Short reportWork stress of primary care physicians in the US, UK and German health care systems⋆
Section snippets
Background
Work-related stress among physicians has been an issue of growing concern in recent years (Bond & Bond, 2000). It appears most evident among primary care physicians, who care for the majority of illness in society. Recent organizational and legal changes are thought to impact physician autonomy (clinical guidelines and performance measures), while heavier workloads, and changing reimbursement methods (pay-for-performance and salaried positions) appear to contribute to the growing levels of job
Study design
In-depth interviews and self-administered questionnaires, including the questions on work stress which are of special interest for this analysis, were administered during two balanced factorial experiments designed to simultaneously measure the unconfounded effects of (a) patient attributes (age, gender, race/ethnicity, and socio-economic status), (b) physician characteristics (gender and years of clinical experience), and (c) health care system (United States (US), the United Kingdom (UK), and
Differences of work stress between health care systems
Table 5 (upper part) demonstrates significant differences in the mean level of work stress (overall scale) between the physicians in the three health care systems, with highest level in German physicians, intermediate level in US physicians (two studies), and lowest level in UK physicians. Pair-wise comparisons by country and study (Table 4) reveal a striking consistency of these differences. Further exploration based on the two subscales of work stress, effort and reward, indicates that
Discussion
Firstly, employing data obtained from 640 randomly sampled primary care physicians working in three different health care systems, the United States, the United Kingdom, and Germany, we observed significant differences in mean level of psychosocial stress at work, measured by the effort–reward imbalance model. The highest level of work stress was reported by physicians in Germany and the lowest level by physicians in the UK, with US physicians reporting intermediate levels. The robustness of
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