[Working conditions and depression in physicians]

Managers perception of hospital employees' effort-reward imbalance

OBJECTIVE

Hospitals are frequently associated with poor working conditions that can lead to work stress and increase the risk for reduced employee well-being. Managers can shape and improve working conditions and thereby, the health of their teams. Thus, as a prerequisite, managers need to be aware of their employees' stress levels. This study had two objectives: At first, it aimed to test the criterion validity of the Effort-Reward Imbalance (ERI) questionnaire measuring psychosocial workload in hospital employees. Secondly, mean scales of the ERI questionnaire filled in by employees were compared with mean scales of an adapted ERI questionnaire, in which managers assessed working conditions of their employees.

METHODS

Managers (n = 141) from three hospitals located in Germany assessed working conditions of their employees with an adapted external, other-oriented questionnaire. Employees (n = 197) of the mentioned hospitals completed the short version of the ERI questionnaire to assess their working conditions. Confirmatory factor analyses (CFA) were applied to test factorial validity, using the ERI scales for the two study groups. Criterion validity was assessed with multiple linear regression analysis of associations between ERI scales and well-being among employees.

RESULTS

The questionnaires demonstrated acceptable psychometric properties in terms of internal consistency of scales, although some indices of model fit resulting from CFA were of borderline significance. Concerning the first objective, effort, reward, and the ratio of effort-reward imbalance were significantly associated with well-being of employees. With regard to the second objective, first tentative findings showed that managers' ratings of their employees' effort at work was quite accurate, whereas their reward was overestimated.

CONCLUSIONS

With its documented criterion validity the ERI questionnaire can be used as a screening tool of workload among hospital employees. Moreover, in the context of work-related health promotion, managers' perceptions of their employees' workload deserve increased attention as first findings point to some discrepancies between their perceptions and those provided by employees.

Bedürfnisorientierte Arbeitswelten im Krankenhaus: Entwicklung und Akzeptanz des HEMI-Architekturkonzepts

Dieser Beitrag in der Zeitschrift Gruppe. Interaktion. Organisation (GIO), Themenheft New Work – Inspirierende, kooperationsfördernde Arbeitsumgebungen beschreibt die Entwicklung und wissenschaftliche Prüfung eines Architekturkonzepts zur evidenzbasierten Gestaltung innovativer und bedürfnisorientierter Arbeitswelten im Krankenhaus. Das Konzept basiert auf einer berufsunabhängigen Neubewertung der Krankenhausumgebung und definiert fünf Umgebungskategorien und architektonische Qualitäten: (H) hands on/off (Arbeiten mit oder ohne direktem Patientenkontakt), (E) eyes on/off (Arbeiten mit oder ohne indirektem Patientenkontakt), (M) mind on (konzentrierte Arbeiten), mind off (Entspannung und Regeneration) und (I) interact on/off (Arbeiten mit oder ohne Kontakt zu Kollegen). Die Kategorien lassen Rückschlüsse auf den psycho-emotionalen Stress und die kognitive Beanspruchung der Mitarbeitenden zu und bestimmen die auf diese reagierende architektonische Gestaltung. Im Unterschied zum bisherigen deutschen Krankenhausentwurf durchbricht das (HEMI) Architekturkonzept veraltete Organisationsstrukturen, geht architekturpsychologisch auf die steigende Belastung der Mitarbeitenden ein und formuliert räumliche Lösungen. Die Akzeptanz der zentralen Arbeitswelt, die das Konzept u. a. vorsieht und die in einer bundesweiten Befragung an Klinikärztinnen und -ärzten durchgeführt wurde, ist hoch und abhängig von Alter‑, Einkommen und Dienstjahren.

Arbeitsbelastung und Arbeitszufriedenheit rechtsmedizinisch tätiger Ärztinnen und Ärzte

Hintergrund und Ziele

Das Fach Rechtsmedizin unterscheidet sich strukturell und inhaltlich sehr von anderen medizinischen Disziplinen. Da zu Arbeitsbelastung und Berufszufriedenheit der Rechtsmediziner*innen im deutschsprachigen Raum bislang wenig bekannt ist, wurden diese Aspekte über eine Online-Befragung untersucht.

