 67% (1014/1520) in 2010, 71% (1279/1792) in 2012, 75% (1158/1545) in 2014 and 73% (1604/2195) in 2016-2017. The same 548 doctors responded at all four points in time.

MAIN OUTCOME MEASURE

Job Satisfaction Scale (JSS), a 10-item widely used instrument, with scores ranging from 1 (low satisfaction) to 7 (high satisfaction) for each item, and an unweighted mean total sum score.

ANALYSIS

General Linear Modelling, controlling for gender and age, and paired t-tests.

RESULTS

For all doctors, the mean scores of JSS decreased significantly from 5.52 (95% CI 5.42 to 5.61) in 2010 to 5.30 (5.22 to 5.38) in 2016-2017. The decrease was significant for GPs (5.54, 5.43 to 5.65 vs 5.17, 5.07 to 5.28) and hospital doctors (5.14, 5.07 to 5.21 vs 5.00, 4.94 to 5.06). Private practice specialists were most satisfied, followed by GPs and hospital doctors. The difference between the GPs and the private practice specialists increased over time.

CONCLUSIONS

From 2010 to 2016-2017 job satisfaction for Norwegian doctors decreased, but it was still at a relatively high level. Several healthcare reforms and regulations over the last decade and changes in the professional culture may explain some of the reduced satisfaction.

How do doctors experience the interactions among professional fulfilment, organisational factors and quality of patient care? A qualitative study in a Norwegian hospital

OBJECTIVES

Doctors increasingly experience high levels of burnout and loss of engagement. To address this, there is a need to better understand doctors' work situation. This study explores how doctors experience the interactions among professional fulfilment, organisational factors and quality of patient care.

DESIGN

An exploratory qualitative study design with semistructured individual interviews was chosen. Interviews were transcribed verbatim and analysed by a transdisciplinary research group.

SETTING

The study focused on a surgical department of a mid-sized hospital in Norway.

PARTICIPANTS

Seven doctors were interviewed. A purposeful sampling was used with gender and seniority as selection criteria. Three senior doctors (two female, one male) and four in training (three male, one female) were interviewed.

RESULTS

We found that in order to provide quality care to the patients, individual doctors described 'stretching themselves', that is, handling the tensions between quantity and quality, to overcome organisational shortcomings. Experiencing a workplace emphasis on production numbers and budget concerns led to feelings of estrangement among the doctors. Participants reported a shift from serving as trustworthy, autonomous professionals to becoming production workers, where professional identity was threatened. They felt less aligned with workplace values, in addition to experiencing limited management recognition for quality of patient care. Management initiatives to include doctors in development of organisational policies, processes and systems were sparse.

CONCLUSION

The interviewed doctors described their struggle to balance the inherent tension among professional fulfilment, organisational factors and quality of patient care in their everyday work. They communicated how 'stretching themselves', to overcome organisational shortcomings, is no longer a feasible strategy without compromising both professional fulfilment and quality of patient care. Managers need to ensure that doctors are involved when developing organisational policies, processes and systems. This is likely to be beneficial for both professional fulfilment and quality of patient care.

Perceived bullying among Norwegian doctors in 1993, 2004 and 2014-2015: a study based on cross-sectional and repeated surveys

OBJECTIVES

To examine 12-month prevalence of perceived bullying at work for doctors in different job categories and medical disciplines in 1993, 2004 and 2014-2015, and personality traits, work-related and health-related factors associated with perceived workplace bullying.

DESIGN

Cross-sectional questionnaire surveys in 1993, 2004 and 2014-2015 where the 2004 and the 2012-2015 samples are partly overlapping.

SETTING

Norway.

PARTICIPANTS

Response rates were 72.8% (2628/3608) in 1993, 67% (1004/1499) in 2004 and 78.2% (1261/1612) in 2014-2015. 485 doctors responded both in 2004 and 2014-2015.

