Work-related stress in specialists in occupational health in Croatia: a pilot study

The survey was conducted in 2018 and included 70 SOHs, who were divided in three groups according to the type of organisation in which they work. Eleven were employed in public institutions, 13 in community healthcare centres (HC), 21 in private outpatient clinics that provide healthcare services either under lease at HCs or polyclinics or in their private facilities, and 25 provided no information as to their current employment organisation. All respondents signed a consent for anonymous participation.

Psychosocial risks at work were assessed through 11 key aspects (stressors containing five items each) using the questionnaire designed by the Croatian Institute of Public Health – Department of Occupational Health in 2016 (4) . Scores of each aspect can range between 5 and 25 points, and the score of 14 points and above indicates high stress for this aspect. The sum of all aspects can range between 55 and 275 points, with 135 points set as a threshold for high overall level of stress.

The results were analysed with the SPSS for Windows version 25 (SPSS Inc., Chicago, IL, USA) using descriptive statistics and analysis of variance (ANOVA). Statistical significance was set at p<0.05 (5).

The overall score of 119.7 points (±28.9; range: 38–175) of maximum 275 suggests that specialists in occupational health have a medium level of stress (Figure 1). Eighteen respondents reported a high level of stress (>135 points), five of whom worked in private outpatient clinics, three in healthcare centres, six in public institutions, while four did not specify their current organisation of employment.

Figure 1

Statistical analysis showed significant differences between the groups divided by organisational structure. With the overall average of 143 points SOHs employed in public institutions had a significantly higher risk of stress (p<0.05) than other SOHs. Pressure at work turned out to be the most prominent stressor and the only one that showed high stress for all SOHs (Table 1).

A more detailed analysis of stressors by groups is shown in Figure 2, while the significance of the stressor effect is reported in Table 1. For SOHs in public institutions, the highest-scoring stressors were pressure at work, overload, poor relationship with superiors (lack of communication and support), and advancement constraints.

Figure 2

Figure 3 reports the differences in stressor scores observed for SOHs employed in HC and those in private outpatient clinics. SOHs who worked in private outpatient clinics reported a significantly higher pressure at work but did not perceive their relationship with superiors as stressful. SOHs in HCs complained of work underload and advancement constraints. A detailed analysis of stressor items (Table 2) showed a significant difference between SOHs in private clinics and SOHs in HCs.

Figure 3

The last few years have seen a rising number of reports on work-related stress and burnout in physicians. (6, 7). Physician burnout in the United States has reached epidemic proportions with prevalence now exceeding 50 %, according to a review published in 2017 by Rothenberger (6). Work-related stress has been associated with different diseases in different medical specialties (8, 9, 10, 11, 12) and a number of stress relief methods have been studied to help them (13, 14, 15).

Our pilot study was focused on assessing work-related stress in physicians specialising in occupational medicine and sports, as there is little recent literature on the subject in Croatia. In a 2011 study (17) conducted among physicians working at the University Clinical Centre in Tuzla, Bosnia and Herzegovina, 37.4 % reported emotional exhaustion, while 50% reported low sense of accomplishment.

Our findings suggest that only 25% of SOHs showed higher levels of stress, which can be attributed to most of them working either alone or in smaller healthcare settings rather than in hospitals. A 2017 study (18) reported lower stress levels among physicians in public hospitals than in private clinics. Our study found the opposite; the highest levels of stress were reported by SOHs working in public institutions, while SOHs working in private clinics reported the lowest stress. We have also found that work satisfaction reported by SOHs employed in public institutions is highly associated with interpersonal relationships. An earlier report (19) suggests that conflicts with supervisors can lead to reduced resources and negative attitude towards work and that lowering work-related stress among physicians employed in public institutions greatly depends on effective conflict management.

Our assumption that different work organisation could significantly affect results was confirmed by a more detailed analysis of individual stressors at work by organisational subgroups. The pressure at work aspect revealed that the SOHs in private clinics complained of having to do a lot of paperwork, multitasking, and high impact of work on their private lives. SOHs in HCs complained that they could not push their ideas past superiors, could not communicate with them, could not predict their reactions, and did not get quality feedback from them (relationship with superiors aspect). They also reported too low responsibility at work (work underload aspect) and having to pretend that they were busy. As for the advancement constraints aspect, SOHs in HCs reported limited opportunity for promotion and pay raise, gender and age discrimination, no acknowledgement of their work, and no personal satisfaction with their work. In other words, HCs turned out to be the least demanding and therefore the least stimulating organisations. In contrast, private occupational health practices seem to provide best opportunity for improvement in work design, which is in line with earlier reports (19).

In conclusion, our pilot study gives a glimpse at work-related stress among occupational health physicians, which has poorly been investigated or documented in Croatia in recent time. Its findings may be of some value for SOHs engaged in training programmes as examiners and educators. The observed differences in stressors with regard to organisational structure call for further improvement of the questionnaire and for continued investigation that could give a better insight into the role of various stressors in work efficiency and satisfaction among SOHs.