Material und Methoden

Der Fragebogen wurde im September 2019 online an 436 rechtsmedizinisch tätige Ärzt*innen verschickt. Er enthielt je nach Antwortverhalten der Teilnehmer bis zu 53 Fragen zu den Themen Arbeitsbelastung und -zufriedenheit, Weiterbildung, Karriere, Forschung, Beruf vs. Privatleben und Generationenwandel. Die psychosoziale Arbeitsbelastung wurde anhand des Modells der beruflichen Gratifikationskrisen überprüft.

Ergebnisse

Von 199 bearbeiteten Fragebogen waren 181 vollständig ausgefüllt und konnten ausgewertet werden. Der Großteil der Befragten war zufrieden mit der Routinetätigkeit. Die Hälfte der Weiterbildungsassistent*innen (WBA) war zufrieden mit den institutsinternen Weiterbildungsbedingungen. Nur etwas mehr als ein Drittel der Befragten war zufrieden mit der wissenschaftlichen Tätigkeit; die Hälfte der befragten Ärzt*innen forschte aktiv. Die psychosoziale Arbeitsbelastung war bei einem mittleren ER-Quotienten von 1,24 insgesamt eher hoch. Es zeigten sich keine Unterschiede bezüglich Arbeitsbelastung und -zufriedenheit zwischen Assistenz- und Fachärzt*innen. Nur wenige WBA strebten eine zukünftige Leitungsposition an.

Diskussion

Die (hohe) psychosoziale Arbeitsbelastung der Rechtsmediziner*innen ist vergleichbar mit anderen medizinischen Fachrichtungen. Die gleichzeitig hohe Arbeitszufriedenheit könnte für eine Inkaufnahme der (Mehr‑)Belastung aufgrund einer hohen intrinsischen Motivation sprechen. Aus den erhobenen Daten lässt sich Handlungsbedarf zur Etablierung optimierter Bedingungen für Forschung und institutsinterne Weiterbildung ableiten.

Psychological impact of healthcare workers in China during COVID-19 pneumonia epidemic: A multi-center cross-sectional survey investigation

BACKGROUND

Since the outbreak of 2019 new coronavirus (COVID-19) pneumonia, healthcare workers (HCW) have suffered psychological stress. The present study is to examine the prevalence of stress, anxiety and depression of HCW in China during the COVID-19 epidemic, and to determine the risk factors predicting psychological morbidities that can be used as psychological intervention targets.

METHODS

A cross-sectional survey was conducted to investigate the psychological levels of HCW in multiple centers in China. The prevalence of stress, anxiety and depression were determined by using Perceived Stress Scale (PSS-14) and Hospital Anxiety / Depression scale (HAD). Psychology related factors were evaluated and correlation between job title and contact history was analyzed.

RESULTS

We received 958 of effective responses, 73.6% of which were from Wuhan and 67.2% were female participants. 55.1% of respondents had psychological stress that is higher than that of HCW during SARS. 54.2% and 58% of participants had symptoms of anxiety and depression. Stress levels of HCW were different in job titles and years of work experience. Anxiety and depression levels were different between different gender, job titles, degrees of protective measures and levels of contact history. Gender, intermediate title, protective measures and contact history were the independent risk factors for anxiety. Protective measures and contact history were the independent risk factors for depression.

CONCLUSIONS

The COVID-19 epidemic has induced stress levels for HCW, and high percentages of HCW have anxiety and depression. The situation of HCW is worrying and intervention service is urgent.