OUTCOME MEASURE

Perceived bullying at work from colleagues or superiors at least a few times a month during the last year.

RESULTS

Between the samples from 1993, 2004 and 2014-2015, there were no significant differences in the prevalence of perceived bullying at work. More senior hospital doctors and surgeons reported being bullied. Doctors with higher scores on the personality trait neuroticism were more likely to perceive bullying, as were female doctors, doctors with poor job satisfaction and poor self-rated health.

CONCLUSIONS

The fraction of doctors who experienced bullying at work was stable over a 20-year period. Psychological, psychosocial and cultural factors are predictors of perceived bullying.

Changes in prevalence of workplace violence against doctors in all medical specialties in Norway between 1993 and 2014: a repeated cross-sectional survey

OBJECTIVES

The aim of this study was to investigate whether reported prevalence of experienced threats, real acts of violence and debilitating fear of violence among Norwegian doctors have increased over the last two decades.

DESIGN

Repeated cross-sectional survey.

SETTING

All healthcare levels and medical specialties in Norway.

PARTICIPANTS

Representative samples of Norwegian doctors in 1993 (n=2628) and 2014 (n=1158).

MAIN OUTCOME MEASURES

Relative risk (RR) of self-reported prevalence of work-time experiences of threats and real acts of violence, and of being physically or psychologically unfit during the last 12 months due to fear of violence, in 2014 compared with 1993, adjusted by age, gender and medical specialty.

RESULTS

There were no differences in self-reported threats (adjusted RR=1.01, 95% CI 0.95 to 1.08) or real acts (adjusted RR=0.90, 95% CI 0.80 to 1.03) of violence when comparing 2014 with 1993. The proportion of doctors who had felt unfit due to fear of violence decreased from 1993 to 2014 (adjusted RR=0.53, 95% CI 0.39 to 0.73). Although still above average, the proportion of doctors in psychiatry who reported real acts of violence decreased substantially from 1993 to 2014 (adjusted RR=0.75, 95% CI 0.60 to 0.95).

CONCLUSIONS

A substantial proportion of doctors experience threats and real acts of violence during their work-time career, but there was no evidence that workplace violence has increased over the last two decades. Still, the issue needs to be addressed as part of the doctors' education and within work settings.

Doctors' working hours and time spent on patient care in the period 1994 - 2014

BACKGROUND

There is always a keen interest in the qualitative and quantitative aspects of doctors’ working hours. In this study developments are described in terms of total weekly working hours and time spent on direct patient care from 1994 to 2014 by doctors working in different job categories and medical disciplines in Norway.

MATERIAL AND METHOD

All data has been obtained from LEFO’s reference panel of doctors, a near representative sample of approximately 1 600 practising doctors who have been followed up with questionnaires every second year since 1994. In the course of this period, doctors have come off the panel as they retired and new young doctors have been included in replacement. Questions relating to how they spend their time have always featured in the questionnaire. This article is based on data from 1994, 2000, 2006, 2010 and 2014.

RESULTS

Response rates were between 67 and 95  %. From 1994 to 2014, total weekly working hours remained the same for all categories of doctors, except those working in academia. Time spent on direct patient care has fallen, but not significantly, for general practitioners, specialists working in private practice and doctors working in academia and administration. Meanwhile, community medical officers and hospital doctors have seen their time spent on patient care fall significantly over the 20-year period. There is however great variation, particularly between the different medical disciplines in hospitals.

INTERPRETATION

Differences and changes in the amount of time spent by doctors on direct patient care are caused by both structural and cultural factors relating to the working situation, and not least by a considerable increase in the number of hospital doctors.

Weekly working hours for Norwegian hospital doctors since 1994 with special attention to postgraduate training, work-home balance and the European working time directive: a panel study

OBJECTIVES

To examine the weekly working hours of Norwegian hospital doctors from 1994 to 2012 with special emphasis on the quality of postgraduate training and work-home balance, and in relation to the requirements of the European Working Time Directive (EWTD).

