Job satisfaction among Norwegian general practitioners

The impact of clinical experience on working tasks and job-related stress: a survey among 1032 Norwegian GPs

BACKGROUND

General practice is a generalist discipline fraught with complexity. For inexperienced physicians, it may be demanding to get to grips with the clinical challenges. The purpose of this article is to describe possible differences in the range of tasks between inexperienced and experienced general practitioners (GPs), and the extent to which clinical experience affects the way in which GPs perceive their daily work.

METHODS

An online questionnaire was sent to all regular GPs in Norway (N = 4784) in 2018. The study sought to document the tasks performed during a typical working day and how the GPs perceived their working situation. In this study, we compare the tasks, working situation and occurrence of potentially conflictual consultations among 'less experienced physicians' (≤ 5 years of experience in general practice) versus 'more experienced physicians' (> 5 years of experience). The findings are discussed in light of theories on development of expertise.

RESULTS

We received responses from 1032 GPs; 296 (29%) were less experienced and 735 (71%) more experienced. The two groups reported virtually the same number of consultations (19.2 vs. 20.5) and clinical problems handled (40.4 vs. 44.2) during the study day. The less experienced physicians reported a higher proportion of challenging and/or conflictual consultations, involving prescriptions for potentially addictive medication (5.7% vs. 3.1%), sickness certification (4.1% vs. 2.4%) and referral for medical investigations on weak clinical indication (8.1% vs. 5.6%). For other clinical issues there were minor or no differences. Both GP groups reported high levels of work-related stress with negative effect on self-perceived health (61.6% vs 64.6%). GPs who felt that high job demands harmed their health tended to handle a slightly higher number of medical issues per consultation and more consultations with elements of conflict.

CONCLUSIONS AND IMPLICATIONS

Inexperienced GPs in Norway handle a workload comparable to that of experienced GPs, but they perceive more conflictual consultations. These findings have relevance for training and guidance of future GP specialists. Irrespective of experience, the GPs report such high levels of negative work-related stress as to indicate an acute need for organisational changes that imply a reduced workload.

Job satisfaction and support in the medical profession: The foundations of efficient organizational healthcare performance

Purpose

The purpose of the paper is to examine the levels of job satisfaction among doctors who work in Greek public hospitals, to determine the factors that may influence their satisfaction, to examine the contribution that staff support makes to job satisfaction and to investigate the potential impact that an economic recession might have on job satisfaction.

Design/methodology/approach

The sampling process used was stratified sampling and it was applied to all health regions in Greece. An official request to carry out the study was sent to 45 hospitals for the approval of their management. Through random sampling, 5% of the doctors' population was selected from each participating hospital, with the resulting sample consisting of 458 doctors from all the health regions of Greece. An anonymous questionnaire was administered to the sample of medical doctors to gather data on their perception of the work they do in public hospitals.

Findings

Empirical results showed that (1) the most important factor in doctors' job satisfaction appears to be the nature of their job and the high levels of autonomy that they have, and (2) doctors' level of commitment is maintained by enhancing their positive emotions and sense of professional well-being.

Originality/value

A deeper understanding of important concepts of an organization's behavior such as job satisfaction, staff support and their connection with internal organizational structures will facilitate policy makers and those who make decisions on the strategic management of medical staff in public hospitals.

Burnout in French General Practitioners: A Nationwide Prospective Study

Background: We aimed to evaluate the prevalence of burnout among French general practitioners in private practice and to study the risk and protective factors of burnout. Methods: A nationwide cross-sectional study was conducted with French GPs working in a private practice in France who were asked to fulfil an internet questionnaire. We used the secure internet application REDCap^®. Exclusion criteria were only working in a hospital, substitute doctors, and internship students. There was a putative sample size of 88,886 GPs. We retrieved the Maslach Burnout Inventory (MBI), occupational characteristics (type of installation, emergency regulated shifts, night shifts, university supervisor, weekly hours worked, seniority), and personal characteristics such as age, gender, marital status, and number of children. Results: We included 1926 GPs among the 2602 retrieved questionnaires. A total of 44.8% of French liberal GPs were experiencing burnout, with 4.8% (95%CI 3.9–5.9%) experiencing severe burnout. The risk factors of severe burnout were male gender (RR = 1.91, 95%CI 1.15–3.16), working in a suburban area (5.23, 2.18–12.58), and having more than 28 appointments per day (1.95, 1.19–3.19). Working more than 50 h weekly showed a tendency to increase the risk of severe burnout (1.55, 0.93–2.59, p = 0.095), with a significant increase in the risk of low and moderate burnout (1.31, 1.02–1.67 and 1.86, 1.34–2.57, respectively). Protective factors were mainly resident training, which decreased the risk of both low, moderate, and severe burnout (0.65, 0.51–0.83; 0.66, 0.48–0.92; and 0.42, 95%CI 0.23–0.76, respectively). Performing home visits decreased the risk of severe burnout (0.25, 0.13–0.47), as did group practice for intermediate level of burnout (0.71, 0.51–0.96). Conclusion: GPs are at a high risk of burnout, with nearly half of them in burnout, with burnout predominantly affecting males and those between the ages of 50 and 60 years old. The main risk factors were a high workload with more than 28 appointments per day or 50 h of work per week, and the main protective factors were related to social cohesion such having a teaching role and working in a group practice with back-office support.