Hospital Medical and Nursing Managers' Perspective on the Mental Stressors of Employees

Working conditions in hospitals are characterized by occupational stressors, which lead to potentially harmful psychosocial stress reactions for medical and nursing staff. Representative surveys showed that almost every second hospital physician or nurse is affected by burnout and that there is a strong association between leadership behavior and employee health. Workplace health promotion programs can only be successful and sustainable if managers support them. However, it is still unclear whether hospital managers are aware of the working conditions and perceive them as an influence on the health of their employees. Therefore, the aim of this qualitative study was to explore the hospital medical and nursing managers' perspective on the mental stress of their employees. Semi-standardized interviews with 37 chief physicians (CP), senior physicians (SP) and senior nurses (SN) in total were carried out in one German hospital. The interviews were content-analyzed based on the guideline for the mental risk assessment of the 'Gemeinsame Deutsche Arbeitsschutzstrategie' (GDA). Most reported work characteristics related to work organization, work task, and social factors. Staff shortage could be identified as an underlying stressor for several other burdens. Social support by managers and among colleagues was mentioned as main resource. The findings indicate that managers strive to reduce the burden on their staff, especially through their personal support. Nevertheless, it seemed that managers need additional resources to counteract stressors.

How Do Hospital Medical and Nursing Managers Perceive Work-Related Strain on Their Employees?

Health-oriented supportive leadership behavior is a key factor in reducing work stress and promoting health. Employees in the health sector are subject to a heavy workload, and it has been shown that 40% of them show permanent health problems. A supportive leadership behavior requires the manager's awareness of the employees' well-being. However, little is yet known about how medical and nursing managers perceive the well-being of their staff. To explore this issue, we conducted a total of 37 semi-standardized interviews with 37 chief physicians (CPs), senior physicians (SPs), and senior nurses (SNs) in one German hospital. The interviews were content-analyzed based on the definitions of strain of the 'Federal Institute for Occupational Safety and Health'. Results show that hospital managers are aware of fatigue and further consequences such as deterioration of the team atmosphere, work ethics, treatment quality, and an increased feeling of injustice among employees. Most managers reported sick leaves as a result of psychosomatic complaints due to the permanent overstrain situation at work in the hospital. Results of this qualitative study are discussed in the light of health-oriented management relating to relevant stress models and to findings concerning staff shortages.

Hospital Medical and Nursing Managers' Perspectives on Health-Related Work Design Interventions. A Qualitative Study

BACKGROUND

Research indicates that the active support of managers is essential for the sustainable implementation of health-related work design interventions in organizations. However, little is known about managers' perceptions of such health promotion measures.

OBJECTIVE

Our study aims to provide information that help to foster managers active support of health-related work design interventions in hospitals. Based on Ajzen's Theory of Planned Behavior (TPB) we explore the attitudes, perceived organizational norms, and perceived behavioral control of managers in the hospital regarding such interventions.

METHODS

Semi-structured interviews with 37 managers (chief physicians, senior physicians, and senior nurses) were carried out in one German hospital. A software aided qualitative content analysis was applied.

RESULTS

We observed that the majority of managers are aware of the importance of health-related work design. We found a high variation in the perception of organizational norms related to mental health promotion of employees. Behavioral control for supporting interventions is perceived more on an individual (e.g., appraisal interviews, professional development or support) and team level (e.g., fair work schedule, regular team meetings), less on an organizational level.

CONCLUSION

To enable and to motivate hospital medical and nursing managers to support health-related work design, hospitals need to establish clear organizational norms that the health promotion of their employees is an important organizational goal. Moreover, managers need to get more work-design competencies and decision latitude to get more control. Important arguments for the top hospital management could be that health-related work design is highly effective for economic success, for treatment quality, and that the middle management already has a positive attitude toward the implementation of measures that help promote the mental health of their staff.

Mindfulness-based programme for residents: study protocol of a randomised controlled trial

INTRODUCTION

Residency is a stressful phase associated with high prevalence of mental distress. Besides impaired personal health, mental distress in residents has an impact on the quality of patient care and produces economic costs. Therefore, there is demand for interventions that improve resident physicians' mental health. The aim of the present study is to examine the effects of a mindfulness-based intervention that has been tailored to residents' needs. Specifically, mindfulness has been supplemented by a focus on the concept of Muße.

METHODS AND ANALYSIS

This study applies a randomised controlled multimethod design. Residents assigned to the intervention group will participate in an 8-week mindfulness course followed by a 4-month maintenance phase, whereas residents assigned to the control group will read text-based information about mindfulness on a weekly basis for the duration of 8 weeks. The intervention is focussed on a transfer of learnt techniques into the daily routine and is targeted to promote residents' self-care as well as on building empathic relationships. Participants will be assessed before, directly after the intervention, after the maintenance phase as well as at follow-up 6 months after the intervention group completes the intervention. Assessments will consist of self-report measures, physiological data, qualitative interviews, third-party reports as well as implicit and projective measures and will focus on both psychopathology and salutogenesis. The primary outcome will be burnout. Data will be analysed using linear mixed modelling.