DESIGN

Panel study based on postal questionnaires.

SETTING

Norway.

PARTICIPANTS

Unbalanced cohort of 1300-1600 doctors in 1994, 1995, 1996, 1997, 2000, 2002, 2004, 2006, 2008, 2010 and 2012.

OUTCOME MEASURES

Self-reported total weekly working hours and whether 45 weekly working hours are too short, sufficient, or too long to meet the quality requirements of obligatory postgraduate training for junior doctors.

RESULTS

From 1994 to 2012, the number of weekly working hours was stable for senior (46-47 h) and junior (45-46 h) hospital doctors. In 2012, significantly more senior (27-35%) than junior (11-20%) doctors reported suboptimal work-home balance, defined as working more than 48 h a week. The majority perceived the present situation with an average of 45 h per week for juniors as sufficient for obligatory postgraduate specialist training, but doctors of higher age (OR 1.04, 95% CI 1.01 to 1.08), senior doctors (1.07, 1.04 to 1.11) and doctors working in surgical specialties (OR 1 vs laboratory medicine 0.03, 0.01 to 0.25, internal medicine 0.31, 0.17 to 0.58, psychiatry 0.12, 0.04 to 0.36, paediatrics 0.36, 0.12 to 1.07, anaesthesiology 0.08, 0.02 to 0.39, gynaecology 0.07, 0.01 to 0.56 and others 0.39, 0.04 to 3.56) were more likely to want the work-week to be longer.

CONCLUSIONS

The weekly working hours of Norwegian hospital doctors were always below the EWTD requirements. A significant growth of hospital doctor density over the past two decades, national regulations and cultural values might be important factors. Specialty differences in perception of sufficient training time may call for more flexibility in working time regulations.

Differences in sickness absence between self-employed and employed doctors: a cross-sectional study on national sample of Norwegian doctors in 2010

Background

Doctors have a low prevalence of sickness absence. Employment status is a determinant in the multifactorial background of sickness absence. The effect of doctors’ employment status on sickness absence is unexplored. The study compares the number of sickness absence days during the last 12 months and the impact of employment status, psychosocial work stress, self-rated health and demographics on sickness absence between self-employed practitioners and employed hospital doctors in Norway.

Methods

The study population consisted of a representative sample of 521 employed interns and consultants and 313 self-employed GPs and private practice specialists in Norway, who received postal questionnaires in 2010. The questionnaires contained items on sickness absence days during the last 12 months, employment status, demographics, self-rated health, professional autonomy and psychosocial work stress.

Results

84% (95% CI 80 to 88%) of self-employed and 60% (95% CI 55 to 64%) of employed doctors reported no absence at all last year. In three multivariate logistic regression models with sickness absence as response variable, employment category was a highly significant predictor for absence vs. no absence, 1 to 3 days of absence vs. no absence and 4 to 99 days of absence vs. no absence), while in a model with 100 or more days of absence vs. no absence, there was no difference between employment categories, suggesting that serious chronic disease or injury is less dependent on employment category. Average or poor self-rated health and low professional autonomy, were also significant predictors of sickness absence, while psychosocial work stress, age and gender were not.

Conclusion

Self-employed GPs and private practice specialist reported lower sickness absence than employed hospital doctors. Differences in sickness compensation, and organisational and individual factors may to a certain extent explain this finding.

Changes in the lifetime prevalence of suicidal feelings and thoughts among Norwegian doctors from 2000 to 2010: a longitudinal study based on national samples

BACKGROUND

Thinking about suicide is an indicator of suicide risk. Suicide rates are higher among doctors than in the population. The main aims of this study are to describe the changes in the lifetime prevalence of suicidal feelings from 2000 to 2010 and the possible predictors of serious suicidal thoughts in 2010 among Norwegian doctors. Differences in lifetime prevalence of suicidal feelings between Norwegian doctors in 2010 and German doctors in 2006 will be also described.