Burnout, satisfaction and happiness among German general practitioners (GPs): A cross-sectional survey on health resources and stressors

Well-being is a major issue among health care professionals, especially physicians. Less job satisfaction and impaired health can have an impact on health care quality. Our aim was to examine the association of stressors (illegitimate tasks) and health related resources (work-related sense of coherence; recovery experience) with life satisfaction, happiness, job satisfaction and burnout among German general practitioners (GPs). We conducted a cross-sectional survey among general medical practices in Germany. Main outcome measures were life satisfaction, happiness (Subjective Happiness Scale), job satisfaction (Work Satisfaction Scale) and burnout (Copenhagen Burnout Inventory). 548 GPs from across Germany participated (53.6% males, 45.6% females; mostly representative of German GPs). One third (35.2%) of the participants reported a high prevalence of personal, and one quarter (26.5%) indicated a high prevalence of work-related burnout symptoms. Illegitimate tasks are negatively associated with life and job satisfaction and are positively associated with personal, work-related and patient-related burnout among GPs. Work-SoC and recovery experience are positively associated with life satisfaction, happiness, and job satisfaction and are negatively associated with personal, work-related and patient-related burnout. Female physicians have a higher job satisfaction than male physicians. Being female and working as an employed physician is associated with a higher prevalence of personal burnout symptoms. GPs working in a group practice are happier and more satisfied with their job than GPs in single practices. Personal, work-related and patient-related burnout symptoms are stronger in GPs working in a single practice than in GPs in group practices. Our results highlight that Work-SoC, recovery experience and illegitimate tasks are important for creating work-related well-being among GPs. Introducing health promotion activities which aim to strengthen recovery experience and Work-SoC, as well as interventions to restructure tasks, may increase life satisfaction, happiness, and job satisfaction and reduce burnout symptoms in this health care profession.

Job satisfaction of general practitioners: a cross-sectional survey in 34 countries

BACKGROUND

Job satisfaction of general practitioners (GPs) is important because of the consequences of low satisfaction for GPs, their patients and the health system, such as higher turnover, health problems for the physicians themselves, less satisfied patients, poor clinical outcomes and suboptimal health care delivery. In this study, we aim to explain differences in the job satisfaction of GPs within and between countries.

METHODS

We performed a secondary analysis of cross-sectional survey data, collected between 2010 and 2012 on 7379 GPs in 34 (mostly European) countries, as well as data on country and health system characteristics from public databases. Job satisfaction is measured through a composite score of six items about self-reported job experience. Operationalisation of the theoretical constructs includes variables, such as the range of services GPs provide, working hours, employment status, and feedback from colleagues. Data were analysed using linear multilevel regression analysis, with countries and GPs as levels. We developed hypotheses on the basis of the Social Production Function Theory, assuming that GPs 'produce' job satisfaction through stimulating work that provides a certain level of comfort, adds to their social status and provides behavioural confirmation.

RESULTS

Job satisfaction varies between GPs and countries, with high satisfaction in Denmark and Canada (on average 2.97 and 2.77 on a scale from 1-4, respectively) and low job satisfaction in Spain (mean 2.15) and Hungary (mean 2.17). One-third of the total variance is situated on the country level, indicating large differences between countries, and countries with a higher GDP per capita have more satisfied GPs. Health system characteristics are not related to GP job satisfaction. At the GP and practice level, performing technical procedures and providing preventive care, feedback from colleagues, and patient satisfaction are positively related to GP job satisfaction and working more hours is negatively related GP job satisfaction.

