Article

Work stress of primary care physicians in the US, UK and German health care systems

Department of Medical Sociology, University of Duesseldorf, Germany.
Social Science [?] Medicine (Impact Factor: 2.56). 07/2010; 71(2):298-304. DOI: 10.1016/j.socscimed.2010.03.043
Source: PubMed

ABSTRACT Work-related stress among physicians has been an issue of growing concern in recent years. How and why this may vary between different health care systems remains poorly understood. Using an established theoretical model (effort-reward imbalance), this study analyses levels of work stress among primary care physicians (PCPs) in three different health care systems, the United States, the United Kingdom and Germany. Whether professional autonomy and specific features of the work environment are associated with work stress and account for possible country differences are examined. Data are derived from self-administered questionnaires obtained from 640 randomly sampled physicians recruited for an international comparative study of medical decision making conducted from 2005 to 2007. Results demonstrate country-specific differences in work stress with the highest level in Germany, intermediate level in the US and lowest level among UK physicians. A negative correlation between professional autonomy and work stress is observed in all three countries, but neither this association nor features of the work environment account for the observed country differences. Whether there will be adequate numbers of PCPs, or even a field of primary care in the future, is of increasing concern in several countries. To the extent that work-related stress contributes to this, identification of its organizational correlates in different health care systems may offer opportunities for remedial interventions.

Full-text

Available from: Rebecca S Piccolo, Jan 27, 2014
0 Followers
 · 
106 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Poor hospital work environments affect physicians' work stress. With a focus on hospital pediatricians, we sought to investigate associations between work stress, burnout, and quality of care. A cross-sectional study was conducted in N = 96 pediatricians of a German academic children's hospital (response rate = 73.8 %). All variables were assessed with standardized questionnaires. Multivariate regression analyses were applied to investigate associations after adjusting for potential confounders. Critically high work stress (effort/reward ratio, ERR > 1.0) was reported by N = 25 (28.4 %) participants. Pediatricians in inpatient wards had significantly more work stress than their colleagues in intensive care units and outpatient wards; 10.2 % of surveyed pediatricians reported critically high burnout. Again, inpatient ward staff reported significantly increased emotional exhaustion. After controlling for several confounders, we found that pediatricians with high work stress and emotional exhaustion reported reduced quality of care. Mediation analyses revealed that especially pediatricians' emotional exhaustion partially mediated the effect of work stress on quality of care. Results demonstrate close relationships between increased work stress and burnout as well as diminished quality of care. High work stress environments in pediatric care influence mental health of pediatricians as well as quality of patient care. What is Known: • The quality of pediatricians' work environment in the hospital is associated with their work stress and burnout. • The consequences of pediatricians' work life for the quality of care need to be addressed in order to inform interventions to improve work life and care quality. What is New: • Our study shows associations between increased work stress and burnout with mitigated quality of care. • Beyond indirect effects of work stress through emotional exhaustion on quality of care we also observed direct detrimental effects of pediatricians' work stress on mitigated care quality.
    European Journal of Pediatrics 04/2015; DOI:10.1007/s00431-015-2529-1 · 1.98 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: As one of the most destructive natural disasters, earthquakes affect the health of survivors. The devastating earthquakes that hit Sichuan, China have aroused the concern of domestic and international scholars. The health-related quality of life (HRQOL) of survivors also requires substantial research. Studies on impact factors, such as gender, age, monthly income, and education, have become controversial. The subjects in this study are the people of five hard-hit disaster counties in Sichuan Province, namely, Wenchuan, Qingchuan, Mianzhu, Lushan, and Dujiangyan. A preliminary survey was conducted in May and June 2013 in areas badly hit by the earthquake in Sichuan, China. A total of 2000 questionnaires were distributed, and 1672 of which were received, yielding a recovery rate of 83.6 %. To further complement and corroborate the conclusions, a follow-up survey was conducted in October and November 2013, where 1526 effective questionnaires were received. The analysis in this paper is mainly based on the first survey, and the collected data from the follow-up survey were used to perform a supplementary analysis. By analyzing data from five hard-hit areas in Sichuan and by establishing models, we drew the following conclusions: The results of analysis of variance and Tukey’s honestly significant difference tests revealed the following results. First, the results of two investigations indicate the HRQOL of earthquake survivors is relatively poor, especially in terms of general health (GH), mental health (MH), social functioning (SF), etc. However, results of the second survey indicate that the scores of all domains (except GH) have increased significantly, with the SF having the most significant increase. Second, the HRQOL scores of men are higher than those of women. Individuals with higher education or monthly income have higher HRQOL scores than those with lower education or income. Moreover, younger survivors have higher HRQOL scores than older survivors. Third, a positive correlation exists among the HRQOL domains of all survivors. Among all domains, the PF, RP, GH, MH, and VT of survivors have a very strong correlation. In addition, SF, BP, MH, and VT have a strong correlation. Other variables have a relatively weak correlation.
    Social Indicators Research 11/2014; 119(2). DOI:10.1007/s11205-013-0525-2 · 1.26 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective Work stress among physicians is a growing concern in various countries and has led to migration. We compared the working conditions and the work stress between a migrated population of German physicians in Sweden and a population of physicians based in Germany. Additionally, specific risk factors for work stress were examined country wise. Method Using a cross-sectional design, 85 German physicians employed in Sweden were surveyed on working conditions and effort–reward imbalance and compared with corresponding data on 561 physicians working in Germany. Multiple linear regression analyses were applied on both populations separately to model the associations between working conditions and effort–reward ratio (ERR), adjusted for a priori confounders. Results German physicians in Sweden had a significantly lower ERR than physicians in Germany: mean (M) = 0.47, standard deviation (SD) = 0.24 vs. M = 0.80, SD = 0.35. Physicians in Sweden worked on average 8 h less per week and reported higher work support and responsibility. Multivariate analyses showed in both populations a negative association between work support and the ERR (β = −0.148, 95 % CI −0.215 to (−0.081) for physicians in Sweden and β = −0.174, 95 % CI −0.240 to (−0.106) for physicians in Germany). Further significant associations with the ERR were found among physicians in Sweden for daily breaks (β = −0.002, 95 % CI −0.004 to (−0.001)) and among physicians in Germany for working hours per week (β = 0.006, 95 % CI 0.002–0.009). Conclusion Our findings show substantial differences in work stress and working conditions in favor of migrated German physicians in Sweden. To confirm our results and to explain demonstrated differences in physicians’ work stress, longitudinal studies are recommended.
    International Archives of Occupational and Environmental Health 09/2014; 88(4). DOI:10.1007/s00420-014-0978-x · 2.20 Impact Factor