Job related affective well-being among primary health care physicians

European Journal of Public Health, Vol. 17, No. 5, 514–519 ß The Author 2006. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved. doi:10.1093/eurpub/ckl264 Advance Access published on December 21, 2006 ............................................................................................... Job related affective well-being among primary health care physicians Yesim Uncu1, Nuran Bayram2, Nazan Bilgel3 Keywords: affective well-being, general practitioner, primary health care, stress, work ............................................................................................... Introduction Positive emotions help people not only to survive, but also to thrive when confronted with adverse situations. Happiness is a lay construct, replete with personal meaning for each of us. It has been tended to treat happiness as psychological well-being, which also referred to as emotional well-being or subjective well-being.1 Job satisfaction is ‘a pleasurable or positive emotional state resulting from the appraisal of one’s job or job experiences’,2 and it is an important issue in every work environment, but its importance is significantly higher in the field of medicine as medicine is involved with critical decisions regarding one’s health. Numerous industrial studies emphasized the role of psychological well-being in job performance and job satisfaction.3 One study among physicians revealed that one third of all doctors reported lowered standards of patient care that is associated to primarily stress-related origins, and tiredness were determined to be at fault for 48.8% of the incidents, where doctors provided a lowered standard of care to their patients.4 Studies focused on primary health care physicians mostly assessed the sources of stress and predictors of job satisfaction among GPs, and indicated how job stress affects levels of job satisfaction.5–11 Time pressure, interruptions, practice administration, dealing with difficult patients and work/home conflict were found as the main sources of stress for GPs.12–15 In Australia, 68% of GPs that were questioned 1 Ass. Prof., Uludag University, Faculty of Medicine, Department of Family Medicine, 16059 Bursa, Turkey 2 Assoc. Prof., Uludag University, Faculty of Administrative and Economic Sciences, Department of Econometrics, 16059 Bursa Turkey 3 Prof., Uludag University, Faculty of Medicine, Department of Family Medicine, 16059 Bursa, Turkey Correspondence: Yesim Uncu, MD, Uludag University, Faculty of Medicine Department of Family Medicine, 16059 Bursa, Turkey, tel: þ90 22 44 42 86 58, fax: þ90 224 442 89 29, e-mail: were satisfied with their job;16 in the US, the satisfaction level increased to 82% among primary care physicians.17 Another survey reported that 59% of family physicians in the US were happy with their careers.18 In Turkey, studies about these issues are rare and somehow, medical professionals are seen as super-humans and the expectation of self-sacrificing is higher than in other professions. On the other side, health policies and primary health care systems are changing rapidly in our country, and these changes are a burden for job related affective well-being. Nowadays a transition period for the health care system is being considered. This transition period consists of adopting a family medicine model for primary health care services. While family doctor and general practitioner are used interchangeably in most countries, they are distinct in Turkey. All medical school graduates can work as GPs, who are not considered as specialists. These doctors usually work in health centres, providing preventive and primary health care. Family doctors are specialists, who receive an additional 3 years of training with an extensive curative focus. Since there are an insufficient number of family doctors, GPs will take responsibility in this scheme after some training. But the question of how will the training be arranged still remains unknown. With this recently proposed family medicine system, the primary health care physicians will be appointed upon the contracts made with the National Health Insurance Organization and paid through this organization. This is a new concept for GPs and it brings the fear of losing their jobs. Since the beginning of the Turkish Republic, all GPs were governmental officers, paid by the state budget, without any contract or limitations, and they get fixed salaries arranged by their length of service. The purpose of this study is to investigate a group of Turkish primary health care physicians’ job related emotional perceptions and their outcomes in terms of stress, anxiety and depression. Our study group did not represent all the primary health care physicians in the country; but it gives us an understanding about their job related well-being situation that is rarely assessed. Background: Job related affective well-being is important for a healthy life and job satisfaction for all individuals, including physicians. The later group, however, is most often compromised. Objectives: We aimed to investigate a group of Turkish primary health care physicians’ job related emotional perceptions and to assess their reactions in terms of stress, anxiety and depression. Methods: A descriptive, cross-sectional, self-reported questionnaire study was conducted. A total of 60 primary health care centres and 274 general practitioners who were working at these centres participated in the study. The response rate was 74%. Printed questionnaires were completed by the participants anonymously. We used the Job Related Affective Well-Being Scale (JAWS) and Depression Anxiety Stress Scale (DASS 42). Correlation analysis and hierarchic regression were performed. Results: Correlations between JAWS and DASS total scores were negative and statistically significant (r ¼
0.52; P< 0.01). Low pleasure/high arousal (LPHA) and low pleasure/low arousal (LPLA) variations that describe negative emotional states show a positive and significant relationship with depression, anxiety and stress values. The highest mean score was obtained for the high pleasure/low arousal (HPLA) status that can be interpreted to mean that our study group was pleased with their job but was not motivated. Conclusions: Physician’s job related negative emotional perceptions are associated with reactions in terms of stress, anxiety and depression. For this reason, it is critical to consider primary care physicians’ job related affectations and job related stimuli. Job related affective well-being Methods of problem from mild to extreme.22 The first studies by using the DASS-42 scale were performed by the developers on 3540 volunteer university students from Australia,23 and they found a good convergent validity with other scales. Another study with DASS-42 was done in the Netherlands to detect anxiety disorder and depression in 326 employees absent from work because of ment (...truncated)