CONCLUSION

Overall and in terms of our theoretical approach, we found that GPs are able to 'produce' work-related well-being through activities and resources related to stimulation, comfort and behavioural confirmation, but not to status.

Communication Skills and Transformational Leadership Style of First-Line Nurse Managers in Relation to Job Satisfaction of Nurses and Moderators of This Relationship

The job satisfaction of nurses is reflected in almost all organizational outputs of medical facilities. First-line nurse managers (FLNMs), who are directly related to subordinate nurses, have a great influence on this satisfaction. The aim of our paper is to examine the connection between communication skills and the transformation style of FLNMs management with the job satisfaction of nurses and to verify the influence of three moderators on the strength of this relationship. The chosen moderators-the practice of managing FLNMs, the degree of control (span of control) and psychosocial work-follow from theoretical studies. The moderating effect of the variable management practice is also significant from the point of view of Slovak legislation. The sample consisted of 132 FLNMs from five university hospitals in Slovakia. Data collection took place in the form of a questionnaire. All data were processed using the SPSS 24 software package. A series of regression analyzes were used to identify the proposed hypotheses. ANOVA analysis was used to analyze multiple dependencies. We worked at a 5% level of significance. The findings point to the strong direct effects of communication skills and the transformational leadership style of FLNMs on nurses' job satisfaction. Moderation effects are mild, but significant in the case of management and span of control practices. The lower values of both variables reinforce the positive relationships among the two predictors and the job satisfaction of nurses. The third moderator, psychosocial work factors, also have a significant moderating effect, which is negative, and the higher value of this moderator mitigates both positive direct effects.

Public health: The voice of professionals

OBJECTIVE

To monitor, for the first time in Portugal, job satisfaction on public health units (PHUs).

DESIGN

Observational, transversal and descriptive/correlational study.

SETTING

All 55 PHUs of mainland Portugal.

PARTICIPANTS

This study targeted all 1196 public health professionals working in PHUs.

MAIN OUTCOME MEASURES

Instrument to Assess Satisfaction of Professionals (IASP), filled online, respecting the ethical considerations and a conceptual measurement model.

RESULTS

Data were obtained from 64% of professionals serving in PHUs, 73% of them female. Response rate of the physicians was 59.1%, with 72.3% of environmental health technicians, 62.0% of nurses and 58.3% of technical assistants. The average age was 47.6(±10.4) years, from 22 to 69 years. We found fair/good satisfaction with men, less educated and professionals with coordination functions more satisfied and low-level satisfaction with salary. Sociodemographic and labour characteristics play a relevant role on job satisfaction. Being female, a physician and an environmental health technician or working in a public setting increases the probability of low satisfaction.

CONCLUSIONS

Public health professionals are satisfied with their job, revealing high pride in their professions and strongly recommending their units to family and friends. Some variables, for example gender, leadership, marital status and education, do influence satisfaction. However, we found dissatisfaction among physicians when practice is compared with what is thought in the internship. It is possible to change the reality in which public health professionals work and to contribute to a reorganization of resources, new internal dynamics and establishment of improvement plans, aimed at a full accomplishment and job satisfaction.

Why do doctors in Norway choose general practice and remain there? A qualitative study about motivational experiences

Objective: To explore experiences motivating doctors to become and remain GPs.Design and contributors: Qualitative analysis of written responses from an open-ended question about motivational experiences posted on an internet discussion list for GPs in Norway. Texts from 25 contributors were analysed with Systematic Text Condensation, supported by theories about calling as motivation.Results: Analysis revealed numerous aspects of motivation to become and remain a general practitioner. Inspirations from early experiences and skilled role models had conveyed values and offered insight into a fascinating world of care, gratitude and respect. Close and continuous relationships with patients provided GPs with humbling experiences and learning moments. Contributors described how these encounters became rewarding sources of insight and mutual trust, improving interpersonal skills. Also, the extensive variety of tasks during the workday and the space for autonomy and independence was emphasised.Implications: Understanding motivational experiences influencing GPs' choice of medical career is necessary to develop strategies for recruitment and stability and contribute to prevention of burn-out and improper work-life balance. GPs' professional identities and commitments should be recognized and developed in dialogues between authorities and GPs to enhance communication, improve the structural frames of work environment and thereby sustainable recruitment.Key pointsGPs regard their choice of medical career as strongly influenced by motivational experiences in childhood, adolescence and as medical studentsRole models, diversity of work, feelings of being able to contribute and rewarding and continuous relationships with patients were mentioned to activate and maintain general practice commitmentKnowledge about motivational influences, professional identities and commitment for GPs is crucial for medical education and dialogue to promote general practice as a career choice and prevent dangers of work overload and burnout.