METHODS

Longitudinal and cross-sectional study based on questionnaire data from 2000 and 2010, including approximately 1,600 Norwegian doctors. In Germany, cross-sectional study based on questionnaire data from 2006 among a sample of 3,295 doctors. The main outcome measures were the lifetime prevalence of suicidal feelings (felt life was not worth living, wished own death, had thoughts of taking own life).

RESULTS

The prevalences in 2000 and 2010 of ever had feelings of life not worth living were 48 (44 to 52) % and 45 (41 to 49) %, of ever wished own death 27 (23 to 30) % and 23 (20 to 26) %, and of ever had thoughts of taking own life 29 (16 to 33) % and 24 (21 to 27) %. Paired t-tests among those who responded both in 2000 and 2010 show significant reductions for felt life not worth living (t = -3.4; p = 0.001), wished own death (t = -3.1; p = 0.002) and had thoughts of taking own life (t = -3.5; p < 0.0001). In 2010, significant predictors of serious suicidal thoughts in a multivariate model were low subjective well-being (OR 0.68; 95% CI 0.52-0.90), poor or average self-rated health (2.36; 1.25-4.45) and high psychosocial work stress (1.92; 1.06-3.46), controlled for age, gender, speciality and job satisfaction. Norwegian doctors in 2010 compared with their German counterparts in 2006 reported quite similar prevalences of suicidal feelings.

CONCLUSIONS

Suicidal feelings among Norwegian doctors decreased from 2000 to 2010. Individual and work-related factors may to certain explain these findings. Compared with other professionals in Norway and doctors in Germany, Norwegian doctors showed no higher risk of suicidal thoughts.

Changes in alcohol drinking patterns and their consequences among Norwegian doctors from 2000 to 2010: a longitudinal study based on national samples

AIMS

To describe changes in the patterns and consequences of alcohol use among Norwegian doctors from 2000 to 2010.

METHODS

Longitudinal study based on data from nation-wide postal surveys in 2000 and 2010 among a representative sample of 682 doctors in Norway. The Alcohol Use Disorder Identification Test (AUDIT) was used to measure the changes in drinking patterns (frequency of drinking, frequency of heavy drinking and quantity of drinking), symptoms of alcohol dependence and adverse consequences of drinking. A score above 8 was defined as hazardous drinking.

RESULTS

From 2000 to 2010, the proportion of doctors who used alcohol twice a week or more significantly increased from 31.4 (27.9-34.9) % to 48.7 (44.9-48.7) %, and the proportion of those who drank to intoxication weekly or more decreased significantly from 6.6 (4.7-8.6) % to 2.5 (1.3-1.7) %. The proportion who scored above 8 on the AUDIT decreased from 10.7 (8.4-13.0) % in 2000 to 8.2 (6.2-10.3) % in 2010. There was a significant increase in the partial AUDIT-score for drinking patterns (t = 2.4; P = 0.016), and a significant decrease in the partial AUDIT-score for adverse consequences of drinking (t = -3.6; P < 0.001). The partial AUDIT-score for symptoms of alcohol dependence did not change significantly (t = -1.6; P = 0.112). There were gender differences in drinking patterns. Females had less frequent alcohol consumption and fewer episodes of heavy and hazardous drinking in 2000 and 2010.

CONCLUSION

The drinking pattern of Norwegian doctors has changed over the past decade towards more moderate alcohol consumption and less negative alcohol-related consequences. Changes in the attitude towards alcohol consumption may to a certain extent explain these findings.

