Stress from uncertainty from graduation to retirement--a population-based study of Swiss physicians

Abstract

Background: Uncertainty shapes many decisions made by physicians everyday. Uncertainty and physicians' inability to handle it may result in substandard care and unexplained variations in patterns of care.

Objective: To describe socio-demographic and professional characteristics of reactions to uncertainty among physicians from all specialties, including physicians in training.

Design: Cross-sectional postal survey.

Participant: All physicians practicing in Geneva, Switzerland (n = 1,994).

Measurement: Reaction to medical care uncertainty was measured with the Anxiety Due to Uncertainty and Concern About Bad Outcomes scales. The questionnaire also included items about professional characteristics and work-related satisfaction scales.

Results: After the first mailing and two reminders, 1,184 physicians responded to the survey. In univariate analysis, women, junior physicians, surgical specialists, generalist physicians, and physicians with lower workloads had higher scores in both scales. In multivariate models, sex, medical specialty, and workload remained significantly associated with both scales, whereas clinical experience remained associated only with concern about bad outcomes. Higher levels of anxiety due to uncertainty were associated with lower scores of work-related satisfaction, while higher levels of concern about bad outcomes were associated with lower satisfaction scores for patient care, personal rewards, professional relations, and general satisfaction, but not for work-related burden or satisfaction with income-prestige. The negative effect of anxiety due to uncertainty on work-related satisfaction was more important for physicians in training.

Conclusion: Physicians' reactions to uncertainty in medical care were associated with several dimensions of work-related satisfaction. Physicians in training experienced the greatest impact of anxiety due to uncertainty on their work-related satisfaction. Incorporating strategies to deal with uncertainty into residency training may be useful.

Figure 1

Relationship between work-related satisfaction and reactions to uncertainty scores for three different levels of clinical experience among 1,184 doctors in Geneva, Switzerland (light gray solid line: community-based doctors, black dotted line: hospital-based senior doctors, gray broken line: hospital-based doctors in training). Lines represent nonparametric regression estimates (LOWESS).