ETHICS AND DISSEMINATION

The study was approved by the ethics committee of the Medical Center - University of Freiburg and is funded by the German Research Foundation as part of the interdisciplinary Collaborative Research Center 'SFB Muße 1015'. The results of this study will be published in scientific journals and disseminated through the study's website, and conferences.

TRIAL REGISTRATION NUMBER

DRKS00014015.

Desired improvements of working conditions among medical assistants in Germany: a cross-sectional study

Background

In outpatient care in Germany, medical assistants (MAs) are the contact persons for patients' concerns and their working conditions are relevant to their own health and the provided quality of care. MAs working conditions have been described as precarious leading to high levels of work stress. Consequently, we aimed to examine MAs' needs for work-related improvements.

Methods

We surveyed 887 employed MAs between September 2016 and April 2017. A 20-item questionnaire measured desired improvements. To measure correlations between variables we computed a matrix of tetrachoric correlations for binary variables and performed an exploratory factor analysis. We ran ordinal logistic regression models employing 11 independent variables to examine determinants of needs.

Results

A total of 97.3% of the participants expressed any need and, on average, 10.27 needs were reported. Most frequently, needs were expressed related to a higher salary (87.0%), less documentation (76.0%) and more recognition from society (75.4%). Exploratory factor analysis suggested three dimensions of needs for work-related improvements (i.e. working conditions, reward from the supervisor and task-related independence). Ordinal logistic regression models only identified determinants for the outcome variable task-related independence, which was more frequent in those with longer work experience or in a leadership position.

Conclusions

The high prevalence of desired workplace-related improvements among MAs highlights the relevance of modifying their working conditions. The fact that we found only few determinants signals that there are no specific high-risk subgroups, but interventions to improve MAs' working conditions should target the entire MA population.

Associations of psychosocial working conditions with health outcomes, quality of care and intentions to leave the profession: results from a cross-sectional study among physician assistants in Germany

BACKGROUND

Numerous epidemiological studies among health care staff have documented associations of adverse psychosocial working conditions with poorer health-related outcomes, a reduced quality of patient care and intentions to leave the profession. The evidence for physician assistants in Germany remains limited though.

METHODS

We surveyed a total of 994 physician assistants between September 2016 and April 2017. Psychosocial working conditions were measured by the established effort-reward imbalance (ERI) questionnaire and by a questionnaire specifically developed to capture psychosocial working conditions among physicians. Health outcomes (i.e., self-rated health, depression, anxiety), self-rated quality of care and the intention to leave the profession were assessed by established measures. We ran multivariable logistic regression analyses.

RESULTS

The prevalence of work stress in terms of ERI equalled 73.77%. Work stress according to the ERI model was associated with significantly poorer self-rated health [odds ratio (OR) 3.62], elevated symptoms of depression (OR 8.83) and anxiety (OR 4.95), poorer quality of care (OR for medical errors 4.04; OR for interference of work with patient care 3.88) and an increased intention to leave one's current profession (OR 3.74). The PA-specific questionnaire showed similar, albeit weaker, associations (all ORs > 1.22).

CONCLUSIONS

Our results are in line with previous findings among health care staff and provide specific and novel evidence for physician assistants. Interventions aiming at the improvement of working conditions seem needed given their potential adverse consequences in terms of employee health, quality of care, and personnel policy.

