Psychiatrists Plagued by Job Stress

Deborah Brauser

June 17, 2014

Psychiatrists are a highly stressed group, owing in large part to their interaction with patients, new research suggests.

A survey of nearly 3000 physicians from Finland showed that psychiatrists were less satisfied with their jobs, had more psychological distress, and felt more patient-related stress compared with other medical specialists.

However, the study also showed that psychiatrists have a significantly better "team climate" and more opportunities to control what happens in their jobs than other specialists.

"It was not surprising that psychiatrists had higher levels of stress, but what surprised me a bit was that they also had higher levels of job resources," lead author Tarja Heponiemi, PhD, senior researcher at the National Institute for Health and Welfare in Helsinki, Finland, told Medscape Medical News.

"I think that for those who work in leadership positions and in management, it would be important to think about how it would be possible to alleviate psychiatrists' stress resulting from patient load," added Dr. Heponiemi.

The study was published in the June issue of Psychiatric Services.

Elevated Suicide Risk

The researchers note that many countries have a shortage of psychiatrists and that it is "the least desirable specialty" among medical students in the United Kingdom. The number of psychiatrists in Finland is also expected to decline.

Dr. Tarja Heponiemi

"Psychiatrists have been found to be dissatisfied more often with their medical career compared with other specialists or general practitioners. Moreover, psychiatrists have elevated suicide risk compared with other physicians," write the investigators.

According to the American Foundation for Suicide Prevention, between 300 and 400 physicians die by suicide every year in the United States, with the number of women completers equal to men. However, the organization does not segment suicide rates by medical specialty.

For the current study, the investigators drew a random sample of 7000 physicians from the Finnish Medical Association database. They then sent emailed invitations to the physicians in the sample to participate in an online survey.

The final sample of responders consisted of 2776 physicians (59% women) between the ages of 25 and 69 years (mean age, 49.2 years).

The survey included questions about medical specialty, job satisfaction, overall optimism, psychological stress, stress factors, such as time issues, patient-related stress, and work interference with family life, and job resources, including the level of teamwork and cooperation.

Four items from the General Health Questionnaire were used to measure psychological distress.

A total of 11% of the participants were psychiatrists.

Patient-Related Stress

Results showed that the psychiatrists had significantly higher levels of psychological distress (P = .02) and patient-related stress (P < .001) and lower levels of job satisfaction (P = .002) than did the other participants.

"Our results highlight the strenuousness of working with anxious, restless, and disruptively behaving patients," write the investigators.

"Some research suggests that psychiatrists view aggressiveness among patients as the factor that causes them the most stress. Because of the nature of their work, psychiatrists are exposed to patients who have difficult and often violent behaviors," they add.

Interestingly, the study's psychiatrists also reported higher levels of job control (P = .001) and team climate (P = .02) compared with other medical specialists.

There were no significant between-group differences in work interference with family, time pressure, or overall optimism.

Although adjusting for time pressure and patient-related stress alleviated the significance of an association between specialty and psychological distress, the association with job satisfaction remained significant (P < .001).

Overall, "it is important to try to alleviate the high levels of patient-related stress among psychiatrists and to further increase their job resources," write the researchers. "Doing so may enhance the attractiveness of psychiatry as a specialty choice."

They add that generalizing the study results to psychiatrists throughout the world should be done with caution because workloads often differ by country.

"However, it seems that the weekly work hours of Finnish psychiatrists correspond quite well to those of psychiatrists in the United States, for example."

Dr. Heponiemi reported that the investigators will continue to look into these issues.

"Our research group's next step is to examine physicians' stress coming from on-call duties and how different on-call arrangements and schedules can affect [that], such as sleeping problems and cognitive load," she said.

Growing Pressure

Dauda Griffin, MD, medical director of Laurel Heights Hospital in Atlanta, Georgia, told Medscape Medical News that the overall findings were not surprising.

"A lot of what we deal with is people who are in emotional, and sometimes physical, pain. When you deal with that day in and day out, unless you're very diligent about putting ways to protect yourself in place, it's easy to take on or absorb some of that," said Dr. Griffin, who is also a current member of the American Psychiatric Association's Council on Children, Adolescents, and their Families.

"I also think it is stressful for reasons that might not be so obvious, which include pressures to spend less time with patients and to see more patients in the day in order to meet financial goals," he said.

Dr. Griffin noted that receiving more input from outside sources, such as insurance companies, in terms of treatment also contributes to a psychiatrist's stress level. "There's more time doing paperwork and going through lots of red tape."

He added that he was also not surprised by the previously reported statistics concerning physician suicides.

"It's expensive to become a physician. So when you get out, you have a lot of pressure to work to be able to offset that debt. And there's just lots of pressure to produce, given cuts in reimbursement for what we do," said Dr. Griffin.

He also noted that some stress might be affected by generational factors and that the field of psychiatry, "at least in the Americas," is maturing.

"I think the older generation had the idea that you work until the job gets done. And your identity is tied to what you do. But I think younger generations have more of a focus on work-life balance," he said.

"Both of those ideologies have pluses and minuses. But as a culture, I think we're trying to figure out what a good work-life balance is in the workplace," said Dr. Griffin.

Dr. Griffin noted that having such a large need for more psychiatrists also contributes to stress.

"Psychiatrists are getting older, and as they approach retirement, there's going to be an even greater reduction in the workforce," he said.

"And what you're finding now is that you are really, really busy because there are fewer of us out in communities, particularly in rural areas. That means that patients we see are sicker because they don't have as wide access as we'd like," said Dr. Griffin.

"As a relatively young psychiatrist, I certainly have job security. But the job itself is becoming more difficult."

The study authors report no relevant financial relationships.

Psychiatr Serv. 2014;65:796-801. Abstract


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