Olaf Gjerløw Aasland

Health complaints and job stress in Norwegian physicians: the use of an overlapping questionnaire design

An extensive research program has been undertaken in Norway on physician health, sickness, working conditions and quality of life. Data are collected from cross-sectional and longitudinal prospective and retrospective surveys, qualitative studies, and vital statistics. This paper presents findings on subjectively experienced health problems, emotional distress, experienced job stress and job satisfaction, based on an extensive cross-sectional postal questionnaire study in 1993. An overlapping questionnaire design was used to allow many relationships to be estimated without exhausting the recipients. 9266 active physicians were included, which comprises close to the total Norwegian physician work-force minus a representative sample of 2100, used for other studies. The primary questionnaire was returned by 6652 (71.8%), the great majority of which also returned three secondary questionnaires. The results indicate that health complaints were significantly more frequent in female physicians and decreased with age. Low job satisfaction, high job stress, and emotional distress were all found to be significant predictors of subjective health complaints, as measured by the Ursin Health Inventory.

Female medical leadership : cross sectional study

Objective: To assess the relation between male and female medical leadership. Design: Cross sectional study on predictive factors for female medical leadership with data on sex, age, specialty, and occupational status of Norwegian physicians. Setting: Oslo,Norway. Subjects: 13844 non-retired Norwegian physicians. Main outcome measure: Medical leaders, defined as physicians holding a leading position in hospital medicine, public health, aacademic medicine, or private health care. Results: 14.6% (95% confidence interval 14.0% to 15.4%) of the men were leaders compared with 5.1% (4.4% to 5.9%) of the women. Adjusted for age men had a higher estimated probability of leadership in all categories of age and job, the highest being in academic medicine with 0.57(0.42to 0.72) for men aged over 54years compared with 0.39(0.21to 0.63) for women in the same category. Among female hospital physicians there was a positive relation between the proportion of women in their specialty and the probability of leadership. Conclusion: Women do not reach senior positions as easily as men. Medical specialties with high proportions of women have more female leaders.

Suicide rates according to education with a particular focus on physicians in Norway 1960-2000

BACKGROUND Suicide rates are higher in certain educational groups. The highest rates are generally found in the medical and allied professions, but the empirical evidence for high suicide rates may be questionable. This study compares the rate of suicide among trained physicians, dentists, nurses, police officers and theologians with the rate among other university graduates and the general population according to sex, age and time period. METHOD Census data from 1960, 1970, 1980 and 1990 relating to education were linked to suicide as cause of death data from Statistics Norway, and followed up for the period 1960-2000, comprising 46 and 49 million person-years among men and women respectively. RESULTS Physicians still have a higher rate compared with other graduates and the general population, both among males [43.0, 95% confidence interval (CI) 35.3-52.5] and females (26.1, 95% CI 15.1-44.9). Suicide rates increased steeply by age among physicians and other graduates, whereas for non-graduates the rate was highest in the 40-60 years age group. The suicide rate among female nurses was also elevated, whereas police officers seemed to have an intermediate suicide risk. The rate among theologians was low (7.0, 95% CI 2.9-16.9). The suicide rates in the 1990s were significantly lower than in the 1980s. CONCLUSIONS The high suicide rates among physicians and elderly graduates are of concern. The reasons why graduates are more vulnerable than others when getting older and the low rate among theologians warrant further study.

Counselling for burnout in Norwegian doctors: one year cohort study

Objective To investigate levels and predictors of change in dimensions of burnout after an intervention for stressed doctors. Design Cohort study followed by self reported assessment at one year. Setting Norwegian resource centre. Participants 227 doctors participating in counselling intervention, 2003-5. Interventions Counselling (lasting one day (individual) or one week (group based)) aimed at motivating reflection on and acknowledgement of the doctors’ situation and personal needs. Main outcome measures Levels of burnout (Maslach burnout inventory) and predictors of reduction in emotional exhaustion investigated by linear regression. Results 185 doctors (81%, 88 men, 97 women) completed one year follow-up. The mean level of emotional exhaustion (scale 1-5) was significantly reduced from 3.00 (SD 0.94) to 2.53 (SD 0.76) (t=6.76, P<0.001), similar to the level found in a representative sample of 390 Norwegian doctors. Participants had reduced their working hours by 1.6 hours/week (SD 11.4). There was a considerable reduction in the proportion of doctors on full time sick leave, from 35% (63/182) at baseline to 6% (10/182) at follow-up and a parallel increase in the proportion who had undergone psychotherapy, from 20% (36/182) to 53% (97/182). In the whole cohort, reduction in emotional exhaustion was independently associated with reduced number of work hours/week (β=0.17, P=0.03), adjusted for sex, age, and personality dimensions. Among men “satisfaction with the intervention” (β=0.25, P=0.04) independently predicted reduction in emotional exhaustion. Conclusions A short term counselling intervention could contribute to reduction in emotional exhaustion in doctors. This was associated with reduced working hours for the whole cohort and, in men, was predicted by satisfaction with the intervention.

