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Less work: more burnout? A comparison of working conditions and the risk of burnout by German physicians before and after the implementation of the EU Working Time Directive

  • Astrid Richter
  • Petya Kostova
  • Xaver Baur
  • Ralf Wegner
Original Article

Abstract

Objectives

The present study is a 10-year comparison (1997 vs. 2007) of occupational and health aspects before and after the implementation of the European Working Time Directive on German hospital physicians. A major focus is whether the changes in working conditions are accompanied by a lower risk for burnout.

Methods

Three hundred and twenty-eight physicians from the Medical Register of the city of Hamburg completed the survey in 1997 and 994 physicians in 2007. The response rates were 55.4 and 46.5 %, respectively. All participants filled in a 22-item version of the German translation of the Maslach Burnout Inventory. Results of multivariate covariance analyses are reported.

Results

The work of physicians has changed significantly within the 10-year period, for example, work time decreased by 4.5 h on average to 55.8 h per week in 2007. Junior physicians profited more from this development, but on-call duties increased for senior physicians in particular. The reduced hours were at the expense of fewer rests. Junior, as well as senior, physicians reported significantly higher rates on the burnout scale for emotional exhaustion (mean 21.8, SD 10.7) in the latter survey and senior physicians also on the depersonalization scale (mean 9.7, SD 6.3).

Conclusions

Changes in working conditions in accordance with the European Working Time Directive are not accompanied by reduced strain and risk of burnout for physicians. Rather, our data argue for greater intensification in work, especially for senior physicians. Further studies are suggested in order to explore interventions for a sustainable improvement in the working conditions of physicians.