Correlations of the "Work-Family Conflict" With Occupational Stress-A Cross-Sectional Study Among University Employees

Background: The working conditions at universities and hospitals are reported to be stressful. Several national and international studies have investigated occupational stress in hospitals. However, scientific studies at colleges and universities addressing psycho-social stress factors and their potential consequences are scarce. In this context, the consequences and correlations of the factor of work-family conflict, in particular, are currently uninvestigated. The aim of our study was to assess data on psychosocial stress in the context of the compatibility of work and family. Methods: Data were gathered through a cross-sectional-study, N = 844 (55% female, 41% male), on university staff (42.3% scientists, 14.3% physicians, 19.4% employees in administration, and 19.3% employees in service). Participants filled out questionnaires to provide their personal data and details of their work and private life conditions. For this purpose, we used the Work-Family and Family-Work Conflict Scales, Effort-Reward Inventory and Overcommitment Scale (ERI, OC), Patient Health Questionnaire (PHQ-4), short-form Maslach Burnout Inventory (MBI), and questions on their subjective health. Statistical analyses were performed using SPSS 22. Results: We found high levels of stress parameters in the total sample: extra work (83%), fixed-term work contracts (53%), overcommitment (OC, 26%), Effort-Reward Imbalance (18%, ERI Ratio > cut-off 0.715), work-family conflict (WFC, 35%), and family-work conflict (FWC, 39%). As hypothesized, we found significant correlations of both WFC and FWC with psychosocial work strain (ERI Ratio) as well as overcommitment (OC). Mental and somatic health parameters also had a significant positive correlation with WFC and FWC. Using a regression analysis (N = 844), we identified WFC as a predictor of burnout, while emotional exhaustion, extra work, and overcommitment could be identified as predictors of WFC and FWC. Discussion: The results of our study point toward deficits in the compatibility of work life and private life in the work fields of science, colleges, and universities. Furthermore, we found indicators that work-family conflicts (interrole conflicts) have an impact on mental and somatic health. These work-family conflicts should be targets for preventions and interventions with the aim of improving the work-life balance and mental and somatic wellbeing of employees.

Variation in staff perceptions of patient safety climate across work sites in Norwegian general practitioner practices and out-of-hour clinics

Introduction

Measuring staff perceptions with safety climate surveys is a promising approach to addressing patient safety. Variation in safety climate scores between work sites may predict variability in risk related to tasks, work environment, staff behavior, and patient outcomes. Safety climate measurements may identify considerable variation in staff perceptions across work sites.

Objective

To explore variation in staff perceptions of patient safety climate across work sites in Norwegian General Practitioner (GP) practices and Out-of-hours clinics.

Methods

The Norwegian Safety Attitudes QuestionnaireAmbulatory Version (SAQ A) was used to survey staff perceptions of patient safety climate across a sample of GP practices and Out-of-hours clinics in Norway. We invited 510 primary health care providers to fill out the questionnaire anonymously online in October and November 2012. Work sites were 17 regular GP practices in Sogn & Fjordane County, and seven Out-of-hours clinics, of which six were designated as “Watchtower Clinics”. Intra–class correlation coefficients were calculated to identify what proportion of the variation in the five factor scores (Teamwork climate, Safety climate, Job satisfaction, Perceptions of management, and Working conditions) were at work site-level.

Results

Of the 510 invited health care providers, 266 (52%) answered the questionnaire. Staff perceptions varied considerably at the work site level: intra–class correlation coefficients (ICCs) were 12.3% or higher for all factors except for Job satisfaction–the highest ICC value was for Perceptions of management: 15.5%.

Conclusion

Although most of the score variation was at the individual level, there was considerable response clustering within the GP practices and OOH clinics. This implies that the Norwegian SAQ A is able to identify GP practices and OOH clinics with high and low patient safety climate scores. Patient safety climate scores produced by the Norwegian version of the SAQ A may, thus, guide improvement and learning efforts to work sites according to the level of their scores.

