Abstract
Objective
Estimate the effort–reward imbalance prevalence (ERI) among physicians.
Methods
A systematic review was conducted from 2005 to 2019 using PRISMA guidelines on the PubMed and EBSCOhost search engines. Data were classified according to the ERI definition used by the authors. A meta-analysis was performed on effort and reward scores and on ERI prevalence rates.
Results
Out of 3787 results, we selected 41 studies. The physicians’ ERI prevalence rate ranged from 3.50 to 96.9%. The standardized pooled effort mean score was 58.5 for effort and 48.9 for a reward out of 100, respectively. The overall combined ERI rate (when the ratio between effort and reward scores was above 1) was 40.2% among 21,939 practitioners (31.7% in the working European population). ERI rate was 70.2% using a four-point Likert scale and 21.1% using a five-point Likert scale. The highest rate (96.9%) was observed among German rural general practitioners and the lowest rate (3.50%) among Swiss hospital practitioners. The low percentage of variability (I2 = 27%) attributed to effort scores heterogeneity between studies suggested that this dimension is not discriminant in the physician ERI assessment. The high heterogeneity in reward scores (I2 = 83%) indicated that this dimension is sensible in ERI assessment among physicians. The number of items used did not appear as a significant source of heterogeneity.
Conclusion
Physician job ERI appeared to be higher than in the working population. Studying each dimension and item indicators could help improve psychosocial risk prevention.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Arnold H, Meyer CP, Salem J, Raspe M, Struck JP, Borgmann H (2017) Work and training conditions of residents in urology in Germany Results of a 2015 nationwide survey by the German Society of Residents in Urology [Weiterbildungs- und Arbeitsbedingungen urologischer Assistenzärzte in Deutschland: Ergebnisse einer GeSRU-Umfrage von 2015]. Urologe 56(10):1311–1319. https://doi.org/10.1007/s00120-017-0495-0
Bagaajav A, Myagmarjav S, Nanjid K, Otgon S, Chae YM (2011) Burnout and job stress among mongolian doctors and nurses. Ind Health 49(5):582–588. https://doi.org/10.2486/indhealth.MS1256
Bauer J, Groneberg D (2013) Distress among physicians in hospitals—an investigation in Baden-Württemberg, Germany [Ärztlicher Disstress –eine Untersuchung baden-württembergischer Ärztinnen und Ärzte in Krankenhäusern]. DMW Dtsch Med Wochenschr 138(47):2401–2406. https://doi.org/10.1055/s-0033-1359859
Bauer J, Groneberg DA (2014a) Stress and job satisfaction in the discipline of inpatient anesthesiology Results of a web-based survey [Stress und Berufszufriedenheit im Fachgebiet der stationären Anästhesiologie: Ergebnisse einer webbasierten Befragung]. Der Anaesth 63(1):32–40. https://doi.org/10.1007/s00101-013-2275-6
Bauer J, Groneberg DA (2014b) Distress and job satisfaction among hospital physicians in internal medicine [Disstress und Berufszufriedenheit unter Klinikärzten der Inneren Medizin]. Der Internist 55(10):1242–1250. https://doi.org/10.1007/s00108-014-3575-x
Bauer J, Groneberg DA (2017) Distress among surgeons—a study in German Hospitals [Disstress in der Chirurgie - Eine Untersuchung in deutschen Krankenhäusern]. Zentralbl Chir 142(6):590–598. https://doi.org/10.1055/s-0033-1350893
Birgit E, Gunnevi S, Ann Ö (2013) Work experiences among nurses and physicians in the beginning of their professional careers - analyses using the effort-reward imbalance model: Work experiences among nurses and physicians. Scand J Caring Sci 27(1):36–43. https://doi.org/10.1111/j.1471-6712.2012.00997.x