Moral distress among Norwegian doctors

Background: Medicine is full of value conflicts. Limited resources and legal regulations may place doctors in difficult ethical dilemmas and cause moral distress. Research on moral distress has so far been mainly studied in nurses. Objective: To describe whether Norwegian doctors experience stress related to ethical dilemmas and lack of resources, and to explore whether the doctors feel that they have good strategies for the resolution of ethical dilemmas. Design: Postal survey of a representative sample of 1497 Norwegian doctors in 2004, presenting statements about different ethical dilemmas, values and goals at their workplace. Results: The response rate was 67%. 57% admitted that it is difficult to criticise a colleague for professional misconduct and 51% for ethical misconduct. 51% described sometimes having to act against own conscience as distressing. 66% of the doctors experienced distress related to long waiting lists for treatment and to impaired patient care due to time constraints. 55% reported that time spent on administration and documentation is distressing. Female doctors experienced more stress that their male colleagues. 44% reported that their workplace lacked strategies for dealing with ethical dilemmas. Conclusion: Lack of resources creates moral dilemmas for physicians. Moral distress varies with specialty and gender. Lack of strategies to solve ethical dilemmas and low tolerance for conflict and critique from colleagues may obstruct important and necessary ethical dialogues and lead to suboptimal solutions of difficult ethical problems.

Unhappy doctors? A longitudinal study of life and job satisfaction among Norwegian doctors 1994 – 2002

BackgroundGeneral opinion is that doctors are increasingly dissatisfied with their job, but few longitudinal studies exist. This study has been conducted to investigate a possible decline in professional and personal satisfaction among doctors by the turn of the century.MethodsWe have done a survey among a representative sample of 1 174 Norwegian doctors in 2002 (response rate 73 %) and compared the findings with answers to the same questions by (most of) the same doctors in 1994 and 2000. The main outcome measures were self reported levels of life satisfaction and job satisfaction according to the Job Satisfaction Scale (JSS).ResultsMost Norwegian doctors are happy. They reported an average life satisfaction of 5.21 in 1994 and 5.32 in 2002 on a scale from 1 (extremely dissatisfied) to 7 (extremely satisfied). Half of the respondents reported a very high level of general life satisfaction (a score of 6 or 7) while only one third said they would have reported this high level of satisfaction five years ago. The doctors thought that they had a higher level of job satisfaction than other comparable professional groups. The job satisfaction scale among the same doctors showed a significant increase from 1994 to 2002. Anaesthesiologists and internists reported a lower and psychiatrists and primary care doctors reported a higher level of job satisfaction than the average.ConclusionNorwegian doctors seem to have enjoyed an increasing level of life and job satisfaction rather than a decline over the last decade. This challenges the general impression of unhappy doctors as a general and worldwide phenomenon.

A three-year cohort study of the relationships between coping, job stress and burnout after a counselling intervention for help-seeking physicians

