Analysis of Career Stage, Gender, and Personality and Workplace Violence in a 20-Year Nationwide Cohort of Physicians in Norway.

Importance: Workplace violence (WPV) is a worldwide problem in health services. Several studies have pointed to organizational factors, such as working in psychiatry and work stress. However, there is a lack of long-term longitudinal cohort studies with respect to trends during the career and individual factors among physicians. Objective: To investigate WPV trends during Norwegian physicians' careers and assess individual and work-related factors associated with WPV in a long-term longitudinal study. Design, Setting, and Participants: This cohort study involved 2 nationwide medical student cohorts who graduated 6 years apart and were surveyed at graduation (T1: 1993-1994 and 1999) and 4 years later (T2), 10 years later (T3), 15 years later (T4), and 20 years after graduation (T5). Generalized estimated equations were used. Statistical analysis was performed from January to September 2020. Exposures: Medical career during 20 years in Norway. Main Outcomes and Measures: WPV was measured as threats or acts of violence from a patient or visitor experienced at least twice, at each of the stages after leaving medical school. Individual factors were obtained at T1 and work-related factors at T2 through T5. We analyzed WPV by repeated measures. Results: At T1, a total of 893 participants (with a mean [SD] age of 28 (2.83) years; 499 [56%] women) responded to the questionnaire. The prevalence of multiple threats of violence was 20.3% (156 of 769) at T2, 17.1% (118 of 691) at T3, 11.2% (66 of 588) at T4, and 8.6% (46 of 536) at T5; and the prevalence of multiple acts of violence was 4.3% (33 of 763) at T2, 5.2% (36 of 687) at T3, 3.1% (18 of 584) at T4, and 2.2% (12 of 532) at T5. There was a decline from T2 to T5 of both multiple threats (ß = -1.06; 95% CI, -1.31 to -0.09; P < .001) and acts of violence (ß = -1.13; 95% CI, -1.73 to -0.53; P < .001). In adjusted analysis, factors associated with multiple threats of violence were male gender (odds ratio [OR], 2.76; 95% CI, 1.73 to 4.40; P < .001), vulnerability trait (neuroticism) (OR, 0.90; 95% CI, 0.82 to 0.99; P = .03), young physician cohort (OR, 1.63; 95% CI, 1.04 to 2.58; P = .04), and working in psychiatry (OR, 7.50; 95% CI, 4.42 to 12.71; P < .001). Factors associated with multiple acts of violence in adjusted analysis were male gender (OR, 3.37; 95% CI, 1.45 to 7.84; P = .005), young physician cohort (OR, 6.08; 95% CI, 1.68 to 21.97; P = .006), and working in psychiatry (OR, 12.34; 95% CI, 5.40 to 28.23; P < .001). There were no interactions with gender or cohort in the significant associated factors. Conclusions and Relevance: Higher rates of multiple threats and acts of violence were observed during early medical careers, among male physicians, and in psychiatry. Low levels of the vulnerability trait (neuroticism) were associated with the experience of multiple threats. There was an association between the young physician cohort and WPV. Preventive efforts should include early-career and male physicians, with additional emphasis on personality.

Life satisfaction in Norwegian medical doctors: a 15-year longitudinal study of work-related predictors.