Unselfish leaders? Understanding the role of altruistic leadership and organizational learning on happiness at work (HAW)

Purpose

The purpose of this paper is to examine to what extent altruistic leadership (AL) contribute to happiness at work (HAW). In addition, the authors analyze the mediating role of those conditions that facilitate learning in the relationship between AL and HAW.

Design/methodology/approach

Confirmatory factor analysis by means of structural equation models was performed to check the proposed theoretical model, using a sample of 122 frontline bank employees.

Findings

Results show that, although specific leadership styles might contribute to employee well-being, it seems the shared characteristic of altruism what significantly impact employees HAW, by means of organizational learning capability.

Originality/value

Scarce research examines altruism as a leadership behavior. The authors provide to the leadership literature a theoretical model, and empirical evidence that altruism is an essential leadership behavior to promote learning and HAW.

Job satisfaction of primary care physicians in Switzerland: an observational study

BACKGROUND

Job satisfaction of physicians is an important issue for performance of a health care system. The aim of the study was to evaluate the job satisfaction of primary care physicians in Switzerland and to explore associations between overall job satisfaction, individual characteristics and satisfaction with aspects of work within the practice separated by gender.

METHODS

This cross-sectional study was based on a job satisfaction survey. Data were collected from 176 primary care physicians working in 91 primary care practices. Job satisfaction was measured with the 10-item Warr-Cook-Wall job satisfaction scale. Stepwise linear regression analysis was performed for physicians separated by gender.

RESULTS

The response rate was 92.6%. Primary care physicians reported the highest level of satisfaction with 'freedom of working method' (mean = 6.45) and the lowest satisfaction for 'hours of work' (mean = 5.38) and 'income' (mean = 5.49). Moreover, some aspects of job satisfaction were rated higher by female physicians than male physicians. Within the stepwise regression analysis, the aspect 'opportunity to use abilities' (β = 0.644) showed the highest association to overall job satisfaction for male physicians while for female physicians it was income (β = 0.733).

CONCLUSIONS

The presented results contribute to an understanding of factors that influence levels of satisfaction of female and male physicians. Therefore, research and intervention about job satisfaction should consider gender as well as the stereotypes that come along with these social roles.

Private or salaried practice: how do young general practitioners make their career choice? A qualitative study

BACKGROUND

Young French postgraduates in general practice increasingly prefer salaried practice to private practice in spite of the financial incentives offered by the French government or local communities to encourage the latter. This study aimed to explore the determinants of choice between private or salaried practice among young general practitioners.

METHODS

A qualitative study was conducted in the South West of France. Semi-structured interviews of young general practitioners were audio-recorded until data saturation. Recordings were transcribed and then analyzed according to Grounded Theory by three researchers working independently.

RESULTS

Sixteen general practitioners participated in this study. For salaried and private doctors, the main factors governing their choice were occupational factors: working conditions, need of varied scope of practice, quality of the doctor-patient relationship or career flexibility. Other factors such as postgraduate training, having worked as a locum or self-interest were also determining. Young general practitioners all expected a work-life balance. The fee-for-service scheme or home visits may have discouraged young general practitioners from choosing private practice.

CONCLUSIONS

National health policies should increase the attractiveness of ambulatory general practice by promoting the diversification of modes of remuneration and encouraging the organization of group exercises in multidisciplinary medical homes and community health centers.

Medical engagement and organizational characteristics in general practice

BACKGROUND

Medical engagement is a mutual concept of the active and positive contribution of doctors to maintaining and enhancing the performance of their health care organization, which itself recognizes this commitment in supporting and encouraging high quality care. A Medical Engagement Scale (MES) was developed by Applied Research Ltd (2008) on the basis of emerging evidence that medical engagement is critical for implementing radical improvements.

OBJECTIVES

To study the importance of medical engagement in general practice and to analyse patterns of association with individual and organizational characteristics.

DESIGN AND SETTING

A cross-sectional study using a sampled survey questionnaire and the official register from the Danish General Practitioners' Organization comprising all registered Danish GPs.

METHOD

The Danish version of the MES Questionnaire was distributed and the survey results were analysed in conjunction with the GP register data.

RESULTS

Statistically adjusted analyses revealed that the GPs' medical engagement varied substantially. GPs working in collaboration with colleagues were more engaged than GPs from single-handed practices, older GPs were less engaged than younger GPs and female GPs had higher medical engagement than their male colleagues. Furthermore, GPs participating in vocational training of junior doctors were more engaged than GPs not participating in vocational training.

