Cross-national comparison of job satisfaction in doctors during economic recession.

BACKGROUND: Job satisfaction in doctors is related to migration, burnout, turnover and health service quality. However, little is known about their job satisfaction during economic recessions. Iceland and Norway have similar health care systems, but only Iceland was affected severely by the 2008 economic crisis. AIMS: To examine job satisfaction in Icelandic and Norwegian doctors, to compare job satisfaction with Icelandic data obtained before the current recession and to examine job satisfaction in response to cost-containment initiatives. METHODS: A survey of all doctors working in Iceland during 2010, a representative comparison sample of Norwegian doctors from 2010 and a historic sample of doctors who worked at Landspitali University Hospital in Iceland during 2003. The main outcome measure was job satisfaction, which was measured using a validated 10-item scale. RESULTS: Job satisfaction levels in Icelandic doctors (response rate of 61%, n = 622/1024), mean = 47.7 (SD = 10.9), were significantly lower than those of Norwegian doctors (response rate of 67%, n = 1025/1522), mean = 53.2 (SD = 8.5), after controlling for individual and work-related factors. Doctors at Landspitali University Hospital (response rate of 59%, n = 345/581) were less satisfied during the recession. Multiple regression analysis showed that cost-containment significantly affected job satisfaction (P < 0.001). CONCLUSIONS: Job satisfaction in doctors was lower in Iceland than in Norway, which may have been attributable partly to the current economic recession.

Suicidal ideation among medical students and young physicians: a nationwide and prospective study of prevalence and predictors.

BACKGROUND: Despite an increased risk of suicide among physicians we lack studies on prevalence and predictors of suicidal ideation among medical students and young doctors. METHOD: A prospective study of Norwegian medical students (n=522) re-examined after the first postgraduate year, comprising suicidal thoughts and attempts, perceived study stress, job stress, and personality. RESULTS: The previous year prevalence of suicidal thoughts was 14% at both points of time. The lifetime prevalence was 43%, while 8% had planned suicide, and 1.4% had attempted suicide. Suicidal ideation in medical school was predicted by lack of control, personality trait, single marital status, negative life events and mental distress (anxiety and depression). In the first postgraduate year, mental distress was the most important predictor, but before controlling for this variable, job stress, vulnerability (neuroticism), single status, and less working hours were independent predictors. Prospectively, suicidal thoughts and vulnerability as student predicted postgraduate suicidal ideation. CONCLUSIONS: The level of suicidal thoughts was high, but the level of attempts was low. CLINICAL IMPLICATIONS: Preventive efforts should be directed both at the students' abilities to cope with stress and at mental health services for young doctors. LIMITATIONS OF STUDY: The lower response rate at follow-up (57%) may reduce external validity.

Factors in medical school that predict postgraduate mental health problems in need of treatment. A nationwide and longitudinal study.

CONTEXT: Physicians show an increased prevalence of mental health problems, the first postgraduate years being particularly stressful. OBJECTIVES: To study the prevalence of mental health problems during the fourth postgraduate year, and to investigate whether it is already possible to predict such problems at medical school. SUBJECTS: A cohort of medical students (n=396) from all Norwegian universities, who were approached in their graduating semester (baseline) and in their fourth postgraduate year. METHODS: A nationwide and longitudinal postal questionnaire survey, including measures of perceived mental health problems in need of treatment, personality, perceived stress and skills, and ways of coping. Data were analysed using logistic regression. RESULTS: Mental health problems in need of treatment during the fourth postgraduate year were reported by 17.2% (n=66), with no gender difference, possibly because of a higher prevalence among the men compared with the general population. A majority had not sought help. Univariate medical school predictors of mental health problems included: previous mental health problems; not being married/cohabitant; the personality traits 'vulnerability' (or neuroticism) and 'reality weakness'; perceived medical school stress, and lack of perceived diagnostic skills. In addition, the coping variables avoidance, blamed self and wishful thinking were univariate predictors. Multivariate analysis identified the following adjusted predictors: previous mental health problems; 'intensity' (extraversion); perceived medical school stress, and wishful thinking. Medical school variables were inadequate for predicting which individual students would experience postgraduate mental health deterioration. However, the perceived medical school stress instrument may be used for selecting a subgroup of students suitable for group-oriented interventions.

[Health problems and use of health services among physicians]. / Helseproblemer og helsetjeneste blant leger.