Braun M, Schönfeldt-Lecuona C, Freudenmann RW, Mehta T, Hay B, Kächele H, Beschoner P (2010) Depression, burnout and effort-reward imbalance among psychiatrists. Psychother Psychosom 79(5):326–327. https://doi.org/10.1159/000319531
Buddeberg-Fischer B, Klaghofer R, Buddeberg C (2005a) Stress at Work and Well-being in Junior Residents [Arbeitsstress und gesundheitliches Wohlbefinden junger Ärztinnen und Ärzte]. Z Psychosom Med Psychother 51(2):163–178. https://doi.org/10.13109/zptm.2005.51.2.163
Buddeberg-Fischer B, Klaghofer R, Abel T, Buddeberg C (2005b) Junior physicians’ workplace experiences in clinical fields in German-speaking Switzerland. Swiss Med Wkly 135(1–2):19–26 (PMID: 15662576)
Buddeberg-Fischer B, Stamm M, Buddeberg C, Bauer G, Hämmig O, Klaghofer R (2008) Work stress, health and satisfaction of life in young doctors: results of a longitudinal study in Switzerland [Arbeitsstress, Gesundheit und Lebenszufriedenheit junger Ärztinnen und Ärzte]. DMW Dtsch Med Wochenschr 133(47):2441–2447. https://doi.org/10.1055/s-0028-1100936
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(4):373–379. https://doi.org/10.1007/s00420-009-0467-9
Clough BA, March S, Chan RJ, Casey LM, Phillips R, Ireland MJ (2017) Psychosocial interventions for managing occupational stress and burnout among medical doctors: a systematic review. Syst Rev 6(1):144. https://doi.org/10.1186/s13643-017-0526-3
Cox T, Griffiths A, Rial-González E (2000) Research on work-related stress. Office for Official Publications of the European Communities ; Bernan Associates [distributor], Luxembourg
de Cássia Fogaça M (2010) Preliminary study about occupational stress of physicians and nurses in pediatric and neonatal intensive care units: the balance between effort and reward. Rev Lat Am Enferm 18(1):67–72. https://doi.org/10.1590/S0104-11692010000100011
Doi SAR, Barendregt JJ, Khan S, Thalib L, Williams GM (2015) Advances in the meta-analysis of heterogeneous clinical trials I: The inverse variance heterogeneity model. Contemp Clin Trials 45:130–138. https://doi.org/10.1016/j.cct.2015.05.009
Dutheil F, Aubert C, Pereira B, Dambrun M, Moustafa F, Mermillod M, Navel V (2019) Suicide among physicians and health-care workers: A systematic review and meta-analysis. PLoS ONE. https://doi.org/10.1371/journal.pone.0226361
Estryn-Behar M, Fry C, Guetarni K, Aune I, Machet G, Doppia MA, Prudhomme Ch (2011) Work week duration, work-family balance and difficulties encountered by female and male physicians: Results from the French SESMAT study. Work 40:83–100. https://doi.org/10.3233/WOR-2011-1270
Furuya-Kanamori L, Barendregt JJ, Doi SAR (2018) A new improved graphical and quantitative method for detecting bias in meta-analysis. Int J Evid-Based Healthc 16(4):195–203. https://doi.org/10.1097/XEB.0000000000000141
Georgiou K, Larentzakis A, Papavassiliou AG (2017) Surgeons’ and surgical trainees’ acute stress in real operations or simulation: a systematic review. The Surgeon 15(6):355–365. https://doi.org/10.1016/j.surge.2017.06.003
Godin I, Kittel F (2004) Differential economic stability and psychosocial stress at work: associations with psychosomatic complaints and absenteeism. Soc Sci Med 58(8):1543–1553. https://doi.org/10.1016/S0277-9536(03)00345-9
Goldberg M, Chastang JF, Leclerc A, Zins M, Bonenfant S, Bugel I, Imbernon E (2001) Socioeconomic, demographic, occupational, and health factors associated with participation in a long-term epidemiologic survey: a prospective study of the French GAZEL cohort and its target population. Am J Epidemiol 154(4):373–384. https://doi.org/10.1093/aje/154.4.373