Healthcare reforms and job satisfaction among doctors in Norway

Aims: To examine the trend in job satisfaction from 2000 to 2006 among Norwegian doctors, and the possible impact of two comprehensive healthcare reforms on doctors’ job satisfaction. Methods: The study population consisted of a representative sample of approximately 1,600 Norwegian doctors, selected from nationwide repeated postal surveys in 2000, 2002, 2004 and 2006. The questionnaires contained the validated 10-item job satisfaction scale (JSS). Each item was scored on a seven-point Likert scale from 1 (very dissatisfied) to 7 (very satisfied). General linear modelling (GLM) controlled for gender, age, specialty and type of job was used to describe the trend in the score of JSS from 2000 to 2006. Results: The overall job satisfaction among Norwegian doctors was high and relatively stable from 2000 to 2004, with a non-significant dip in 2002. There was a significant increase in job satisfaction from 2000 to 2006. The job satisfaction was generally higher for older doctors than for younger doctors, but no gender difference was found. Private practice specialists were the most satisfied at all points in time, and general practitioners were more satisfied than hospital doctors. No significant or persistent impact of two healthcare reforms was found. Conclusion: Job satisfaction among Norwegian doctors is high and increasing. The lack of impact on this even from comprehensive healthcare reforms points to a robust satisfaction based on internal values more than external changes. The consistent finding of increasing — rather than declining — job satisfaction among Norwegian doctors, contrasts with widely held opinions in the public.

Age differences in alcohol drinking patterns among Norwegian and German hospital doctors--a study based on national samples

AIMS

To describe and discuss the alcohol drinking patterns of the younger generation of hospital doctors in Norway and Germany - respectively the abstainers, frequent drinkers, episodic heavy drinkers and hazardous drinkers.

METHODS

Data were collected in nationwide postal surveys among doctors in Norway (2000) and Germany (2006). A representative sample of 1898 German and 602 Norwegian hospital doctors aged 27-65 years were included in the analyses (N=2500). Alcohol drinking patterns were measured using the first three items of AUDIT in Norway and the AUDIT-C in Germany, scores of >or=5 (ranking from 0 to 12) indicating hazardous drinking. Episodic heavy drinking was defined by the intake of >or=60 g of ethanol, on one occasion, at least once a week. Frequent drinkers were who drank alcoholic beverages at least twice a week. Abstainers were persons who drank no alcohol. The analyses were performed separately for age groups (27-44 years versus 45-65 years) and genders.

RESULTS

Compared to the age groups 45 to 65 years in the Norwegian and German samples, the younger age groups (27-44 years) tend to have higher rates of abstainers, higher rates of infrequent drinking of moderate amount of alcoholic drinks, lower rates of episodic heavy drinking and lower rates of hazardous drinking.

CONCLUSION

The younger generation of hospital doctors in Norway and Germany showed tendencies to healthier drinking habits. Changes in professional life, and in the attitude towards alcohol consumption, may go some way towards explaining these findings.

Study-related health and behavior patterns of medical students: A longitudinal study

BACKGROUND

Little is known about specific health risks and resources and their development influencing medical students' stress.

AIM

To evaluate the development of quality of life and study-related behavior and experience patterns among medical students.

METHODS

Data were collected in the first (n = 112 of 182 in 2006) and the fourth semesters (n = 164 of 176 in 2008). The instruments "Work-Related Behavior and Experience Patterns" (AVEM, including four main patterns: "Health", "Unambitious," "Overexertion," "Burnout") and "Short Form-12 Health Survey (SF-12)" were used at both points in time.

RESULTS

The medical students scored significantly lower on mental health compared with reference samples of young adults. The proportion of students with a healthy pattern decreased from 47.3% (95% CI 38.1-56.5%) in the first semester to 36.9% (29.4-44.4%) in the fourth semester. This corresponded to an increase in the proportion of students at risk for burnout from 7.1% (2.3-11.9%) to 20% (13.8-26.2%). At both time points, female students had a higher risk for overexertion and a lower prevalence of a healthy pattern than male students.

CONCLUSION

Our data provide evidence for a decrease in the healthy pattern and an increase in the burnout pattern. Intervention is needed, especially for students at risk for burnout.

