Junior house officers have traditionally been the most distressed doctors in the health service.1 Recently, however, there have been reports of significant psychological morbidity in senior doctors such as hospital consultants.2 Previous studies found that levels of distress decrease with increasing medical seniority.3 Much of the organisational burden of recent hospital reform has fallen on consultants, while junior doctors continue to have their hours of work reduced. We investigated whether these changes had affected the relation between medical seniority, psychological morbidity, and job satisfaction.
Subjects, methods, and results
We carried out two postal surveys. Questionnaires were sent to all hospital consultants in five UK teaching hospitals as part of the NHS workforce survey.4 Questionnaires were also sent to all preregistration medical house officers working in two teaching hospitals in 1995 and 1996. Follow up questionnaires were sent to non-responders, and the house officers also received telephone reminders. We used the 12 item version of the general health questionnaire as a measure of psychological distress.5 This can be scored 0-12, a score of 4 or more identifying a probable case of minor psychiatric disorder such as anxiety or depression.2 Each item can also be rated on a three point Likert scale giving a potential score of 0-36, with higher scores representing greater distress. The questionnaire also included validated Likert measures of job satisfaction, work demands, and job autonomy.4
The response rate was 60% (267/445) for consultants and 96% (89/93) for house officers. There was no difference in response rates by specialty or hospital. The consultants were older than the house officers (mean age (SD) 45 (7.8) versus 25.6 (3) years) and a greater proportion were men (77% (206/267) versus 57% (51/89) women). The table shows the consultants and house officers’ scores for various measures; 25% (66/267) of consultants and 19% (17/89) of house officers scored as cases of psychiatric disorder. For consultants, general health questionnaire scores were most strongly correlated with scores on the work demands scale (Pearsons +0.42, P<0.001). For house officers, the scores were most strongly correlated with scores on the job autonomy scale (Pearsons −0.48, P<0.001).
Comment
In our study consultants had higher levels of psychological distress and suffered greater demands at work than the house officers. The house officers had lower overall job satisfaction and less job autonomy but were more satisfied with their hours of work.
Non-response among the consultants was a potential source of bias. However, previous studies with higher response rates have reported similar levels of distress.2 A study carried out as part of the NHS workforce survey found no difference in the levels of distress between responders and non-responders,4 suggesting that non-response was not systematically related to psychological health. Our results may not be generalisable to non-teaching hospitals and might be confounded by the fact that consultants and house officers were selected from different trusts. In fact, one hospital was a source of both consultants and house officers for this study, and the occupational group differences at this hospital remained significant.
Some of these data are three years old. The continued upheaval in the health service and further reductions in junior house doctors’ working hours mean that the differences in psychological distress between senior hospital doctors and their most junior colleagues may now be more pronounced. One approach to addressing this problem could be to tackle specific sources of occupational stress in different groups. For example, our results suggest consultants might benefit from a reduction in their workload, while house officers might benefit if they had greater autonomy.
Table.
Comparison of job satisfaction, work demands, job autonomy, and general health questionnaire scores for consultants and house officers. Scores on 16 items of job satisfaction are also listed. In all cases higher scores indicate more favourable outcomes except for 12 item version of general health questionnaire (GHQ) and work demands scale where higher scores indicate greater psychological morbidity and increased work demands respectively. Values are mean (SD) unless stated otherwise
| Variable (potential range) | Consultants* (n=267) | House officers (n=89) | Difference in means (95% CI) | P value for difference† |
|---|---|---|---|---|
| Job satisfaction: | ||||
| Job variety (1–7) | 5.8 (1.0) | 4.0 (1.4) | 1.8 (1.5 to 2.1) | <0.001 |
| Opportunity to use abilities (1–7) | 5.3 (1.3) | 4.0 (1.3) | 1.3 (1.0 to 1.6) | <0.001 |
| Amount of responsibility (1–7) | 5.8 (1.1) | 4.6 (1.2) | 1.2 (0.9 to 1.5) | <0.001 |
| Pay (1–7) | 4.8 (1.5) | 3.7 (1.5) | 1.1 (0.7 to 1.5) | <0.001 |
| Trust management (1–7) | 4.3 (1.2) | 3.2 (1.4) | 1.1 (0.8 to 1.4) | <0.001 |
| Management-worker relationships (1–7) | 4.1 (1.3) | 3.3 (1.3) | 0.8 (0.5 to 1.1) | <0.001 |
| Freedom to choose work method (1–7) | 5.3 (1.3) | 4.6 (1.0) | 0.7 (0.4 to 1.0) | <0.001 |
| In job training (1–7) | 4.2 (1.4) | 3.6 (1.5) | 0.6 (0.2 to 1.0) | 0.002 |
| Attention paid to suggestions (1–7) | 4.3 (1.3) | 4.0 (1.2) | 0.3 (−0.04 to 0.6) | 0.09 |
| Recognition for good work (1–7) | 4.3 (1.5) | 4.1 (1.3) | 0.2 (−0.1 to 0.5) | 0.35 |
| Fellow workers (1–7) | 5.5 (1.1) | 5.5 (1.0) | 0 (−0.2 to 0.2) | 0.93 |
| Job security (1–7) | 5.5 (1.1) | 5.6 (1.0) | −0.1 (−0.3 to 0.1) | 0.32 |
| Working conditions (1–7) | 4.2 (1.5) | 4.4 (1.3) | −0.2 (−0.55 to 0.15) | 0.22 |
| Chance of promotion (1–7) | 4.4 (1.4) | 4.7 (1.0) | −0.3 (−0.65 to 0.05) | 0.053 |
| Your immediate boss (1–7) | 4.9 (1.4) | 5.4 (1.2) | −0.5 (−0.8 to −0.2) | 0.001 |
| Hours of work (1–7) | 3.7 (1.6) | 4.2 (1.6) | −0.5 (−0.9 to −0.1) | 0.006 |
| Work demands (6–30) | 21.4 (6.0) | 14.9 (4.4) | 6.5 (5.2 to 7.8) | <0.001 |
| Total job satisfaction (16–112) | 74.4 (11.8) | 69.1 (10.2) | 5.3 (2.4 to 8.3) | <0.001 |
| Job autonomy (6–30) | 23.9 (4.5) | 19.0 (3.5) | 4.9 (3.8 to 6.0) | <0.001 |
| GHQ 12 score (0–36) | 12.1 (4.7) | 9.5 (4.5) | 2.6 (1.5 to 3.7) | 0.002 |
Consultants from different specialties considered together as no difference in GHQ scores or job satisfaction. †t test for independent samples.
Acknowledgments
We would like to thank the consultants and house officers.
Footnotes
Funding: The NHS workforce survey was funded under the mental health programme of the NHS executive (Northern and Yorkshire).
Conflict of interest: None.
References
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