Excessive working hours and health complaints among hospital physicians: a study based on a national sample of hospital physicians in GermanyArbeitszeitbelastung und körperliche Beschwerden: bundesweite Erhebung bei Krankenhausärzten und -ärztinnen im Herbst 2006

GMS German Medical Science — an Interdisciplinary Journal

Andreas Gerber²  Judith Rosta¹ 

[1]Federal Institute for Population Research, Wiesbaden, Germany

[2]Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Cologne, Germany

关键词: Germany;    hospital physicians;    health complaints;    working hours;   

Others  :  869050

实施日期：2007-10-01，发布日期：2007-11-29

【 摘 要 】

Objectives: To determine correlations between excessively long working hours and subjectively experienced somatic health complaints among hospital physicians.

Methods: Quantitative data were collected as part of the survey “Working life, Lifestyle and Health of Hospital Physicians in Germany 2006” using self-reporting questionnaires. The individually experienced health was assessed on the basis of Zerssen’s [1] list of somatic complaints. The indicator of excessively long working hours was defined as 10 or more working hours per working day and 6 or more on-call shifts a month among full-time employees. The net sample consisted of 3295 randomly selected physicians from 515 hospitals.

Results: The response rate was 58% (n=1917). Physicians with excessively long working hours (19%) had significantly higher sum score of health complaints (p=0.0001) and significantly increased mental and physical fatigue symptoms (feeling faint, languor, uneasiness, heavy legs, excessive need for sleep, trembling; p=0.0001 to 0.047), mood changes (irritability, brooding; p=0.008 to 0.014), gastrointestinal (nausea, loss of weight; p=0.0001 to 0.014) and heart disorders (lumpy sensation in the throat, chest pain; p=0.0001 to 0.042). When the sum score of health complaints was controlled for selected confounders, being female (B=-3.44, p=0.0001) and having excessively long working hours (B=2.76, p=0.0001) were significantly correlated with health complaints. In a separate gender analysis, being exposed to excessively long working hours remained a significant predictor for health complaints among both females (B=3.78, p=0.001) and males (B=2.28, p=0.004).

Conclusions: Excessively long working hours are associated with an increased risk of health complaints. Reducing working hours may be the first step to improving physicians' health.