Job satisfaction among hospital doctors in Norway and Germany. A comparative study on national samples

Aims: To compare German and Norwegian hospital doctors on 10 different aspects of job satisfaction and general life satisfaction. Methods: The study population consisted of a representative sample of 1,448 German and 484 Norwegian hospital doctors aged 33—65 years (n = 1,932), selected from nationwide postal surveys in 2006. The questionnaires contained items on subjective life satisfaction and the validated 10-item Job Satisfaction Scale. Each item was scored on a seven-point Likert scale from 1 (very dissatisfied) to 7 (very satisfied). A mean sum score was calculated, ranging from 1 to 7. Regression analyses and generalized-linear-model-estimated means controlled for age and gender with 95% confidence intervals were used for comparison. Results: Norwegian hospital doctors had significantly higher life satisfaction (mean 5.31 vs. 5.15) and job satisfaction (mean 5.09 vs. 4.55) than their German colleagues. Item by item, doctors in Norway were significantly more content with seven aspects of their work: ``Freedom to choose your own methods of working'' (mean 5.00 vs. 4.72), ``opportunities to use your skills'' (mean 5.49 vs. 5.01), ``physical working conditions'' (mean 4.62 vs. 4.08), ``recognition you get for good achievements'' (mean 4.83 vs. 4.26), ``overall job situation'' (mean 5.57 vs. 4.64), ``work hours'' (mean 4.39 vs. 3.39), ``rate of pay'' (mean 4.70 vs. 3.70). General life satisfaction and age, but not gender, were positively associated with job satisfaction in both countries. Conclusions: Norwegian hospital doctors enjoy a higher level of life and job satisfaction than German hospital doctors. The most likely reasons for this are more acceptable work hours, salary and control over clinical work in Norway.

Involvement of capsaicin-sensitive afferent nerves in the proteinase-activated receptor 2-mediated vasodilatation in the rat dura mater

Neurogenic inflammation of the dura mater encephali has been suggested to contribute to the mechanisms of meningeal nociception and blood flow regulation. Recent findings demonstrated that the rat dura mater is innervated by trigeminal capsaicin-sensitive peptidergic nociceptive afferent nerves which mediate meningeal vascular responses through activation of the transient receptor potential vanilloid type 1 (TRPV1) receptor. The present work explored the functional significance of the capsaicin-sensitive subpopulation of dural afferent nerves via their contribution to the meningeal vascular responses evoked through activation of the proteinase-activated receptor 2 (PAR-2). The vascular responses of the dura mater were studied by laser Doppler flowmetry in a rat open cranial window preparation. Topical applications of trypsin, a PAR-2-activator, or Ser-Leu-Ile-Gly-Arg-Leu-amide (SLIGRL-NH(2)), a selective PAR-2 agonist peptide, resulted in dose-dependent increases in meningeal blood flow. The SLIGRL-NH(2)-induced vasodilatation was significantly reduced following capsaicin-sensitive afferent nerve defunctionalization by prior systemic capsaicin treatment and by pretreatment of the dura mater with the calcitonin gene-related peptide (CGRP) receptor antagonist CGRP(8-37). Nomega-nitro-L-arginine methyl ester hydrochloride (L-NAME) an unspecific inhibitor of nitric oxide (NO) production, but not 1-(2-trifluoromethylphenyl) imidazole (TRIM), a neuronal NO synthase inhibitor, also inhibited the vasodilator response to SLIGRL-NH(2). The vasodilator responses elicited by very low concentrations of capsaicin (10 nM) were significantly enhanced by prior application of SLIGRL-NH(2). The present findings demonstrate that activation of the PAR-2 localized on capsaicin-sensitive trigeminal nociceptive afferent nerves induces vasodilatation in the dural vascular bed by mechanisms involving NO and CGRP release. The results indicate that the PAR-2-mediated activation and sensitization of meningeal capsaicin-sensitive C-fiber nociceptors may be significantly implicated in the pathophysiology of headaches.