CONCLUSION

Medical engagement in general practice varies a great deal and this is determined by a complex interaction between both individual and organizational characteristics. Working in collaboration, having staff and being engaged in vocational training of junior doctors are all associated with enhanced levels of medical engagement among GPs.

The influence of a market-oriented primary care reform on family physicians' working conditions: A qualitative study in Turkey

BACKGROUND

Turkey has undergone a 'Health transformation programme' putting emphasis on the reorganization of primary care (PC) services towards a more market-oriented system.

OBJECTIVES

To obtain a deep understanding of how family physicians (FPs) experienced the process of the reforms by focusing on working conditions.

METHODS

This phenomenological and qualitative research used maximum variation sampling and 51 FPs were interviewed in 36 in-depth and four focus-group interviews.

RESULTS

Thematic analysis of interviews provided seven themes: (1) change in the professional identity of PC physicians (physician as businessperson); (2) transformation of the physician-patient relationship in PC (into a provider-customer relationship); (3) job description and workload; (4) interpersonal relationships; (5) remuneration of FPs, (6) uncertainty about the future and (7) exhaustion. Most FPs felt that the Family medicine model (FMM) placed more emphasis on the business function of family practice and this conflicted with their professional characteristics as physicians. FPs complained that some of their patients behaved as extremely demanding consumers. Continuously increasing responsibilities and extremely high workload were commonly reported problems. Most participants described the negative incentives in the performance scheme as a degrading method of punishment. The main factor was job insecurity caused by contract-based employment. FPs described the point at which they are with terms such as exhaustion.

CONCLUSION

By increasing workload and creating uncertainty about the future and about income, the PC reforms have led to working conditions, which has led to changes in the professional attitudes of physicians and their practice of medicine.

Assessing the relation between career satisfaction in psychiatry with lifelong learning and scientific activity

Lifelong learning (LLL) is an essential feature for the doctor to keep clinically updated and has been described as an indicator of competence and professionalism. The aim of this study was to evaluate the association between career satisfaction in psychiatry, lifelong learning, and commitment in scientific activities, taking into account other personal and professional effects. The survey was sent to 453 national psychiatrists and 190 surveys (41.9%) were completed online and validated. The Jefferson Scale of Physician Lifelong Learning (JSPLL) was used to assess the level of LLL for each doctor. The results of the analysis of JSPLL showed that participants more satisfied with their career have greater motivation and invest more in the LLL. Furthermore, participants who were more satisfied with their career had a higher percentage of scientific activity in the last year. Multiple linear regression with these two effects in the model revealed a positive association between career satisfaction in psychiatry, LLL and the publication of scientific papers, leading to the main conclusion that satisfaction with a career in psychiatry has a significant correlation with LLL and with involvement in scientific activities.

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.

The impact of change in a doctor's job position: a five-year cohort study of job satisfaction among Norwegian doctors

BACKGROUND

Job satisfaction among physicians may be of importance to their individual careers and their work with patients. We lack prospective studies on whether a change in a doctor's job position influences their job satisfaction over a five-year period if we control for other workload factors.

METHODS

A longitudinal national cohort of all physicians who graduated in Norway in 1993 and 1994 was surveyed by postal questionnaire in 2003 (T1) and 2008 (T2). Outcomes were measured with a 10-item job satisfaction scale. Predictor variables in a multiple regression model were: change in job position, reduction in work-home interface stress, reduction in work hours, age, and gender.

RESULTS

A total of 59% of subjects (306/522) responded at both time points. The mean value of job satisfaction in the total sample increased from 51.6 (SD = 9.0) at T1 to 53.4 (SD = 8.2) at T2 (paired t test, t = 3.8, p < 0.001). The major groups or positions at T1 were senior house officers (45%), chief specialists in hospitals (23%), and general practitioners (17%), and the latter showed the highest levels of job satisfaction. Physicians who changed position during the period (n = 176) experienced an increase in job satisfaction from 49.5 (SD = 8.4) in 2003 to 52.9 (SD = 7.5) in 2008 (paired t test, t = 5.2, p < 0.001). Job satisfaction remained unchanged for physicians who stayed in the same position. There was also an increase in satisfaction among those who changed from positions other than senior house officer at T1 (p < 0.01). The significant adjusted predictor variables in the multiple regression model were the change in position from senior house officer at T1 to any other position (β = 2.83, p < 0.001), any change in job position (from any position except SHO at T1) (β = 4.18, p < 0.01) and reduction in work-home interface stress (β = 1.04, p < 0.001).