【 授权许可】

   
© 2007 Rosta et al.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

【 参考文献 】

• [1]von Zerssen D. Die Beschwerden-Liste. Weinheim: Beltz; 1976.
• [2]Josefson D. New York's junior doctors work illegally long hours. BMJ. 1998;316:1625.
• [3]Brettingham M. Trusts should cut workload of senior physicians to retain them. BMJ. 2005;331:798.
• [4]Marburger Bund. Pressemitteilung Nr. 29/05: Nationaler Protesttag der Krankenhausärzte am 5. August 2005 in Berlin. Berlin; 2005. Available from: http://www.marburger-bund.de/marburgerbund/bundesverband/presse/pressemitteilungen/pm2005/pm29_05.php [1. December 2006]. 
• [5]Gesundheitswissenschaften: Von Ärzteüberhang keine Spur. (Projekt "Befragung zur Teilzeitarbeit und Arbeitszeitrealität bei im Krankenhaus beschäftigten Ärztinnen und Ärzten in Berlin", Daniel Sagebiel.) Forschung aktuell, Wissenschaftsdienst der TU Berlin. 2002;3(1). Available from: http://www2.tu-berlin.de/presse/wissenschaftsdienst/02sep/aerzte.htm 
• [6]Kühn H, Klinke S, Kaiser R. Empirische Untersuchungen zu Arbeitsbedingungen und Versorgungsqualität im Krankenhaus unter DRG-Bedingungen. Erste Teilergebnisse zur Arbeitszeit von Krankenhausärztinnen und -ärzten. Hess Ärztebl. 2005;11:742-4.
• [7]Bornschein S, Erbas B, Borelli S, Emminger C, Hesse J, Pilz J, Schwarzkopf-Steinhauser G, Wenzl H, Kunze D, Borelli C. Arbeitszeit und Arbeitszufriedenheit angestellter und beamteter Ärzte in München. Ergebnisse einer anonymen Befragung. Gesundheitswesen. 2006;68(8-9):535-44.
• [8]Rosta J. Arbeitszeit der Krankenhausärzte in Deutschland. Erste Ergebnisse einer bundesweiten Erhebung im Herbst 2006. Dtsch Ärztebl. 2007;36:2417-23.
• [9]Reuters. European Parliament backs limits on physicians work hours. November 17, 1999.
• [10]Council Directive 93/104/EC of 23 November 1993 concerning certain aspects of the organization of working time. Official Journal of the European Community. 1993;307:18-24.
• [11]Nachreiner F, Radiker B, Janssen D, Schomann C. Untersuchungen zum Zusammenhang zwischen der Dauer der Arbeitszeit und gesundheitlichen Beeinträchtigungen. Ergebnisse einer Machbarkeitsstudie. Oldenburg: Gesellschaft für Arbeits-, Wirtschafts- und Organisationspsychologische Forschung e.V.; 2005.
• [12]Spurgeon A, Harrington JM, Cooper CL. Health and safety problems associated with long working hours: a review of the current position. Occup Environ Med. 1997;54(6):367-75.
• [13]Caruso CC, Hitchcock EM, Dick RB, Russo JM, Schmit JM. Overtime and Extended Work Shifts: Recent Findings on Illnesses, Injuries, and Health Behaviors. U. S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. Publication No. 2004-143. NIOSH; 2004.
• [14]Johnson JV, Lipscomb J. Long working hours, occupational health and the changing nature of work organization. Am J Ind Med. 2006;49(11):921-9.
• [15]Scott AJ. Shift work and health. Prim Care. 2000;27(4):1057-79.
• [16]van der Hulst M. Long workhours and health. Scand J Work Environ Health. 2003;29(3):171-88.
• [17]Grosch JW, Caruso CC, Rosa RR, Sauter SL. Long hours of work in the U.S.: associations with demographic and organizational characteristics, psychosocial working conditions, and health. Am J Ind Med. 2006;49(11):943-52.
• [18]Sokejima S, Kagamimori S. Working hours as a risk factor for acute myocardial infarction in Japan: case-control study. BMJ. 1998;317(7161):775-80.
• [19]Kawakami N, Araki S, Takatsuka N, Shimizu H, Ishibashi H. Overtime, psychosocial working conditions, and occurrence of non-insulin dependent diabetes mellitus in Japanese men. J Epidemiol Community Health. 1999;53(6):359-63.
• [20]Trinkoff AM, Storr CL. Work schedule characteristics and substance use in nurses. Am J Ind Med. 1998;34(3):266-71.
• [21]Shields M. Long working hours and health. Health Rep. 1999;11(2):33-48.
