Physician stress: Results from the physician worklife study

Rapid changes in the US health care system may predispose to physician stress. This can impair patient interactions, diminish productivity, and lead to turnover in physician practices. A model with 'therapeutic implications' for prevention of stress would be beneficial. The US Physician Worklife Study is a stratified random survey of 5704 primary care and subspeciality physicians (2326 respondents, adjusted response rate 52 per cent). We assessed the contribution of the demand-control-support model to better understanding stress in these physicians. Potential predictors included gender, age, case mix, time pressure in patient visits, workload, practice type, specialty, work control, isolation, and support for balancing work and home. A 4-item stress scale was adapted from Cohen et al.; Cronbach's alpha in the current sample was 0.75. Linear regression was used to assess the relationship between stress and potential predictors. Mean stress scores were 2.4 (potential range 1-5, 22 percent scored 3 or higher.) Job demands such as solo practice (p<0.05), work hours (p<0.001), time pressure (p<0.05) and case mix (p<0.05) predicted stress, as did less control of the workplace (p<0.001) and 'hassles' (p<0.05). Lack of support by colleagues for balancing work and home (p<0.001) and isolation (p<0.01) also contributed to stress. Physician stress is worsened by work demands such as complex patients and time pressure in patient visits. Adjusting for and modifying these aspects of daily practice and providing more control over work, a more person-centred work environment and more support for balancing work and home life will likely bring less stress to doctors and better care to their patients.