CONCLUSIONS

The physicians experienced an increase in job satisfaction over a five-year period, which was predicted by a change in job position and a reduction in work-home stress. This study has implications with respect to career advice for young doctors.

The impact of change in a doctor's job position: a five-year cohort study of job satisfaction among Norwegian doctors

Background

Job satisfaction among physicians may be of importance to their individual careers and their work with patients. We lack prospective studies on whether a change in a doctor's job position influences their job satisfaction over a five-year period if we control for other workload factors.

Methods

A longitudinal national cohort of all physicians who graduated in Norway in 1993 and 1994 was surveyed by postal questionnaire in 2003 (T1) and 2008 (T2). Outcomes were measured with a 10-item job satisfaction scale. Predictor variables in a multiple regression model were: change in job position, reduction in work-home interface stress, reduction in work hours, age, and gender.

Results

A total of 59% of subjects (306/522) responded at both time points. The mean value of job satisfaction in the total sample increased from 51.6 (SD = 9.0) at T1 to 53.4 (SD = 8.2) at T2 (paired t test, t = 3.8, p < 0.001). The major groups or positions at T1 were senior house officers (45%), chief specialists in hospitals (23%), and general practitioners (17%), and the latter showed the highest levels of job satisfaction. Physicians who changed position during the period (n = 176) experienced an increase in job satisfaction from 49.5 (SD = 8.4) in 2003 to 52.9 (SD = 7.5) in 2008 (paired t test, t = 5.2, p < 0.001). Job satisfaction remained unchanged for physicians who stayed in the same position. There was also an increase in satisfaction among those who changed from positions other than senior house officer at T1 (p < 0.01). The significant adjusted predictor variables in the multiple regression model were the change in position from senior house officer at T1 to any other position (β = 2.83, p < 0.001), any change in job position (from any position except SHO at T1) (β = 4.18, p < 0.01) and reduction in work-home interface stress (β = 1.04, p < 0.001).

Conclusions

The physicians experienced an increase in job satisfaction over a five-year period, which was predicted by a change in job position and a reduction in work-home stress. This study has implications with respect to career advice for young doctors.

Job stress and job satisfaction of physicians in private practice: comparison of German and Norwegian physicians

PURPOSE

This study examined job satisfaction and job stress of German compared to Norwegian physicians in private practice.

METHODS

A representative sample of physicians in private practice of Schleswig-Holstein, Germany (N = 414) and a nationwide sample of Norwegian general practitioners and private practice specialists (N = 340) were surveyed in a cross-sectional design in 2010. The questionnaire comprised the standard instruments "Job Satisfaction Scale (JSS)" and a short form of the "Effort-Reward Imbalance Questionnaire (ERI)".

RESULTS

Norwegian physicians scored significantly higher (<0.01) on all items of the job satisfaction scale compared to German physicians (M 5.57, SD 0.74 vs. M 4.78, SD 1.01). The effect size was highest for the items freedom to choose method (d = 1.012), rate of pay (d = 0.941), and overall job satisfaction (d = 0.931). While there was no significant difference in the mean of the overall effort scale between German and Norwegian physicians, Norwegian physicians scored significantly higher (p < 0.01) on the reward scale. A larger proportion of German physicians (27.6%) presented with an effort/reward ratio beyond 1.0, indicating a risky level of work-related stress, compared to only 10.3% of Norwegian physicians. Working hours, effort, reward, and country differences accounted for 37.4% of the explained variance of job satisfaction.

CONCLUSIONS

Job satisfaction and reward were significantly higher in Norwegian than in German physicians. An almost threefold higher proportion of German physicians exhibited a high level of work-related stress. Findings call for active prevention and health promotion among stressed practicing physicians, with a special focus on improved working conditions.

Occupational isolation among general practitioners in Finland

BACKGROUND

It is proposed that isolation in general practice is one of the factors that leads to work-related stress and the low attraction of this work. In Finland, 71% of physicians who worked or had worked in a primary health care centre agreed with the statement 'working as a doctor in a health centre is too often isolated work'.

AIMS

To gain a deeper understanding of this feeling and to find out which factors constitute it.

METHODS

A qualitative in-depth interview study of 32 physicians working in a primary health care centre in Finland. Qualitative analysis of transcribed verbatim interviews using a constant comparison method.