BACKGROUND, MATERIAL AND METHODS: This paper presents an overview of Norwegian and international studies of physicians' health problems and use of health services. Findings from an e-mail survey of health services for Norwegian physicians are also presented. RESULTS: Male physicians have the same level of physical health as other males, while female physicians are in better physical health than the general population. Some mental disorders (depression, suicide) are more prevalent. Mental health problems are associated with low control at work, pressure for time, and demanding patients. There is no gender difference in prevalence early in the career, but later on, more female doctors experience problems. Doctors take few sick leaves and make little use of primary health care and screening facilities. Self-treatment is common, even for mental disorders. American impaired physician programmes have shown high recovery rates from addiction (70-80%). "Supportive colleagues", an impaired physician programme, is established in all 19 Norwegian counties. "Doctors' doctors", i.e. specially trained general practitioners, were available in all counties, while psychiatrists for doctors were available in only 11 counties. INTERPRETATION: Psychological problems are common among doctors; mental health services should be more accessible.

[The physician-patient relationship when the patient is a physician]. / Lege-pasient-forholdet når pasienten også er lege.

BACKGROUND: Though there are several narratives written by doctors who have experienced personal illness and a troublesome patient-role, few have described the particular problems for the doctor who meets a patient who is also a colleague. MATERIAL AND METHODS: Relevant literature that describes this particular doctor-patient relationship is reviewed. RESULTS: Psychological factors that obstruct the doctor's role are often caused by negative counter-transference reactions. Feelings of inferior professional competence, over-identification, and being too sociable are some pitfalls for the caring doctor. Organisational obstacles are "corridor consultations" and deficiencies in occupational health services and primary health care services for patients who are physicians themselves. They are often treated differently from other patients when admitted to hospital. Doctor-patients tend to deny their own symptoms and to be shameful and reluctant to accept the role of patient. They often have fears about confidentiality and may diagnose themselves and also self-prescribe. This may lead to deficient care-seeking. Some practical advice concerning taking care of doctor-patients is given. INTERPRETATION: Doctor-patients should be met in the same way as other patients, but all medical students and doctors should be aware of the particular obstacles and pitfalls in this special doctor-patient relationship.

The impact of job stress and working conditions on mental health problems among junior house officers. A nationwide Norwegian prospective cohort study.

CONTEXT: Previous studies have shown that physicians have an increased risk of mental health problems such as depression, suicide and substance abuse. OBJECTIVES: To study the prevalence of mental health problems during the first postgraduate year, and to investigate whether work-related factors in hospital are linked to these, when we control for gender, previous mental health problems, personality traits, stress in medical school and other possible predictors. DESIGN: Nationwide and prospective postal questionnaire survey. SETTING: University of Oslo. SUBJECTS: Medical students who answered questionnaires in their graduating semester, and 1 year later when they were junior house officers (n=371). RESULTS: Mental health problems (needing treatment) during internship were reported by 11%, with no gender difference. Adjusted predictors of mental health problems were: previous mental health problems, (odds ratio (OR)=5.1, 95% confidence interval (CI) 1.7 to 15.8); being married/cohabitant (OR=0.2, CI 0.1 to 0.7); the personality trait 'vulnerability' (OR=1.5, CI 1.1 to 2.0); negative life events during internship (OR=2.1, CI 1.2 to 3.5), and job stress as house officer (OR=1.05, CI 1.01 to 1.10). The job stress factor of emotional pressure/demands from patients was most important. Perceived study stress and lack of skills at the end of medical school were univariately related to mental health problems in internship, but not when other variables were adjusted. Gender, weekly working hours and lack of sleep were not linked to having problems. CONCLUSION: Job stress is related to mental health problems among young doctors, even when the variables of previous mental health problems and personality traits are controlled for. More support during internship is needed.

Use of alcohol to cope with tension, and its relation to gender, years in medical school and hazardous drinking: a study of two nation-wide Norwegian samples of medical students.

AIMS: To study the association between the use of alcohol to cope with tension and hazardous drinking, and the prevalence and the predictors of such drinking behaviours. DESIGN: Cross-sectional surveys of two nation-wide samples of medical students, one at the beginning and one at the end of medical training. PARTICIPANTS: Medical students entering Norwegian medical schools in 1993 (N = 379) or graduating in 1993 and 1994 (N = 522); 55.6% of the total sample were women. MEASUREMENTS: Postal questionnaires including SCL-5, Perceived Medical School Stress. FINDINGS: Use of alcohol to cope was reported by 10.5% of the students with no significant gender difference. Hazardous drinking ('binge drinking' at least 2-3 times per month) was reported by 14% of all the students, 24% among the men and 6% among the women. There was a strong association between use of alcohol to cope with tension and hazardous drinking, OR = 5.11, 95% CI (2.88-9.07) when controlling for other possible predictors. Use of alcohol to cope was also associated with increasing age, mental distress and lack of religious activity. The senior students used alcohol as a way of coping less often, but not hazardous drinking. Male gender, religious inactivity, high self-esteem and having no children were predictors of hazardous drinking. CONCLUSION: This study suggests that the use of alcohol to cope with tension is an independent risk factor connected with hazardous drinking among medical students, with no difference in prevalence between the genders.