Acute Stress and Anxiety in Medical Residents on the Emergency Department Duty

The objectives of this longitudinal study were to compare salivary cortisol release patterns in medical residents and their self-perceived anxiety levels between a regular working day and a day when on call in the emergency department (ED-duty day) and to determine any differences in cortisol release pattern as a function of years of residency or sex. The study included 35 residents (physicians-in-training) of the Granada University Hospital, Granada, Spain. Acute stress was measured on a regular working day and an ED-duty day, evaluating anxiety-state with the Spanish version of the State-Trait Anxiety Inventory. Physiological stress assessment was based on salivary cortisol levels. Cortisol release concentrations were higher on an ED-duty day than on a regular working day, with a significantly increased area under the curve (AUC) (p < 0.006). This difference slightly attenuated with longer residency experience. No gender difference in anxiety levels was observed (p < 0.001). According to these findings, the hypothalamic-pituitary-adrenal axis activity and anxiety levels of medical residents are higher on an ED-duty day than on a regular working day.

[Psychosocial working conditions of physician assistants: results from a qualitative study on occupational stress, resources, possible approaches to prevention and intervention needs]

BACKGROUND

Numerous studies have documented adverse psychosocial working conditions among health care staff. Working conditions may not only impair the health outcomes of this professional group, but can also affect the quality of care they deliver to patients. Previous work stress research has mainly focused on physicians and nurses. Comparable evidence remains limited, however, for physician assistants (Medizinische Fachangestellte, MFAs), who represent the largest professional group in German primary care. This study aimed to gain insights into work stressors and resources experienced by MFAs and to explore both possible approaches to prevention and intervention needs.

METHODS

Participants were recruited from a criterion-based sample of medical practices in and around the city of Düsseldorf (Germany) and with assistance provided by the Medical Staff Association (VMF e. V.). In total, 26 qualitative in-depth interviews were conducted (11/2015-02/2016), transcribed and content analyzed using MaxQDA.

RESULTS

MFAs reported a high workload and unforeseeable incidents as salient occupational stressors. Additional stressors included interpersonal relationship problems with superiors and a lack of social support from colleagues. At the same time though, support from superiors and colleagues can provide a key resource for coping with work stressors. Furthermore, social interactions with patients and diversified tasks were perceived as supportive professional resources. Possible approaches to prevention were exclusively seen to operate at the organizational level. The perceived need for intervention primarily concerned adequate wages and appreciation from superiors and society.

CONCLUSIONS

Physician assistants described their working conditions as being characterized by high demands, low job control and low rewards. We suggest basic approaches for employers to improve the working experience of MFAs, which may represent the starting point for further research efforts to develop preventive measures.

Short Questionnaire for Workplace Analysis (KFZA): factorial validation in physicians and nurses working in hospital settings

Background

In recent years, there has been an increasing interest in psychosocial workplace risk assessments in Germany. One of the questionnaires commonly employed for this purpose is the Short Questionnaire for Workplace Analysis (KFZA). Originally, the KFZA was developed and validated for office workers. The aim of the present study was to examine the factorial validity of the KFZA when applied to hospital settings. Therefore, we examined the factorial structure of a questionnaire that contained all the original items plus an extension adding 11 questions specific to hospital workplaces and analyzed both, the original version and the extended version.

Methods

We analyzed questionnaire data of a total of 1731 physicians and nurses obtained over a 10-year period. Listwise exclusion of data sets was applied to account for variations in questionnaire versions and yielded 1163 questionnaires (1095 for the extended version) remaining for factor analysis. To examine the factor structure, we conducted a principal component factor analysis. The number of factors was determined using the Kaiser criterion and scree-plot methods. Factor interpretation was based on orthogonal Varimax rotation as well as oblique rotation.

Results

The Kaiser criterion revealed a 7-factor solution for the 26 items of the KFZA, accounting for 62.0% of variance. The seven factors were named: “Social Relationships”, “Job Control”, “Opportunities for Participation and Professional Development”, “Quantitative Work Demands”, “Workplace Environment”, “Variability” and “Qualitative Work Demands”. The factor analysis of the 37 items of the extended version yielded a 9-factor solution. The two additional factors were named “Consequences of Strain” and “Emotional Demands”. Cronbach’s α ranged from 0.63 to 0.87 for these scales.

Conclusions

Overall, the KFZA turned out to be applicable to hospital workers, and its content-related structure was replicated well with some limitations. However, instead of the 11 factors originally proposed for office workers, a 7-factor solution appeared to be more suitable when employed in hospitals. In particular, the items of the KFZA factor “Completeness of Task” might need adaptation for the use in hospitals. Our study contributes to the assessment of the validity of this popular instrument and should stimulate further psychometric testing.