Keywords

Hospital physicians Stress Strain Burnout Shortage of physicians 

Notes

Acknowledgments

The current study contains parts of the doctoral thesis of Petya Kostova. We are grateful to the Hamburg Medical Register for their support.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. Ahola K, Gould R, Virtanen M, Honkonen T, Aromaa A, Lönnqvist J (2009) Occupational burnout as a predictor of disability pension: a population-based cohort study. Occup Environ Med 66(5):284–290. doi: 10.1136/oem.2008.038935 CrossRefGoogle Scholar
  2. Bakker AB, Demerouti E (2007) The job demands-resources model: state of the art. J Manag Psychol 22(3):309–328. doi: 10.1108/02683940710733115 CrossRefGoogle Scholar
  3. Bakker AB, Demerouti E, Euwema MC (2005) Job resources buffer the impact of job demands on burnout. J Occup Health Psychol 10(2):170–180. doi: 10.1037/1076-8998.10.2.170 CrossRefGoogle Scholar
  4. Barth A (1985) Das MBI-D: Erste Untersuchung mit einer deutschen Übersetzung des, Maslach Burnout Inventory‘bei klientenzentrierten Gesprächstherapeuten und Hochschullehrern. Zulassungsarbeit zur staatlichen Ergänzungsprüfung im Fach Psychologie mit Schulpsychologischem Schwerpunkt, Universität NürnbergGoogle Scholar
  5. Buddeberg-Fischer B, Klaghofer R, Buddeberg C (2005) Stress at work and well-being in junior residents. Z Psychosom Med Psychother 51(2):163–178Google Scholar
  6. Buddeberg-Fischer B, Stamm M, Buddeberg C, Klaghofer R (2010) Chronic stress experience in young physicians: impact of person- and workplace-related factors. Int Arch Occup Environ Health 83:373–379CrossRefGoogle Scholar
  7. Bundesärztekammer (2011) Tätigkeitsbericht 2010 der Bundesärztekammer. http://www.bundesaerztekammer.de/downloads/Taetigkeit2010.pdf. Accessed 5 Dec 2011
  8. Cubrilo-Turek M, Urek R, Turek S (2006) Burnout syndrome: assessment of a stressful job among intensive care staff. Coll Antropol 30:131–135Google Scholar
  9. Fletcher KE, Underwood W 3rd, Davis SQ, Mangrulkar RS, McMahon LF Jr, Saint S (2005) Effects of work hour reduction on residents’ lives: a systematic review. JAMA 294(9):1088–1100CrossRefGoogle Scholar
  10. Friedrich M, Popov A, Schmitto J, Bireta C, Emmert A, Tirilomis T (2011) Meeting the needs of the European Working Time Directive in German medical profession. Dtsch Med Wochenschr 136:1377–1383CrossRefGoogle Scholar
  11. Greenhaus JH, Beutell NJ (1985) Sources of conflict between work and family roles. Acad Manag Rev 10(1):76–88. doi: 10.5465/amr.1985.4277352 Google Scholar
  12. Gundersen L (2001) Physician burnout. Ann Intern Med 135(2):145–148CrossRefGoogle Scholar
  13. Hallsten L, Voss M, Stark S, Josephson M (2011) Job burnout and job wornout as risk factors for long-term sickness absence. Work 38(2):181–192. doi: 10.3233/WOR201101120 Google Scholar
  14. Hutter M, Kellogg K, Ferguson C, Abbott W, Warshaw A (2006) The impact of the 80-hour resident workweek on surgical residents and attending surgeons. Ann Surg 243(6):864–875. doi: 10.1097/01.sla.0000220042.48310.66 CrossRefGoogle Scholar
  15. Isikhan V, Comez T, Danis MZ (2004) Job stress and coping strategies in health care professionals working with cancer patients. Eur J Oncol Nurs 8:234–244. doi: 10.1016/j.ejon.2003.11.004 CrossRefGoogle Scholar
  16. Karasek RA (1979) Job demands, job decision latitude, and mental strain: implications for job design. Admin Sci Quart 24:285–308CrossRefGoogle Scholar
  17. Kopetsch T (2009) Arztzahlentwicklung: Hohe Abwanderung ins Ausland – sehr geringe Arbeitslosigkeit. Dtsch Arztebl 106(16):A757–A766Google Scholar
  18. Kuhn G (2001) Circadian rhythm, shift work, and emergeny medicine. Ann Emerg Med 37:88–98CrossRefGoogle Scholar
  19. Maslach C, Jackson S (1981) The measurement of experienced burnout. J Occup Behav 2:99–113CrossRefGoogle Scholar
  20. Maslach C, Jackson S (1986) Maslach burnout inventory manual, 2nd edn. Consulting Psychologists Press, Palo AltoGoogle Scholar
  21. Maslach C, Schaufeli WB, Leiter MP (2001) Job burnout. Annu Rev Psychol 52:397–422. doi: 0066-4308/01/0201-0397$14.00 CrossRefGoogle Scholar