BackgroundKnowledge about important factors in reduction of burnout is needed, but there is a dearth of burnout intervention program studies and their effects among physicians. The present three-year follow-up study aimed to investigate the roles of coping strategies, job stress and personality traits in burnout reduction after a counselling intervention for distressed physicians.Methods227 physicians who attended a counselling intervention for burnout at the Resource Centre Villa Sana, Norway in 2003-2005, were followed with self-report assessments at baseline, one-year, and three-year follow-up. Main outcome measures were emotional exhaustion (one dimension of burnout), job stress, coping strategies and neuroticism. Changes in these measures were analyzed with repeated measures ANOVA. Temporal relationships between changes were examined using structural modelling with cross-lagged and synchronous panel models.Results184 physicians (81%, 83 men, 101 women) completed the three-year follow-up assessment. Significantly reduced levels of emotional exhaustion, job stress, and emotion-focused coping strategies from baseline to one year after the intervention, were maintained at three-year follow-up.Panel modelling indicated that changes in emotion-focused coping (z = 4.05, p < 0.001) and job stress (z = 3.16, p < 0.01) preceded changes in emotional exhaustion from baseline to three-year follow-up. A similar pattern was found from baseline to one-year follow-up.ConclusionA sequential relationship indicated that reduction in emotion-focused coping and in job stress preceded reduction in emotional exhaustion. As a consequence, coping strategies and job stress could be important foci in intervention programs that aim to reduce or prevent burnout in help-seeking physicians.

The Factorial Validity of the Maslach Burnout Inventory–General Survey in Representative Samples of Eight Different Occupational Groups

The Maslach Burnout Inventory-General Survey (MBI-GS) is designed to measure the three subdimensions (exhaustion, cynicism, and professional efficacy) of burnout in a wide range of occupations. This article examines the factorial validity of the MBI-GS across eight different occupational groups in Norway: lawyers, physicians, nurses, teachers, church ministers, bus drivers, and people working within advertising and information technology (N = 5,024). Separate confirmatory factor analyses using LISREL showed that the hypothesized three-factor model had sufficient fit in all occupational groups except for the group of people working in advertising. In a multigroup analysis including all occupations but the latter one and in an analysis of all individuals combined into one sample, the three-factor model had a clearly better fit than the alternative one-factor and two-factor models. The results support that MBI-GS provides a suitable measurement to assess burnout across a diversity of professions.

Helping Motives in Late Modern Society: values and attitudes among nursing students

This article reports a follow-up study of Norwegian nursing students entitled ‘The helping motive -an important goal for choosing nursing education’. It presents and discusses a significant ambiguity within the altruistic helping motive of 301 nursing students in the light of classical and modern virtue ethics. A quantitative longitudinal survey design was used to study socialization and building professional identity. The follow-up study began after respondents had completed more than two-and-a-half years of the three-year educational programme. Data were collected using a questionnaire with closed questions, supplemented by 18 semi-structured, in-depth, audiotaped interviews. A motive such as ‘desire for human contact/to help others’ appeared to be highly significant. The research questions employed were: What motivates nursing students at the end of their studies to help other people? What does helping others mean for nursing students? Factor analysis revealed two factors. Factor 1 can be expressed as an altruism factor and factor 2 can be interpreted as an ‘acknowledgement-from-the-patient factor’ that in fact indicates an ambiguity within the helping motive itself. Findings from the interviews also reveal ambiguous helping motives. On one hand the students want to be altruistic and on the other they wish to receive positive feedback from patients when giving help. The findings indicate that this positive feedback is essential to the students in order for them to provide altruistic care.

The communication atmosphere between physician colleagues: Competitive perfectionism or supportive dialogue? A Norwegian study

Open and supportive communication is probably one of the most important promotors of learning, coping and satisfaction at the workplace. The aim of this paper is to describe and predict the communication atmosphere between Norwegian physicians. Twenty statements describing communication, as perceived by the physicians themselves, were presented to a random sample of the members of the Norwegian Medical Association of which more than 90% of the physicians in the country are members (N = 2628). In general, this investigation indicates that the communication atmosphere among Norwegian physicians is characterised by support and mutual respect. More than half of the respondents fully agreed that communication between colleagues in the workplace is marked by solidarity, and that experienced colleagues show respect for the less experienced in both personal and professional matters. Physicians working in hospitals described the communication atmosphere as substantially more selfish and competitive than non-hospital physicians, whilst general practitioners considered the atmosphere between colleagues to be more supportive than non-specialists. In addition, high perceived stress was associated with the perception of a less supportive atmosphere. However, the strongest predictor of the communication atmosphere was clearly the physicians perceived autonomy. The comprehensive retrenchment programmes implemented in Norwegian hospitals during recent years have increased stress and restricted professional autonomy among both physicians and other occupational groups. Our findings indicate that the communication atmosphere necessary to secure continuity of knowledge within the medical profession may have been jeopardised by this process. In the long term, this may prove hazardous to the quality of medical care.