Electronic supplementary material

The online version of this article (doi:10.1186/s12995-017-0157-6) contains supplementary material, which is available to authorized users.

The Effort and Reward of Teaching Medical Psychology in Germany: an Online Survey

Background: The increasing significance of university teaching also leads to higher demands for academic teachers. Against this background this study inquires how teachers in the field of medical pychology experience and evaluate their various activities and how their efforts on the one hand and gratifications on the other hand relate to each other (as conceptualized by the effort-reward-imbalance, ERI). Methods: A cross-sectional online survey was conducted in 2012 among the academic staff of departments of medical psychology in Germany. The questionnaire was answered by 188 participants (return rate: 39.2%), of whom 62% were women. Work stress was measured according to Siegrist's effort-reward-imbalance (ERI) model. Further questions referred to the distribution of academic activities and meaningfulness. Results: Among all participants, 67.3% were satisfied with the portion of their workload devoted to teaching, while 63% wanted more time for research. The ERI-coefficient was on average M=0.76 (SD=0.45), thus indicating a shift towards reward. There were no associations with gender, age, or fixed-term work contracts. Meaningfulness was associated negatively with the ERI (r=-.21, p=.012), and positively with overcommitment (r=.52, p<.001) and the desire for less administrative tasks (r=.24, p=.017). Conclusions: Teaching medical psychology is evaluated as positive and meaningful by a majority of respondents. In general, the rewarding aspects seem to outweigh the stressful factors. Thus, teaching might be a protective factor with regard to coping with work related burden.

[Positive and negative perceptions at work: Qualitative study with physicians in a teaching hospital]

INTRODUCTION

Doctors see the suffering of patients and their families; their working conditions are often difficult. High prevalence of occupational diseases are shown in medical literature, especially burnout. Some risk factors are shown depending upon medical specialties and workplace, especially in hospital. The purpose of this article was to qualify these factors by qualitative research, according to hospital doctors' point of view.

METHODS

It was a study with interviews. The analysis was done according to the Grounded Theory.

RESULTS

Nine doctors were interviewed. They expressed difficulties and positive factors at work. Four major themes were demonstrated in selective coding: the organization of work, experienced as positive rather negative, teamwork, work at the hospital and academic work. The three last themes were both a source of well-being and ill-being according to the situations specified in the results.

CONCLUSION

The fact of working in a hospital is meaningful for physicians surveyed. But it could also be source of ill-being and anxiety.

Mental health among currently enrolled medical students in Germany

OBJECTIVES

The study identifies the prevalence of common mental disorders according to the patient health questionnaire (PHQ) and the use of psychotropic substances in a sample of currently enrolled medical students.

STUDY DESIGN

A cross-sectional survey with a self-administrated questionnaire.

METHODS

All newly enrolled medical students at the University of Dusseldorf, with study beginning either in 2012 or 2013, respectively, were invited to participate. The evaluation was based on 590 completed questionnaires. Mental health outcomes were measured by the PHQ, including major depression, other depressive symptoms (subthreshold depression), anxiety, panic disorders and psychosomatic complaints. Moreover, information about psychotropic substances use (including medication) was obtained. Multiple logistic regression analysis was used to estimate associations between sociodemographic and socio-economic factors and mental health outcomes.

RESULTS

The prevalence rates, measured by the PHQ, were 4.7% for major depression, 5.8% for other depressive symptoms, 4.4% for anxiety, 1.9% for panic disorders, and 15.7% for psychosomatic complaints. These prevalence rates were higher than those reported in the general population, but lower than in medical students in the course of medical training. In all, 10.7% of the students reported regular psychotropic substance use: 5.1% of students used medication 'to calm down,' 4.6% 'to improve their sleep,' 4.4% 'to elevate mood,' and 3.1% 'to improve cognitive performance.' In the fully adjusted model, expected financial difficulties were significantly associated with poor mental health (odds ratio [OR]: 2.14; 95% confidence interval [CI]: 1.31-3.48), psychosomatic symptoms (OR:1.85; 95% CI: 1.11-3.09) and psychotropic substances use (OR: 2.68; 95% CI: 1.51-4.75).