RESULTS

The main components of isolation were making decisions alone, lack of collaboration with other workers in the health centre and secondary care specialists, not being a part of the work community and lack of mentoring at work.

CONCLUSIONS

Enabling flexible teamwork and social and professional support networks are the key issues in solving the problem of occupational isolation in general practice.

Job satisfaction among general practitioners: A systematic literature review

OBJECTIVE

In recent years, the incidence of being overworked and burnt out has increased among general practitioners (GPs). One of the factors that influences the development of burnout is the job satisfaction that physicians experience. Therefore, we conducted a literature review to answer the question: what factors influence the job satisfaction experienced by GPs?

METHODS

We used two methods to retrieve citations. We searched four literature databases for citations from 1990 until July 2006, and we checked the reference lists of relevant articles. The inclusion criteria were: GPs had to be the subjects of the study, the study had to describe empirical research, the study had to focus on job satisfaction, and the number of subjects had to be greater than 30.

RESULTS

We found 24 relevant citations. Factors increasing job satisfaction which were mentioned more than twice were: diversity of work, relations and contact with colleagues, and being involved in teaching medical students. Factors decreasing job satisfaction were: low income, too many working hours, administrative burdens, heavy workload, lack of time, and lack of recognition.

CONCLUSION

Aspects of job satisfaction concerning the content of the profession seem to increase job satisfaction, and aspects concerning employment conditions seem to decrease job satisfaction.

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.

Achieving meaningful learning in health information management students: the importance of professional experience

Learning is a complex process, not merely a transfer of information from teacher to student. for learning to be meaningful, students need to adopt a deep approach, and in the case of vocational students, to be given the opportunity to learn experientially. Health information management is a practice profession for which students are educated through theory at university and professional experience in the workplace. This article discusses how, through the process of experiential learning, professional experience can promote reflective thinking and thus deep learning, that is, the ability to integrate theory and practice, as well as professional and personal development in health information management students.

The association between patient shortage and patient satisfaction with general practitioners

OBJECTIVE

The aim of the study was to explore whether or not the influx of patients to a GP's practice is associated with satisfaction with the GP.

DESIGN

Persons in the Norwegian Living Condition Survey answered a questionnaire on satisfaction with their GP. The data on satisfaction were merged with registered information on the GPs and the GPs' patient lists from the National Insurance Administration, with registered information on the sample's sociodemographic background, and on their resident municipality from Statistics Norway.

SETTING

A representative sample of 2326 persons answered the questionnaire. This constituted persons in the survey who had visited their GP during the last six months.

MAIN OUTCOME MEASURE

Satisfaction with the GP's interpersonal skills, the GP's medical skills, the GP's use of time, general accessibility to the GP, and the GP's role as a gatekeeper.

RESULTS

Persons listed with a GP who experience patient shortage were less satisfied than others along four dimensions of satisfaction: the GP's interpersonal skills, the GP's medical skills, the GP's referral practices, and the consultation lengths the GP offered. The GP's age and gender, characteristics of the patient, and characteristics of the organization of primary care had minor influence.

CONCLUSION

Whether or not a GP experiences patient shortage is associated with patient satisfaction. Whether or not the lower patient satisfaction is a result of patient shortage or vice versa is not known.

Balancing - an equilibrium act between different positions: an exploratory study on general practitioners' comprehension of their professional role

OBJECTIVE

There is a call to make the duties and working conditions of the GP more transparent. The aim of this study was to explore practising GPs' personal experiences of their professional role and what they regard to be its salient characteristics.

DESIGN

An exploratory and descriptive study was undertaken by interviewing GPs and by performing a focus-group study of experienced GPs. The interviews were transcribed and analysed, and the text was categorized according to content analysis.

SETTING

The practice of the interviewed GPs.

SUBJECTS

Seven GPs in individual interviews and a focus group of experienced GPs.

RESULTS

A major theme, Balancing, was identified. It was derived from a number of opposing concepts to which different features were related. "The good shepherd" versus "The medical expert"; "Curing" versus "Caring"; "Short visits" versus "Long consultations"; "The personal doctor" versus "The society's doctor". In many consultations the GP has to contemplate how to stay in focus between these diverse roles.

CONCLUSION

General practice requires a balance to be achieved between a number of opposing conditions. In their clinical work GPs have to adjust to and integrate alternative perspectives. Problems of recruiting new GPs might be associated with dilemmas in this balancing act.