INTRODUCTION
Stress is the psychological and physical state
that results when the resources of the individual are not sufficient to cope
with the demands and pressure of the situation.1
Level of job satisfaction and stress can affect both individuals and
organization. At the individual level, low level of job satisfaction and high
level of job stress are threat to mental and physical health, quality of life,
goal achievement and personal development. Whereas, for the workplace these
conditions lead to increased absenteeism, conflict and turnover, and reduced
quality and quantity of work. Thus identification of factors responsible for
stress and its management at its primary level has long term benefits both for
employee and employer.
Job stress is a recognized problem
in health care workers2 and doctors are
considered to be at particular risk of stress and stress related psychosocial
problems. Doctors have higher degree of psychological morbidity,3-5 suicidal tendencies6 and alcohol dependence7 than controls of comparable social class.
Caplan reported that about half of senior medical staff suffers from high level
of stress and a similar proportion suffers from anxiety.8 Similarly, Firth-Cozens found that half of
the junior doctors in their pre-registration year were suffering from emotional
disturbance.9
The delivery of high-quality medical
care contributes to improved health outcomes. Doctor’s job satisfaction affects
quality of medical cares that he/she provides,10 patient’s satisfaction with the doctor,11,12 patient’s adherence to treatment13 and decreases doctor’s turnover.14,15 Studies from West 2,16 deduce that long working hours and
over-work are important factors for job dissatisfaction and stress among
doctors.
To best of our knowledge, there is
no study available to assess the level of job satisfaction and stress among
doctors in Pakistan. Our investigation aimed to assess level of satisfaction
for workplace characteristics and of job stress among doctors working in
teaching hospitals of Karachi, Pakistan. We also aimed to compare these
variables to identify the differences in various workplace characteristics by
different sex of doctors.
MATERIAL AND MEHODS
This
was a cross-sectional, postal survey. A pre-tested, structured questionnaire
and a pre-paid return envelope were sent to 270 doctors on convenience basis
during the months of May and June 2002.
Respondents were given assurance of confidentiality through a covering
letter with the questionnaire. A reminder was sent after one month to those who
didn’t respond. We selected three tertiary care teaching hospitals representing
both public and private sector, providing secondary and tertiary care to a
large number of populations from Karachi as well from other parts of the
country. We received the responses from 189 (70%) doctors and among them 182
were found complete for analysis.
Doctors working as interns, part-time, employed in the hospital for less
than six months and those not directly concerned with patient’s care provision
(pathology, microbiology, radiology, anesthesia and community medicine) were
excluded from the study.
Data collected on demographic and
professional characteristics were sex, age, marital status, years since
graduation (MBBS), level of qualification, average number of patients seen per
week and current working status.
Workplace characteristics for level of job satisfaction were identified
through consensus building technique i,e., twenty doctors were invited to list
down workplace characteristics that affect job satisfaction. The ten most
frequently identified workplace characteristics that related to job
satisfaction were included in the questionnaire (Table 1). These were physical
working conditions, working relation with colleagues and fellows, recognition
and motivation, safety and security, workload, rate of pay and benefits,
opportunity to use skills and ability, professional growth and development,
autonomy, and adequate resources. Respondents graded it on five-point Likert
Scale (1 = very low to 5 = very high). Similarly, level of job stress was
assessed by rating it on five point Likert Scale. In addition, doctors were
asked to identify the affect of stress on their personal lives (family life, mental
health and physical health).
Statistical Package for Social Sciences (SPSS) version 11 was used for
data analysis. Percentages and mean scores with standard error (SE) were
calculated for demographic and workplace characteristics. In order to calculate
difference of categorical variables by sex of doctors, chi-square test was used
and for continuos variables by assuming the equal interval between different
scores of Likert Scale, t-test with 95% confidence interval (CI) for the
differences of means was calculated.
RESULTS
Demographic and professional characteristics of
respondents are shown in table 2. There were 58% male and 42% female doctors.
Majority of them was 35 years or older (61%) and married (79%). Fifty three
percent of the doctors were qualified since more than 10 years. Nearly half of
the respondents had post-graduation diploma/degree and 46% were seeing more
than 100 patients per week. Thirty-three percent respondents were trainee
doctors, 29% Family/General practitioners and 38% Faculty/Consultants.
Majority (68%) of the doctors were
not satisfied with their jobs, females more than males (males 65% and females
72%; p = > 0.05). Mean score for workplace characteristics for job
satisfaction are given in table 3. Characteristics with least satisfaction were
pay and benefits (2.12, SE 0.8), safety and security (2.15, SE 0.8), workload
(2.69, SE 0.9), adequate resources (2.69, SE 0.9) and physical working
conditions (2.79, SE 0.8). Significant
differences for job characteristics by sex (table 4) were found for workload
(mean job satisfaction score difference = 0.60; 95%CI, 0.24 to 0.97), relation
with colleagues and fellows (mean job satisfaction score difference = 0.49; 95%CI, 0.11 to 0.87) and autonomy
(mean job satisfaction score difference = 0.45; 95%CI, 0.07 to 0.82).