CONCLUSION

The high rates of mental disorders among currently enrolled medical students call for the promotion of mental health, with a special emphasis on vulnerable groups.

Hospital physicians' work stressors in different medical specialities: a statistical group comparison

Background

Some studies on the occupational health of hospital physicians have found that working conditions have different effects on physician’s well-being and health in different medical specialities. There has been no comparative study of the effects of various work stressors in different specialities. This study aims to close this gap.

Methods

German hospital physicians were asked about their working conditions and aspects of health. The short version of the Instrument for Stress-Related Job Analysis for Hospital Physicians was used to measure working conditions. Irritation and emotional exhaustion were used to assess health. Physicians were also asked for socio-demographic aspects, including their medical speciality.

Results

Data from 763 hospital physicians were included in the analyses. Significant differences between medical specialities were demonstrated for time pressure, uncertainty, frustration about how work needs to be done and social stressors with patients. Physicians in internal medicine showed consistently high levels of stressors. Time pressure, frustration about how work needs to be done, and emotional dissonance were found to be significantly related to both aspects of health.

Conclusions

The results showed that some medical specialities are more affected by specific stressors. It is therefore discussed how improvements can be implemented. Furthermore, it is illustrated which stressors are especially relevant for health. These relationships to health should be investigated in further research and in longitudinal designs to allow hints of causal relationships.

[Stress and job satisfaction in the discipline of inpatient anesthesiology : results of a web-based survey]

BACKGROUND

How do physicians in the specialty of anesthesiology perceive the working conditions regarding stress and job satisfaction? The health system in Germany has been confronted with a rapidly changing framework over the last 20 years: For example, an increased influence of economic patterns on the workflow and the medical decision of physicians has been established forcing them to always take the economic aspects into account. Moreover, a new generation (generation Y) of physicians with other requirements of the work place, meaning mainly a demand for a better work-life balance, has gained a foothold in hospitals. These changes make it very important to investigate the status quo of current working conditions.

AIM

Working conditions in hospitals in the specialty of anesthesiology is the main issue investigated in this study.

METHODS

For this study 1,321 completed online-questionnaires from physicians in hospitals with the specialty of anesthesiology were analyzed. The questionnaire was based on the stress theory, the effort-reward-imbalance model (ERI) and the job-demand-control model (JDC).The items used in the questionnaire were taken from the ERI questionnaire and the short questionnaire on work analysis (KFZA). By calculating a certain ratio of several items (according to the stress theory), the prevalence of distress could be measured. In addition the overall job satisfaction in the field of anesthesiology was measured and analyzed.

RESULTS

In this study 47.0 % (95 %-CI: 44.3-49.7 %) of all respondents showed signs of distress. Simultaneously, 61.8 % (95 %-CI: 59.2-64.5 %) were very satisfied with the job situation. Regarding gender, female physicians perceived a lower control of the work situation whereas male physicians perceived a much higher decision level. This led to a higher prevalence of distress in the group of female physicians regarding the JDC model (odds ratio, OR: 1.54, 95 %-CI: 1.19-2.01). Regarding age, the prevalence of distress increased from 36.5 % in the respondents under 35 years old to 50.7 % in those 35-59 years old (OR: 1.79, 95 %-CI: 1.38-2.32). Looking at the different functional positions in the hospital, senior doctors showed a much higher prevalence of distress (52.8 %) than junior doctors (OR: 1.57, 95 %-CI: 1.21-2.05). Analyzing job satisfaction with respect to the functional position, the highest significant proportion was shown by senior doctors (65.8 %).

CONSEQUENCES

This study revealed a high prevalence of unfavorable working conditions for anesthetists in hospitals. Taking the forthcoming shortage of qualified physicians in German hospitals into account, these results have to be considered as a cause for concern. Constant unfavorable working conditions have a negative effect on the mental and physical health of employees. Sooner or later a migration of qualified physicians abroad could be the consequence. To prevent a future shortage of qualified physicians and to make the hospital work place more appealing, working conditions have to be adapted to current needs and expectations of employees. The focus should be put on balanced working conditions according to stress models shown in this study.