Hämmig O (2018) Explaining burnout and the intention to leave the profession among health professionals—a cross-sectional study in a hospital setting in Switzerland. BMC Health Serv Res 18(1):785. https://doi.org/10.1186/s12913-018-3556-1
Hämmig O, Brauchli R, Bauer G (2012) Effort-reward and work-life imbalance, general stress and burnout among employees of a large public hospital in Switzerland. Swiss Med Wkly. https://doi.org/10.4414/smw.2012.13577
Hayes B, Prihodova L, Walsh G, Doyle F, Doherty S (2019) Doctors don’t Do-little: a national cross-sectional study of workplace well-being of hospital doctors in Ireland. BMJ Open 9(3):e025433. https://doi.org/10.1136/bmjopen-2018-025433
He Y, Pang Y, Zhang Y, Fielding R, Tang L (2017) Dual role as a protective factor for burnout-related depersonalization in oncologists. Psychooncology 26(8):1080–1086. https://doi.org/10.1002/pon.4425
Higgins JPT (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560. https://doi.org/10.1136/bmj.327.7414.557
Jabbour J (2015) Psychosocial risks and painfulness of work among emergency physicians. Survey conducted in the emergency department of the University Hospital of Nancy (Master’s Thesis). Université de Lorraine.
Jasper S, Stephan M, Al-Khalaf H, Rennekampff H-O, Vogt PM, Mirastschijski U (2012) Too little appreciation for great expenditure? Workload and resources in ICUs. Int Arch Occup Environ Health 85(7):753–761. https://doi.org/10.1007/s00420-011-0721-9
Klein J, Frie KG, Blum K, von dem Knesebeck O (2011) Psychosocial stress at work and perceived quality of care among clinicians in surgery. BMC Health Serv Res 11(1):109. https://doi.org/10.1186/1472-6963-11-109
Kulas JT, Stachowski AA (2009) Middle category endorsement in odd-numbered Likert response scales: associated item characteristics, cognitive demands, and preferred meanings. J Res Pers 43(3):489–493. https://doi.org/10.1016/j.jrp.2008.12.005
Lau B (2008) Effort-reward imbalance and overcommitment in employees in a Norwegian municipality: a cross sectional study. J Occup Med Toxicol 3(1):9. https://doi.org/10.1186/1745-6673-3-9
LeDoux JE (1996) The emotional brain: the mysterious underpinnings of emotional life (p. 384). New York, NY, US: Simon & Schuster. https://psycnet.apa.org/record/1996-98824-000
Leutgeb R, Frankenhauser-Mannuß J, Scheuer M, Szecsenyi J, Goetz K (2018) Job satisfaction and stressors for working in out-of-hours care—a pilot study with general practitioners in a rural area of Germany. BMC Fam Pract. https://doi.org/10.1186/s12875-018-0777-7
Li J, Yang W, Cho S (2006) Gender differences in job strain, effort-reward imbalance, and health functioning among Chinese physicians. Soc Sci Med 62(5):1066–1077. https://doi.org/10.1016/j.socscimed.2005.07.011
Li J, Weigl M, Glaser J, Petru R, Siegrist J, Angerer P (2013) Changes in psychosocial work environment and depressive symptoms: a prospective study in junior physicians: Changes in ERI and Depressive Symptoms. Am J Ind Med 56(12):1414–1422. https://doi.org/10.1002/ajim.22246
Liu L, Chang Y, Fu J, Wang J, Wang L (2012) The mediating role of psychological capital on the association between occupational stress and depressive symptoms among Chinese physicians: a cross-sectional study. BMC Public Health 12(1):219. https://doi.org/10.1186/1471-2458-12-219