About half (48%) of the doctors
graded job stress from high to very high levels. The mean stress score was 3.32
(SE 0.09). Females had higher level of stress (mean score = 3.39; SE 0.12) than
males (mean score = 3.27; SE 0.14) but this was not statistically significant
(mean difference = - 0.12; 95%CI, - 0.25 to – 0.49) (figure 1). Percentages of
different affects of stress on doctor’s personal lives are shown in figure 2.
Affect on family life was reported by 66% of doctors (female 79% and male 57%)
and this was statistically significant (p vale = 0.001). Forty-five percent of
doctors reported that job stress affects on their physical health and 53% said
that it affects their mental health; however these results were not significantly
different in different sex.
DISCUSSION
It
is highlighted in this study that majority of doctors were not satisfied with
their jobs and overall had low level of satisfaction for work place characteristics.
Characteristics where female doctors scored significantly lower than males were
workload, relationships with colleagues and fellows and autonomy. In our
culture, where males are in majority among any working group, interaction and
relationship of females with them is not customary and males have more autonomy
and freedom than their female counterparts.
Job stress leads to poor performance
at work and negatively affects the health of an individual. Stress is inherent in medical career,17 and leads to poor quality of care,
affects career longevity, and causes personal distress. Jennifer and colleagues18 shows that dissatisfied physicians were
much more likely to report difficulties in caring for patients, continuing good
doctor-patient relationship, spending adequate time with patients, and
providing quality care. This study
showed that high level of stress prevails in both sexes among doctors in
teaching hospitals of Karachi.
In England,19 the most significant
factor of stress for female general practitioners was the stress of the job
interfering with family life,
Figure-1: Level of job stress among doctors sex
Figure 2. Affects of job stress among doctors
whereas
for male general practitioners, the work-home interface was the least important
factor. In this study also, female doctors reported more about job stress and
its affect on their family lives compared to male doctors. Female doctors have greater household
responsibilities and are required to take care of the children and other family
members as compared to their male counterparts. Majority of respondents from
both sexes also identified the affects of stress on physical and mental health,
which is again alarming.
The best way to deal with stress is to eliminate it at its origin
i,e., the stress should be dealt in
terms of preventive rather than as a curative strategy. Recognizing problems
and dealing with them positively and pro-actively, is the cost-effective way
forward in the management of stress. These results imply that the focus of
change should be on prevention at the primary level. For example, providing
security to doctors, appropriate pay and benefits, revising job plans, ensuring
adequate hours of work and adequate number of doctors to share the workload and
responsibilities and provision of adequate resources and physical working
conditions.
In addition, the role of
social support and relaxation techniques as stress coping strategies should not
be overlooked as contributory factors for the well being of the doctors. Thus
an integrated approach for successful occupational stress management should be
advocated, which seeks to manage stress at the individual and organizational
levels. Individual approaches include stress management training and one-to-one
psychology service - clinical, occupational and health counseling while
organizational interventions ranging from structural (for example work
schedules, physical environment) to psychological (for example social support,
control of over-work, participation). However, it is also necessary that
doctors are encouraged to use these services.
Table 3. Mean and
standard error scores of workplace characteristics for job satisfaction:
|
Characteristics (n = 182) |
Mean score* |
Std. Error |
|
Physical working conditions Working relation with
colleagues and fellows |
2.79 2.82 |
0.08 0.09 |
|
Recognition and motivation |
2.88 |
0.07 |
|
Safety
and security |
2.15 |
0.08 |
Workload
|
2.69 |
0.09 |
Rate of pay and benefits
|
2.12 |
0.08 |
Opportunity to use skills
and ability
|
3.31 |
0.08 |
Professional growth
|
3.08 |
0.08 |
|
Autonomy |
2.81 |
0.09 |
Adequate resources
|
2.69 |
0.09 |
* Five-point Likert Scale (1 = very
low to 5 = very high).
This study has some limitations. We could not contact a representative
sample of all medical doctors of Karachi because it was proved challenging and
study sample was on convenience basis thus selection bias remains a possibility
and generalizability of the results is in question. Nevertheless, we were able
to collect information from three major hospitals of the city that represent
private as well as public sector. The data of this study was ‘self-reported’
and therefore, there may be a reporting bias. We had about 70% response rate,
Keeping in mind the poor registration and postal system in our local scenario,
this response rate is reasonably good and comparable with other postal surveys
conducted in other parts of the world.2,16