[Job satisfaction of hospital doctors. Results of a study of a national sample of hospital doctors in Germany]

AIMS

This paper presents the findings on the level of job satisfaction among hospital physicians in Germany and puts the results into relation to demographic variables and employment status.

METHODS

Data were collected as part of the survey "Work Life, Lifestyle and Health among Hospital Doctors in Germany 2006" using anonymous self-reporting questionnaires. Job satisfaction was scored using the scale according to Warr et al. It consists of 10 items with a seven-point Likert scale (1=dissatisfaction; 7=satisfaction), so the sum score ranks between 10 and 70. The following variables were correlated to job satisfaction: demographic variables (gender, age), and employment status (specialty, geographical localisation of hospital, hospital type, level of seniority, working time pattern).

RESULTS

The response rate was 58% (n=1917). Doctors reported an average job satisfaction of 44.3. Comparing different specialties, physicians in radiology had the highest (47.6) and in surgery (43.0) the lowest level of job satisfaction. Below-average job satisfaction could also be found in urology (43.5) and internal medicine (43.7). The regression analysis showed that the younger age group (B=-1.45; p=0.031) and those with a status as junior physician (B=-4.97; p=0.0001) were significantly dissatisfied. Out of the ten items assessed "working hours" (3.25), "payment" (3.59), "physical working conditions" (3.96) and "recognition for good work" (4.08) attained the lowest ratings.

CONCLUSIONS

Hospital doctors in Germany are moderately satisfied with their jobs - less satisfied than their colleagues in England, New Zealand and Norway. Improvement of job satisfaction and working conditions should be achieved via effective regulation of working hours and improvement of recognition for medical work regarding monetary and non-monetary factors such as payment and positive feedback for good work.

Hazardous alcohol use among hospital doctors in Germany

AIMS

To describe alcohol use, and the prevalence and predictors of hazardous drinking, among hospital doctors.

METHODS

Data were collected by anonymous mail survey in 2006, from a representative national sample of 1917 (58% response rate) hospital doctors in Germany. Alcohol use was measured using the AUDIT-C, scores of 5 or more for males and females indicating "hazardous drinking."

RESULTS

There were 9.5% abstainers, 70.7% moderate drinkers, and 19.8% hazardous drinkers. The majority of doctors (90.5%) used alcohol--mainly at a sensible level, e.g., 2-4 times a month (32%) or 2-3 times a week (29%), and 1-2 glasses on one occasion (83%). Binge drinking was common (53%), but for most occurred less than once in a month (39%). When hazardous drinking was controlled for certain confounders, being male (OR 4.7; 95% CI 3.4-6.5) and having a surgical specialty (OR 1.4; 1.1-1.8) were significantly correlated to hazardous drinking. Age had no influence on this model. By contrast, the age group 40 years and younger (OR 2.1; 1.4-3.0) was a significant predictor of abstinence.

CONCLUSIONS

There is a higher rate of abstainers and a lower rate of binge drinkers among hospital doctors in Germany than in the general population. However, some hospital doctors drink hazardously, the risk being greater among males and among surgeons, which should be paid due attention in the interest of their health and their function as doctors.

Excessive working hours and health complaints among hospital physicians: a study based on a national sample of hospital physicians in Germany

OBJECTIVES

To determine correlations between excessively long working hours and subjectively experienced somatic health complaints among hospital physicians.

METHODS

Quantitative data were collected as part of the survey "Working life, Lifestyle and Health of Hospital Physicians in Germany 2006" using self-reporting questionnaires. The individually experienced health was assessed on the basis of Zerssen's list of somatic complaints. The indicator of excessively long working hours was defined as 10 or more working hours per working day and 6 or more on-call shifts a month among full-time employees. The net sample consisted of 3295 randomly selected physicians from 515 hospitals.

