Family Practice Vol. 16, No. 6, 600-601
© Oxford University Press 1999
Sources of job satisfaction and psychological distress in GPs and medical house officers
Department of Psychiatry and Behavioural Sciences, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL,
a Child and Family Unit, St James' University Teaching Hospital, Beckett Street, Leeds LS9 7TF and
b Yorkshire Primary Care Research Network, Centre for Research in Primary Care, Hallas Wing, Nuffield Institute for Health, 71–75 Clarendon Road, Leeds LS2 9PL, UK.
Kapur N, Appleton K and Neal RD. Sources of job satisfaction and psychological distress in GPs and medical house officers. Family Practice 1999; 16: 600–601.
Received 17 March 1999; Accepted 25 June 1999.
Abstract
The psychological health and job satisfaction of 285 GPs and 89 medical house officers from Leeds was compared using standardized self-report measures. Forty-eight per cent of the GPs and 20% of the house officers scored as ‘cases' of psychiatric disorder. The GPs were less satisfied with the recognition they received for their work and their hours of work, but more satisfied with their job variety and job autonomy. Further research examining the sources of work-related distress in different medical settings could help inform future organizational changes.
Keywords. GPs, house officers, job satisfaction, organizational structure, psychological distress..
Introduction
General practice may have detrimental effects on psychological well-being and job satisfaction,1 but it is widely believed that the pre-registration house year is the most stressful period of medical practice.2 Recent organizational initiatives have influenced the work of both GPs and house officers. Hospital juniors have had their working hours regulated under the ‘New Deal’ and their training structure reorganized, while GPs have seen many changes over the last decade, starting with the imposition of a new contract. In the current study we sought to compare sources of job satisfaction and psychological distress in GPs and medical house officers.
Methods
Two surveys were carried out. Postal questionnaires were sent to all GPs working in Leeds,1 and to all pre-registration medical house officers working in the two Leeds teaching hospitals during 1995 and 1996. Follow-up questionnaires were sent to non-responders, and the house officers also received telephone reminders. The 12-item version of the General Health Questionnaire3 was used as a measure of psychological distress. This can be scored 0–12, with higher scores indicating greater distress. In this study, a score of 4 or more was taken as identifying probable ‘cases' of psychiatric disorder. This is a conservative cut-off score which has been used in previous similar studies.4 The questionnaire also included validated Likert measures of job satisfaction.4
Results
A total of 285/406 questionnaires were returned by the GPs and 89/93 were returned by the house officers, giving response rates of 70 and 96%, respectively. The GPs were on average older than the house officers [mean age (SD) 42.2 (9.2) versus 25.5 (3) years] and a slightly greater proportion were male [61% (175/285) versus 59% (37/89)]. Forty-five per cent (129/285) of GPs and 19% (19/89) of house officers scored as ‘cases' of psychiatric disorder. The table compares GPs' and house officers' scores on the General Health Questionnaire and measures of job satisfaction.
Conclusion
Studies carried out a decade ago reported relatively good mental health among GPs,5 but found that the rate of emotional disturbance among medical house officers was 50%.2 In the intervening period, the working patterns of both groups have been greatly affected by wider structural changes in the Health Service. In the current study, GPs were found to be more distressed than the medical house officers. Indeed, almost half the GPs scored as probable ‘cases' of minor psychiatric disorder. They were less satisfied with their hours of work and the recognition they received for good work. However, the GPs were more satisfied with their job variety, the opportunity to use their abilities, the degree of freedom, their job responsibility and their working conditions than their more junior colleagues.
The 70% response rate among the GPs was relatively good for a survey of this type, but non-response remains a potential source of bias. The GPs were significantly older on average than the house officers and the results may be confounded by factors such as age and level of experience. However, previous work suggests that hospital consultants (with ages and experience similar to the GPs in this study) suffer lower levels of distress, with just 25% reaching the threshold of ‘caseness' on the General Health Questionnaire.6
It is disconcerting that GPs were significantly more distressed than newly qualified doctors, with nearly half scoring as ‘cases' of psychiatric disorder. A reduction in juniors' hours of work, more structured hospital training and the burden imposed on GPs by a new contract in 1990 are all possible explanations. House officers endure house jobs for 12 months and then have the prospect of moving on to more rewarding careers. Disgruntled GPs may have much less to look forward to. Our results suggest that they feel overworked and undervalued. Further research examining the sources of occupational distress in different groups of doctors could help inform future organizational changes and minimize the detrimental effects of medical working.
Contributors
NK co-ordinated and collected data for the house officer survey and wrote the initial draft of the paper; KA coordinated and collected data for the GP survey and commented on the draft of the paper; and RDN contributed to the overall study design, helped with data analysis and commented on the draft of the paper.
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Acknowledgments
We would like to thank all the GPs and house officers who participated in this study.
References:
1 Appleton K, House A, Dowell A. A survey of job satisfaction, sources of stress and psychological symptoms among general practitioners in Leeds. Br J Gen Pract 1998; 48: 1059–1063.[Web of Science][Medline]
2 Firth-Cozens J. Emotional distress in junior house officers. Br Med J 1987; 295: 533–536.
3 Goldberg DP. The Detection of Psychiatric Illness by Questionnaire. London: Oxford University Press, 1972.
4 Borrill CF, Wall TD, West MA et al. Mental health of the workforce in NHS Trusts –Phase 1 Final report. Institute of Work Psychology, University of Sheffield/Department of Psychology, University of Leeds, 1996.
5 Cooper CL, Rout U, Faragher B. Mental health, job satisfaction and job stress among general practitioners. Br Med J 1989; 298: 366–370.
6
Kapur N, Borrill C, Stride C. Psychological distress and job satisfaction in hospital consultants and junior house officers: cross sectional multi centre study. Br Med J 1998; 317: 511–512.
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