• [22]Nylen L, Voss M, Floderus B. Mortality among women and men relative to unemployment, part time work, overtime work, and extra work: a study based on data from the Swedish twin registry. Occup Environ Med. 2001;58(1):52-7.
• [23]Samkoff JS, Jacques CH. A review of studies concerning effects of sleep deprivation and fatigue on residents' performance. Acad Med. 1991;66(11):687-93.
• [24]Defoe DM, Power ML, Holzman GB, Carpentieri A, Schulkin J. Long hours and little sleep: work schedules of residents in obstetrics and gynecology. Obstet Gynecol. 2001;97(6):1015-8.
• [25]Rosen IM, Bellini LM, Shea JA. Sleep behaviors and attitudes among internal medicine housestaff in a U.S. university-based residency program. Acad Med. 2004;79(25):407-16.
• [26]Baldwin DC Jr, Daugherty SR. Sleep deprivation and fatigue in residency training: results of a national survey of first- and second-year residents. Sleep. 2004;27(2):217-23.
• [27]Leung L, Becker CE. Sleep deprivation and house staff performance: Update 1984-1991. J Occup Med. 1992;34(12):1153-60.
• [28]Howard SK, Gaba DM, Smith BE, Weinger MB, Herndon C, Keshavacharya S, Rosekind MR. Simulation study of rested versus sleep-deprived anesthesiologists. Anesthesiology. 2003;98(6):1345-55.
• [29]Schattner P, Davidson S, Serry N. Doctors' health and wellbeing: taking up the challenge in Australia. MJA. 2004;181(7):348-9.
• [30]Fletcher KE, Underwood W 3rd, Davis SQ, Mangrulkar RS, McMahon LF Jr, Saint S. Effects of work hour reduction on residents' lives: a systematic review. JAMA. 2005;294(9):1088-100.
• [31]Medical Council Ireland. First National Conference of the health of Doctors consensus statement. 16 February 2005. Available from: http://www.medicalcouncil.ie/about/consensus.asp [22. November 2006]. 
• [32]Landrigan CP, Rothschild JM, Cronin JW, Kaushal R, Burdick E, Katz JT, Lilly CM, Stone PH, Lockley SW, Bates DW, Czeisler CA. Effect of reducing interns' work hours on serious medical errors in intensive care units. N Engl J Med. 2004;351(18):1838-48.
• [33]Lehrl S, Kinzel W, Fischer B, Weidenhammer W, Hrsg. Psychiatrische und medizinpsychologische Messverfahren des deutschsprachigen Raumes. Ebersberg: Vless Verlag; 1986.
• [34]European Foundation for the Improvement of Living and Working Conditions. Fourth European Working Conditions Survey. 2005. Available from: http://www.eurofound.eu.int/pubdocs/2006/78/en/1/ef0678en.pdf [15. November 2006]. 
• [35]SPSS Inc. SPSS Version 13. Chicago, IL, USA; 2006.
• [36]Krings A. Theorie und Empirie unterschiedlich langer Arbeitstage am Beispiel von Schicht- und Teilzeitarbeit. Dissertation, Universität Köln; 1999. (Presse-Information 10/2001 der Universität Köln. Available from: http://www.uni-koeln.de/pi/i/2001.010.htm)
• [37]Knaupp P. Die Zwölf-Stunden-Schicht. Eschborn: Rationalisierungs-Kuratorium der Deutschen Wirtschaft e.V.; 1983.
• [38]Akerstedt T. Sleepiness at work: effects of irregular work hours. In: Monk TH, ed. Sleep, sleepiness and performance. New York: John Wiley; 1991. p. 129-52.
• [39]Bhananker SM, Cullen BF. Resident work hours. Curr Opin Anaesthesiol. 2003;16(6):603-9.
• [40]Barden CB, Specht MC, McCarter MD, Daly JM, Fahey TJ 3rd. Effects of limited work hours on surgical training. J Am Coll Surg. 2002;195(4):531-8.
• [41]Caruso CC, Bushnell T, Eggerth D, Heitmann A, Kojola B, Newman K, Rosa RR, Sauter SL, Vila B. Long working hours, safety, and health: toward a National Research Agenda. Am J Ind Med. 2006;49(11):930-42.
• [42]Franke WD, Cox DF, Schultz DP, Anderson DF. Coronary heart disease risk factors in employees of Iowa's Department of Public Safety compared to a cohort of the general population. Am J Ind Med. 1997;31(6):733-7.
• [43]Rüdiger HW. Schicht- und Nachtarbeit aus Sicht der Arbeitsmedizin. Dtsch Med Wochenschr. 2006;131:2451-2.
• [44]Kroenke K, Spitzer RL. Gender differences in the reporting of physical and somatoform symptoms. Psychosom Med. 1998;60(2):150-5.