RESULTS

The response rate was 58% (n=1917). Physicians with excessively long working hours (19%) had significantly higher sum score of health complaints (p=0.0001) and significantly increased mental and physical fatigue symptoms (feeling faint, languor, uneasiness, heavy legs, excessive need for sleep, trembling; p=0.0001 to 0.047), mood changes (irritability, brooding; p=0.008 to 0.014), gastrointestinal (nausea, loss of weight; p=0.0001 to 0.014) and heart disorders (lumpy sensation in the throat, chest pain; p=0.0001 to 0.042). When the sum score of health complaints was controlled for selected confounders, being female (B=-3.44, p=0.0001) and having excessively long working hours (B=2.76, p=0.0001) were significantly correlated with health complaints. In a separate gender analysis, being exposed to excessively long working hours remained a significant predictor for health complaints among both females (B=3.78, p=0.001) and males (B=2.28, p=0.004).

CONCLUSIONS

Excessively long working hours are associated with an increased risk of health complaints. Reducing working hours may be the first step to improving physicians' health.

FEMALE SURGEONS' ALCOHOL USE: A STUDY OF A NATIONAL SAMPLE OF NORWEGIAN DOCTORS

AIMS

This study was designed to describe the alcohol use by female surgeons and the hazards of their drinking habits for them compared with the habits of female doctors from non-surgical specialities, and with those of their male colleagues in surgery, and to identify the variables associated with hazardous drinking.

METHODS

The data were collected in 2000 from a representative national sample of 1120 Norwegian doctors. Alcohol use was measured using a modified version of the Alcohol Use Disorders Identification Test. A score of 9 or more was used as an indicator of hazardous drinking.

RESULTS

Female surgeons compared with female non-surgeons had tendencies for more frequent moderate alcohol consumption accompanied by more frequent consumption of larger amounts of alcohol, and a significantly higher rate of hazardous drinking (18 vs 7.6%). Being a surgeon (OR = 1.7, 95% CI 1.2-2.4), male (OR = 2.7, 1.7-4.1) and aged 45 years or over (OR = 1.5, 1.1-2.2) were significant predictors of hazardous drinking. With separate gender analyses, being a surgeon was a significant predictor for both females (OR = 2.8, 1.2-6.6) and males (OR = 1.5, 1.0-2.3).

CONCLUSION

Female surgeons practising in Norway drink more frequently and more hazardously than other female doctors. There are a number of possible explanations for this. Surgical culture may be an important factor.

Is alcoholism a self-induced disease? A survey among doctors in Aarhus, Denmark and in Mainz, Germany

The intent of this study was to explore differences in views concerning the statements "alcoholism is a disease" and "alcoholism is a self-induced disease" among doctors in two cities from two contrasting countries, relating to different official definitions of alcoholism, namely Denmark, where alcoholism is related to ways of lifestyle and Germany, where alcoholism is related to preliminary diseases. The data come from a postal anonymous survey, carried out between January and February 2000 in Aarhus and Mainz, sent to general practitioners and hospital doctors from surgery, internal medicine and psychiatry. The identified sample was n = 572, and the response rate = 66% (n = 374). As opposed to doctors in Aarhus (73.7%), significantly more doctors in Mainz (92.4%) described alcoholism as a disease, but independent of nationality, about half of the samples (no gender, age and healthcare settings differences) also agreed that "alcoholism is a self-induced disease". The governmental position on alcoholism seems to have an influence on doctors' evaluation: in Denmark, where alcoholism is defined as a disease of lifestyle, doctors in Aarhus were less likely to describe alcoholism as a disease than in Mainz, where alcoholism is seen as a preliminary disease. The ideological background for these differences is connected to the different influence of the temperance groups on the alcohol field -- less in Denmark and more in Germany. However, half of the doctors in Aarhus and Mainz viewed alcoholism as a self-induced disease and so indirectly assumed that alcoholics are responsible for their self-afflicted disease.