BACKGROUND: Despite many recent studies on burn-out and dissatisfaction among American medical doctors, less is known about doctors in the Scandinavian public health service. The aims of this study were to analyse long-term work-related predictors of life satisfaction among established doctors in Norway and to identify predictors in a subgroup of doctors who reported a decline in life satisfaction. METHODS: Two nationwide cohorts of doctors (n = 1052), who graduated medical school 6 years apart, were surveyed at graduation from medical school (T1, 1993/94 and 1999), and 4 (T2), 10 (T3), and 15 (T4) years later. Work-related predictors of life satisfaction (three items) obtained at T2 to T4 were analysed. Individual and lifestyle confounders were controlled for using mixed-models repeated-measures analyses, and logistic regression analyses were applied to identify predictors of the decrease in life satisfaction. RESULTS: Ninety per cent (947/1052) responded at least once, and 42% (450/1052) responded at all four times. Work-related predictors of higher life satisfaction in the adjusted model were work-home stress (ß = - 0.20, 95% confidence interval [CI] = - 0.25 to - 0.16, p < 0.001), perceived job demands (ß = - 0.10, CI = - 0.15 to - 0.05, p < 0.001), and colleague support (ß = 0.05, CI = 0.04 to 0.07, p < 0.001). The new adjusted individual predictors that we identified included female gender, reality weakness trait, and problematic drinking behaviour. Neuroticism trait and low colleague support predicted a decrease in life satisfaction. CONCLUSIONS: Work-home stress, perceived job demands, and colleague support were the most important predictors of life satisfaction related to doctors' work. When personality traits were controlled for, female doctors were more satisfied with their life than male doctors. These findings suggest that improving work-related factors with targeted interventions, including a supportive work environment, may increase life satisfaction among doctors.

Contextual Factors and Mental Distress as Possible Predictors of Hazardous Drinking in Norwegian Medical Doctors: A 15-Year Longitudinal, Nationwide Study.

BACKGROUND: We have previously identified long-term individual predictors of hazardous drinking in doctors, but longitudinal studies on contextual factors (work and life stress) and mental distress being independently linked to hazardous drinking over the first 15 years of a medical career are lacking. METHODS: Two nationwide cohorts of Norwegian doctors (n = 1,052) from all 4 Norwegian universities were surveyed in their final year of medical school (1993/1994 and 1999) (T1), and 4 (T2), 10 (T3), and 15 (T4) years later. Hazardous drinking was measured using a validated 9-item version of the Alcohol Use Disorder Identification Test. Work-related and other predictors were analysed using generalized estimating equations. RESULTS: Ninety percent (947/1,052) responded at least once, and 42% (450/1,052) responded at all 4 time points. Hazardous drinking was reported by 16% at T1, 14% at T2 and T3, and 15% at T4. Life events (p = 0.009) and mental distress (p = 0.002) were adjusted predictors of hazardous drinking, in addition to male gender, no religious activity, drinking to cope with tension, and low conscientiousness. CONCLUSIONS: Doctors' work-related stress was not linked to hazardous drinking, but life events, mental distress, and drinking to cope were. Prevention should target mental distress and drinking to cope with tension.

Risk Factors Measured During Medical School for Later Hazardous Drinking: A 10-year, Longitudinal, Nationwide Study (NORDOC).

AIMS: To investigate the prevalence and temporal patterns of hazardous drinking and risk factors during medical school for future hazardous drinking among doctors. METHODS: Two cohorts of graduating medical students (N = 1052) from all four Norwegian universities (NORDOC) were surveyed in their final year of medical school training (1993/94 and 1999) (T1) and again 4 (T2) and 10 (T3) years later. Longitudinally, 53% (562/1052) of the sample responded at all three time points. Hazardous drinking was defined as drinking five or more drinks during one session at least 2-3 times per month. Predictors of hazardous drinking, identified by logistic regression models after controlling for cohort, included a parental history of alcohol problems, having children, no religious activity, use of alcohol to cope with tension and some personality traits. RESULTS: There was a significant decline in the prevalence of hazardous drinking from T1 (14%) to T2 (10%) but not from T2 to T3 (8%). Approximately 23% of hazardous drinkers at T1 remained hazardous drinkers at T3 (N = 18). At T2, significant adjusted predictors included male gender (OR = 2.0, P = 0.04), use of alcohol as a coping strategy (OR = 2.2, P = 0.03) and hazardous drinking at T1 (OR = 9.8, P < 0.001). The significant adjusted predictors at T3 included older age (OR = 1.1, P = 0.01), male gender (OR = 3.6, P = 0.002) and hazardous drinking at T1 (OR = 7.5, P < 0.001). CONCLUSIONS: Hazardous drinking and drinking to cope with tension during medical school were the most important predictors of later hazardous drinking and should be targets of preventive efforts in medical schools.