  22. McManus IC, Winder BC, Gordon D (2002) The causal links between stress and burnout in a longitudinal study of UK doctors. Lancet 359:2089–2090CrossRefGoogle Scholar
  23. Michalsen A, Hillert A (2011a) Burn-out in anesthesia and intensive care medicine. Part 1. Clarification and critical evaluation of the term. Anaesthesist 60(1):23–30. doi: 10.1007/s00101-009-1659-0 CrossRefGoogle Scholar
  24. Michalsen A, Hillert A (2011b) Burnout in anesthesia and intensive care medicine. Part 2: Epidemiology and importance for the quality of care. Anaesthesist 60(1):31–38. doi: 10.1007/s00101-010-1805-8 CrossRefGoogle Scholar
  25. Nurminen T (1998) Shift work and reproductive health. Scand J Work Environ Health 24(suppl 3):28–34Google Scholar
  26. Nyssen AS, Hansez I, Baele P, Lamy M, De Keyser V (2003) Occupational stress and burnout in anaesthesia. Br J Anaesth 90(3):333–337. doi: 10.1093/bja/aeg058 CrossRefGoogle Scholar
  27. Parshuram CS, Dhanani S, Kirsh JA, Cox PN (2004) Fellowship training, workload, fatigue and physical stress: a prospective observational study. CMAJ 170(6):965–970. doi: 10.1053/cmaj.1030442 CrossRefGoogle Scholar
  28. Prins JT, Gazendam-Donofrio SM, Tubben BJ, Van Der Heijden FM, Van De Wiel HB, Hoekstra-Weebers JE (2007) Burnout in medical residents: a review. Med Educ 41(8):788–800. doi: 10.1111/j.1365-2923.2007.02797.x CrossRefGoogle Scholar
  29. Robeznieks A (2011) Shift work. Mod Healthc 41(30):6–7Google Scholar
  30. Rupert PA (2009) Work-family conflict and burnout among practicing psychologists. Prof Psychol Res Pr 40(1):54–61. doi: 10.1027/1614-0001.30.1.6 CrossRefGoogle Scholar
  31. Sharma A, Sharp D, Walker L, Monson J (2008) Stress and burnout in colorectal and vascular surgical consultants working in the UK national health service. Psychooncology 17:570–576CrossRefGoogle Scholar
  32. Siegrist J (1996) Adverse health effects of high effort-low reward conditions. J Occup Health Psych 1(1):27–41CrossRefGoogle Scholar
  33. Simoens S, Hurst J (2006) The supply of physician services in OECD countries OECD health working papers, 21Google Scholar
  34. Spielberg P (2011) EU-Arbeitszeitrecht. Kein einheitliches Bild. Dtsch Arztebl 108(14):A807–A808Google Scholar
  35. SVR (2009) Qualifikation und Migration: Potenziale und Personalpolitik in der „Firma“ Deutschland. http://www.svr-migration.de/content/wp-content/uploads/2009/05/090528_druckfassung_qualifikation-und-migration.pdf. Accessed 12 Jan 2012
  36. Tan P, Hogle NJ, Widmann WD (2012) Limiting PGY 1 residents to 16 hours of duty: review and report of a workshop. J Surg Educ 69(3):355–359. doi: 10.1016/j.jsurg.2011.10.013 CrossRefGoogle Scholar
  37. Thomas NK (2004) Resident burnout. JAMA 292(23):2880–2889CrossRefGoogle Scholar
  38. Voltmer E (2009) Abwanderung von Ärzten ins Ausland: Psychosoziale Belastungen werden zu wenig thematisiert. Dtsch Arztebl 106(8):A365–A366Google Scholar
  39. Wegner R (2007) Die beruflichen Belastungen von Hamburger Krankenhausärzten. Hamb Arztebl 31:314–318Google Scholar
  40. Wegner R, Wein C (2002) Zur Eignung des Maslach-Burnout-Inventory (MBI) bei arbeitsmedizinischen Erhebungen. In: Rindt (ed) DokBd DGAUM 42, Fulda, pp 319–321Google Scholar
  41. Wegner R, Kostova P, Poschadel B, Baur X (2007) Arbeitsbelastung und Beanspruchung von Hamburger Krankenhausärzten. Weniger Stunden, mehr Arbeit. Hamb Arztebl 11:515–518Google Scholar
  42. Wegner R, Kostova P, Poschadel B, Manuwald U, Baur X (2009) Belastungen und Beanspruchungen von Krankenhausärzten/-innen: Ergebnisse einer aktuellen Erhebung. Arbeitsmed Sozialmed Umweltmed 44(7):389–398Google Scholar
  43. Wismar M et al (2011) Health professional mobility and health systems: evidence from 17 European countries. Euro Observer 13(2):1–4Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Astrid Richter
    • 1
    • 2
  • Petya Kostova
    • 3
  • Xaver Baur
    • 1
    • 2
  • Ralf Wegner
    • 1
    • 2
  1. 1.Institute for Occupational and Maritime Medicine, Ministry of Health and Consumer Protection in HamburgHamburgGermany
  2. 2.University Medical Center Hamburg-EppendorfHamburgGermany
  3. 3.Gertrauden Krankenhaus Berlin-WilmersdorfBerlinGermany

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