The work and training situation for young physicians undergoing specialty training in gynecology and obstetrics in Germany: an assessment of the status quo

Abstract

Purpose: General conditions in the health-care system in Germany have changed dramatically in recent years. Factors affecting this include above all demographic change, rapid developments in diagnostic and therapeutic options, and the application of economic criteria to the health-care sector. This study aimed to establish the current status quo regarding conditions of work and training for young doctors in gynecology and obstetrics, analyze stress factors, and suggest potential improvements.

Methods: Between October 2015 and March 2016, a web-based survey was carried out among residents and members of the German Society for Gynecology and Obstetrics. The electronic questionnaire comprised 65 items on seven topics. Part of the survey included the short version of a validated model of professional gratification crises for analyzing psychosocial work-related stress.

Results: The analysis included a total of 391 complete datasets. Considerable negative findings in relation to psychosocial work pressure, time and organizational factors, quality of specialty training, and compatibility between work and family life and work and academic tasks were detected. A high level of psychosocial work pressure is associated with more frequent job changes, reduced working hours, poorer health among physicians, and a lower subjectively assessed quality of care.

Conclusions: Greater efforts are needed from all the participants involved in patient care to achieve high-quality training and working conditions that allow physicians to work in a healthy and effective way. These aspects are all prerequisites for sustainably maximizing the resource "physician" and for ensuring high-quality patient care.

Keywords: Gynecology and obstetrics; Medical specialty training; Psychosocial work pressure; Stress factors; Working conditions.

Fig. 1

A pessimistic assessment of the quality of care is associated with a high level of psychosocial work pressure. The association between subjectively perceived changes in the quality of care in recent years and the severity of psychosocial work pressure, expressed in terms of the effort–reward (ER) ratio (the options for “No, not at all” (n = 3) and “Don’t know” were excluded from the analysis); P < 0.001

Fig. 2

Correlation between satisfaction with medical specialty training and general job satisfaction and psychosocial work pressure. On the horizontal axis, the 391 respondents are shown in ascending order of satisfaction with their medical training (blue line, “very dissatisfied” = 1 and “very satisfied” = 5). A high level of satisfaction with the specialty training correlates positively with general job satisfaction (red balance line, Spearman’s rho 0.52, P < 0.001, “very dissatisfied” = 1 and “very satisfied” = 5), and correlates negatively with the extent of psychosocial work pressure (represented as the effort–reward ratio, green balance line, Spearman’s rho − 0.38, P < 0.001). ER effort–reward ratio

Fig. 3

Association between transparent allocation of operations and procedures in medical training with higher levels of satisfaction with the training and general job satisfaction, as well as lower psychosocial work pressure (effort–reward ratio). The diagram shows means for training and general job satisfaction (possible answers: “very dissatisfied” = 1 and “very satisfied” = 5; calculations were based on medians; see text for further explanations), P < 0.001 in each case. ER effort–reward ratio