Loerbroks A, Weigl M, Li J, Angerer P (2016) Effort-reward imbalance and perceived quality of patient care: a cross-sectional study among physicians in Germany. BMC Public Health 16(1):342. https://doi.org/10.1186/s12889-016-3016-y
Magnavita N, Fileni A (2014) Association of work-related stress with depression and anxiety in radiologists. Radiol Med (torino) 119(5):359–366. https://doi.org/10.1007/s11547-013-0355-y
Magnavita N, Garbarino S (2013) Social psychiatry in the waiting room: what a physician can learn about occupational stress from workers waiting to be examined. Psychiatry J 2013:1–7. https://doi.org/10.1155/2013/701872
Magnavita N, Fileni A, Magnavita G, Mammi F, Mirk P, Roccia K, Bergamaschi A (2008) Work stress in radiologists. A pilot study. La Radiol Med 113(3):329. https://doi.org/10.1007/s11547-008-0259-4
Marmot M, Shipley M, Brunner E, Hemingway H (2001) Relative contribution of early life and adult socioeconomic factors to adult morbidity in the Whitehall II study. J Epidemiol Community Health 55(5):301–307. https://doi.org/10.1136/jech.55.5.301
Medisauskaite A, Kamau C (2017) Prevalence of oncologists in distress: systematic review and meta-analysis. Psychooncology 26(11):1732–1740. https://doi.org/10.1002/pon.4382
Miller JJ (1978) The Inverse of the Freeman—Tukey Double Arcsine Transformation. Am Stat 32(4):138–138. https://doi.org/10.1080/00031305.1978.10479283
Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, PRISMA-P Group (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 4(1):1. https://doi.org/10.1186/2046-4053-4-1
Moors G (2008) Exploring the effect of a middle response category on response style in attitude measurement. Qual Quant 42(6):779–794. https://doi.org/10.1007/s11135-006-9067-x
Ohlander J, Weigl M, Petru R, Angerer P, Radon K (2015) Working conditions and effort–reward imbalance of German physicians in Sweden respective Germany: a comparative study. Int Arch Occup Environ Health 88(4):511–519. https://doi.org/10.1007/s00420-014-0978-x
Peter R, Alfredsson L, Hammar N, Siegrist J, Theorell T, Westerholm P (1998) High effort, low reward, and cardiovascular risk factors in employed Swedish men and women: baseline results from the WOLF Study. J Epidemiol Community Health 52(9):540–547. https://doi.org/10.1136/jech.52.9.540
Raspe M, Vogelgesang A, Fendel J, Weiß C, Schulte K, Rolling T (2018) Work and training conditions of young German physicians in internal medicine—results of a Second Nationwide Survey by Young Internists from the German Society of Internal Medicine and the German Professional Association of Internists. Dtsch Med Wochenschr 143(7):e42–e50. https://doi.org/10.1055/a-0543-4544
Sakata Y, Wada K, Tsutsumi A, Ishikawa H, Aratake Y, Watanabe M, Tanaka K (2008) Effort-reward imbalance and depression in Japanese medical residents. J Occup Health 50(6):498–504. https://doi.org/10.1539/joh.L8043
Schneider A, Weigl M (2018) Associations between psychosocial work factors and provider mental well-being in emergency departments: a systematic review. PLoS ONE 13(6):e0197375. https://doi.org/10.1371/journal.pone.0197375
Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, Stewart LA (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. https://doi.org/10.1136/bmj.g7647
Siegrist J (1996) Adverse health effects of high-effort/low-reward conditions. J Occup Health Psychol 1(1):27–41. https://doi.org/10.1037//1076-8998.1.1.27
Siegrist J, Starke D, Chandola T, Godin I, Marmot M, Niedhammer I, Peter R (2004) The measurement of effort–reward imbalance at work: European comparisons. Soc Sci Med 58(8):1483–1499. https://doi.org/10.1016/S0277-9536(03)00351-4
