Prevalence of chronic stress in general practitioners and practice assistants: Personal, practice and regional characteristics

Abstract

BackgroundThe majority of studies investigating stress in primary care have focused either on general practitioners (GPs) or practice assistants (PAs), but did not measure stress on a practice level. We analyzed the prevalence of chronic stress for both professional groups and on a practice level and investigated personal, practice, and regional characteristics.MethodsChronic stress was measured in GPs and PAs from 136 German practices using the standardized, self-administered TICS-SSCS questionnaire (12 items). Based on a sum-score, participants per professional group were categorized as having low or high strain due to chronic stress (≤ 25th and ≥ 75th percentile of the study population´s distribution, respectively). For a cluster-level analysis, the mean of all practice means was used to categorize low- and high-stress practices. The intra-class correlation coefficient (ICC) was calculated using ANOVA. Prevalence Ratios (PR) were used to compare low versus high strain due to stress, stratified for personal, practice and regional characteristics.ResultsThe response rate was 74.1% (n = 137/185). Data from 214 GPs (34.1% female), 500 PAs (99.4% female), and 50 PAs in training (98.0% female) were analyzed. Chronic stress was highest in female GPs (median 19, IQR (interquartile range) 11.5), followed by PAs (16, IQR 12.25) and male GPs (15, IQR 10). On a practice level, 26.3% of the practice personnel reported a high stress level. We observed an overall ICC of 0.25, with higher ICCs when stratifying by professional group (PAs: ICC 0.36, GPs in group practices: ICC 0.51). High chronic stress was observed as the number of working hours per week increased (GPs: PR 2.03, 95% CI 1.16–3.56; PAs: PR 2.02, 95% CI 1.22–3.35). There were no differences for practice type (solo/group) and the various regional characteristics.ConclusionPersonal and practice characteristics were associated with chronic stress in GPs, PAs, and on a practice level. The high ICCs indicate a need for stress-reduction strategies geared at both professions on a practice level.

'We always support each other – no matter what': a qualitative analysis of work-related psychosocial demands, stressors and resources in general practice teams

“…medical care centers), or increasing di culties to nd successors willing to pursue a career within a complex and demanding working environment [5][6][7]. Using general practices as an example for small enterprises, this study aims to gain an in-depth understanding of work-related psychosocial demands, stressors and resources in the primary care setting, an increasingly challenging working environment in Germany [8,9] .…”

“…23,24,25]. Compared to the general population and other professions, prior research has shown that the risk of reporting work-related stress is relatively high in health care staff [26], including general practitioners (GPs) and practice staff [8,9,27] (subsequently, the terms "practice staff" or "practice team" include practice assistants and administrative staff to distinguish between the physician and non-physician professions). The reasons are manifold and have, for example, been related to a very high workload, increasing working hours per week or practice characteristics (e.g.…”

“…The reasons are manifold and have, for example, been related to a very high workload, increasing working hours per week or practice characteristics (e.g. high number of patients with statutory health insurance) [9]. Furthermore, a shortage of skilled workers, the economization of the health care system and the increase of administrative tasks can affect job satisfaction of employees and practice owners [6,28].…”

IMPROVEjob – Participatory intervention to improve job satisfaction of general practice teams: A model for structural and behavioural prevention in small and medium-sized enterprises – a study protocol of a cluster-randomised controlled trial

“…Factors that are known to decrease job satisfaction include too many working hours, administrative burdens, inadequate income, heavy workload as well as lack of time and recognition [7]. Persisting low job satisfaction is related not only to chronic stress, burnout, depression, early retirement and other indicators of physicians' health, but is also linked reduced patient outcomes [8][9][10][11][12][13][14][15]. A study by Viehmann et al showed that physicians and non-physician personnel in general practices are twice as likely to perceive high chronic stress compared to the general population [10].…”

'We always support each other – no matter what': a qualitative analysis of work-related psychosocial demands, stressors and resources in general practice teams

“…In several European countries, including Germany [8], employers are required by law to provide measures ensuring decent working conditions. This includes, for example, the prevention of work-related psychosocial risks comprising stressors such as poor work organization or a hazardous working environment, and the promotion of work-related resources [5,9].Compared to the general population and other professions, prior research has shown that the risk of reporting work-related stress is relatively high in health care staff [10], including general practitioners (GPs) and practice staff [11,12] (subsequently, the terms "practice staff" or "practice team" include physician assistants and administrative staff to distinguish between the physician and non-physician professions). The reasons are manifold and have been related to a shortage of skilled workers, the economization of the health care system and the increase of administrative tasks which can affect job satisfaction of employees and practice owners [13].…”