[The changing role of physicians]

Despite a very successful process of professionalisation during the past 150 years, today's physicians face several challenges urging them to adapt their traditional professional role and the patient-physician relationship inherent in this role. Among these challenges, a growing economic influence on physicians' practices, new demands from particular groups of patients (consumerism, role of the Internet etc.), and increasing inter-professional competition deserve special attention. New evidence of an association between a stressful work environment and physician's increased health risks provides additional support in favour of this notion. This contribution suggests potential directions of change of the physician's role by pointing to (a) a growing 'feminisation' of medicine, (b) an even stronger emphasis on patient needs and (c) extended teamwork and inter-professional cooperation.

The mental health of primary care physicians in Rhineland-Palatinate, Germany: the prevalence of problems and identification of possible risk factors

BACKGROUND

The generally high job-related stress level among physicians may lead to various health impairments in the long run. Apart from job-related stress, stress during leisure time and certain personality traits might be risk factors for health impairments. However, very little research on the health situation of primary care physicians (PCPs) in Germany is available. Therefore, the objective of the present study was to systematically assess the stress experience and the health situation of German PCPs. One main focus was on mental health.

METHODS

In 2009, a state-wide survey among practice-based PCPs in the federal German state of Rhineland-Palatinate (cross-sectional study, n = 2092) was carried out in order to assess stress and strain as well as the health situation.

RESULTS

790 participants (37.7%) were eligible for the analyses. One in four PCPs exceeded the cut-off value ≥ 3 for depression in the PHQ-2 (PHQ, Patient Health Questionaire). Moreover, approximately one in six PCPs stated that he or she had used psychotropic drugs or other psychoactive substances at least once in the preceding year. Stress during leisure time, type D personality and low job satisfaction were associated with the presence of mental health impairments in the binary logistic regression analyses.

CONCLUSION

All in all, it appears that mental health impairments are a common health problem among the PCPs. Target-group-specific measures should be taken in order to reduce the subjective stress level, and to foster mental hygiene. Furthermore, the development of favorable personality profiles and the corresponding behavioral patterns should be supported.

[Psychiatric assessment of physicians on probation]

Psychiatric assessment of physicians on probation is a challenge and has been widely neglected in the forensic literature to date. Based on own experience in this area, some typical cases are described. Physicians with substance use and legal problems are especially common. Some general guidelines for psychiatric assessment are discussed.

[Anxiety and depression in residents - results of a Swiss longitudinal study]

OBJECTIVES

The study investigates the development of anxiety and depression during residents' postgraduate training as well as the symptom patterns and the prediction of these patterns of impaired affectivity by personality factors. It furthermore regards the differences between these patterns in workplace- and career-related factors as well as in worklife balance.

METHODS

In a prospective cohort study (2001-2007), 390 junior physicians of various specialties (54.9% females, 45.1% males) were investigated with respect to the percentage of participants with elevated anxiety and depression scores at the beginning of the second, fourth, and sixth year of residency, respectively. Symptom patterns were evaluated by two-step cluster analysis. The prediction of the assignment to the symptom patterns was investigated by logistic regression analysis. The differences in further factors between the two patterns was analyzed by t-tests.

RESULTS

In the second year of residency, relevant anxiety symptoms were found in 30% of the physicians, and in the fourth and sixth year in 20%; relevant depression symptoms were found in 15% and 10%, respectively. The cluster analysis revealed two symptom patterns: Type A (n = 135, 34.6%) with continuously elevated anxiety and depression symptoms; and type B (n = 255, 65.4%) with continuously low values. Personality factors such as the sense of coherence, self-esteem, occupational self-efficacy expectation, and overcommitment significantly predicted the assignment to the symptom patterns. Also in terms of workload, mentoring experience, career satisfaction, and worklife balance, persons of type A differ from those of type B.

CONCLUSION

Personality factors play an important role in physicians' ability to cope with job demands. Persons with an elevated vulnerability for anxiety and depression should be continuously supported and counselled by a mentor during residency.