Siegrist J, Shackelton R, Link C, Marceau L, von dem Knesebeck O, McKinlay J (2010) Work stress of primary care physicians in the US, UK and German health care systems. Soc Sci Med 71(2):298–304. https://doi.org/10.1016/j.socscimed.2010.03.043
Siegrist J, Li J, Montano D (2014) Psychometric properties of the effort-reward imbalance questionnaire. Department of Medical Sociology, Faculty of Medicine, Duesseldorf University, Germany, 2014, vol. 4, p. 1–4. https://www.uniklinik-duesseldorf.de/fileadmin/Fuer-Patienten-und-Besucher/Kliniken-Zentren-Institute/Institute/Institut_fuer_Medizinische_Soziologie/Forschung/PsychometricProperties.pdf
Stehman CR, Testo Z, Gershaw RS, Kellogg AR (2019) Burnout, drop out, suicide: physician loss in emergency medicine, Part I. West J Emerg Med 20(3):485–494. https://doi.org/10.5811/westjem.2019.4.40970
Studer RK, Danuser B, Gomez P (2017) Physicians’ psychophysiological stress reaction in medical communication of bad news: A critical literature review. Int J Psychophysiol 120:14–22. https://doi.org/10.1016/j.ijpsycho.2017.06.006
Tomioka K, Morita N, Saeki K, Okamoto N, Kurumatani N (2011) Working hours, occupational stress and depression among physicians. Occup Med 61(3):163–170. https://doi.org/10.1093/occmed/kqr004
Tsutsumi A, Kawanami S, Horie S (2012) Effort-reward imbalance and depression among private practice physicians. Int Arch Occup Environ Health 85(2):153–161. https://doi.org/10.1007/s00420-011-0656-1
Ulrich L-R, Lemke D, Erler A, Dahlhaus A (2019a) Subjective and objective work stress among ophthalmologists in private practice in Thuringia : results of a state-wide survey. Der Ophthalmol Z Dtsch Ophthalmol Ges 116(7):647–655. https://doi.org/10.1007/s00347-018-0802-1
Ulrich L-R, Lemke D, Erler A, Müller BS, Gerlach FM, Dahlhaus A (2019b) Work Stress among Family Physicians in two Thuringian Districts [Arbeitsbelastung niedergelassener Hausärztinnen und Hausärzte in zwei thüringischen Landkreisen]. ZFA 03(945):112–112
Van Nguyen H, Le Dinh M, Van Nguyen T, Nguyen Ngoc D, Ngoc TTA, Nguyen The, P (2018) A systematic review of effort-reward imbalance among health workers. Int J Health Plann Manage. https://doi.org/10.1002/hpm.2541
Voltmer E, Rosta J, Siegrist J, Aasland OG (2012) Job stress and job satisfaction of physicians in private practice: comparison of German and Norwegian physicians. Int Arch Occup Environ Health 85(7):819–828. https://doi.org/10.1007/s00420-011-0725-5
von dem Knesebeck O, Klein J, Frie KG, Blum K, Siegrist J (2010) Psychosocial stress among hospital doctors in surgical fields. Dtsch Aerzteblatt Online. https://doi.org/10.3238/arztebl.2010.0248
von Hippel PT (2015) The heterogeneity statistic I2 can be biased in small meta-analyses. BMC Med Res Methodol. https://doi.org/10.1186/s12874-015-0024-z
Wang Z, Xie Z, Dai J, Zhang L, Huang Y, Chen B (2014) Physician burnout and its associated factors: a cross-sectional study in Shanghai. J Occup Health 56(1):73–83. https://doi.org/10.1539/joh.13-0108-OA
Weigl M, Schneider A, Hoffmann F, Angerer P (2015) Work stress, burnout, and perceived quality of care: a cross-sectional study among hospital pediatricians. Eur J Pediatr 174(9):1237–1246. https://doi.org/10.1007/s00431-015-2529-1
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Le Huu, P., Bellagamba, G., Bouhadfane, M. et al. Meta-analysis of effort–reward imbalance prevalence among physicians. Int Arch Occup Environ Health 95, 559–571 (2022). https://doi.org/10.1007/s00420-021-01784-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00420-021-01784-x