• [45]Haug TT, Mykletun A, Dahl AA. The association between anxiety, depression, and somatic symptoms in a large population: the HUNT-II study. Psychosom Med. 2004;66(6):845-51.
• [46]Scicchitano J, Lovell P, Pearce R, Marley J, Pilowsky I. Illness behavior and somatization in general practice. J Psychosom Res. 1996;41(3):247-54.
• [47]Aasland OG, Olff M, Falkum E, Schweder T, Ursin H. Health complaints and job stress in Norwegian physicians: the use of an overlapping questionnaire design. Soc Sci Med. 1997;45(11):1615-29.
• [48]Lewis JM, Barnhart FD, Howard BL, Carson DI, Nace EP. Work stress in the lives of physicians. Tex Med. 1993;89(2):62-7.
• [49]Firth-Cozens J, Moss F. Hours, sleep, teamwork, and stress. BMJ. 1998;317(7169):1335-6.
• [50]Wall TD, Bolden RI, Borrill CS, Carter AJ, Golya DA, Hardy GE, Haynes CE, Rick JE, Shapiro DA, West MA. Minor psychiatric disorder in NHS trust staff: occupational and gender differences. Br J Psychiatry. 1997;171:519-23.
• [51]Baldwin DC Jr, Daugherty SR, Tsai R, Scotti MJ Jr. A national survey of residents' self-reported work hours: thinking beyond specialty. Acad Med. 2003;78(11):1154-63.
• [52]Kinzl JF, Traweger C, Biebl W, Lederer W. Burnout und Belastungsstörungen bei Intensivmedizinern. Dtsch Med Wochenschr. 2006;131(44):2461-4.
• [53]Richardsen AM, Burke RJ. Occupational stress and job satisfaction among physicians: sex differences. Soc Sci Med. 1991;33(10):1179-87.
• [54]Hartwig B, Nichols A. GP health and well-being: the issues explored. Brisbane: Brisbane North Division of general Praxis; 2000.
• [55]Cherniss C. Job Stress in the Human Services. Beverly Hills: Sage Publications; 1980.
• [56]Faust V. Seelische Störungen heute. München: CH Beck; 1999.
• [57]Martini S, Arfken CL, Balon R. Comparison of burnout among medical residents before and after the implementation of work hours limits. Acad Psychiatry. 2006;30(4):352-5.
• [58]Keeton K, Fenner DE, Johnson TR, Hayward RA. Predictors of physician career satisfaction, work-life balance, and burnout. Obstet Gynecol. 2007;109(4):949-55.
• [59]Gopal R, Glasheen JJ, Miyoshi TJ, Prochazka AV. Burnout and internal medicine resident work-hour restrictions. Arch Intern Med. 2005;165(22):2595-600.
• [60]Marburger Bund. Pressemitteilung: Keine Änderung der Arbeitszeitrichtlinie. Marburger Bund unterstützt Bundesarbeitsminister Müntefering. 2007. Available from: http://www.marburger-bund.de/marburgerbund/bundesverband/presse/pressemitteilungen/pm2007/pm03_07.php [19. Januar 2007]. 
• [61]Pressemitteilung: Bereitschaftsdienste gelten häufig noch nicht als Arbeitszeit. Available from: http://www.aerzteblatt-studieren.de/doc.asp?docId=104761. 
• [62]EU-Arbeitszeitrichtlinie: Einigung erneut gescheitert. Dtsch Ärztebl. 2006;103:3064.
• [63]Sindicato de Médicos de Asistencia Pública (Simap) v Conselleria de Sanidad y Consumo de la Generalidad Valenciana - Judgment of the Court of 3 October 2000. Case C-303/98. Available from: http://eur-lex.europa.eu/smartapi/cgi/sga_doc?smartapi!celexplus!prod!CELEXnumdoc&lg=en&numdoc=61998J0303. 
• [64]Jaeger, Norbert v. Landeshauptstadt Kiel - Judgment of the Court of 9 September 2003. Case C-151/02. Available from: http://curia.europa.eu/jurisp/cgi-bin/gettext.pl?lang=en&num=79969090C19020151&doc=T&ouvert=T&seance=ARRET&where=() [15. November 2005]. 
• [65]Deutsche Krankenhausgesellschaft. Pressemitteilung: DKG zum Abbau von Arbeitsplätzen im stationären Sektor. Baum: Sanierungsbeitrag streichen - Arbeitszeitgesetz ändern. 9.1.2007. Available from: http://www.dkgev.de/dkgev.php/cat/35/aid/2237/title/DKG+zum+Abbau+von+Arbeitspl%E4tzen+im+station%E4ren+Sektor [19. Januar 2007]. 
• [66]Conigliaro J, Frishman WH, Lazar EJ, Croen L. Internal medicine housestaff and attending physician perceptions of the impact of the New York State Section 405 regulations on working conditions and supervision of residents in two training programs. J Gen Intern Med. 1993;8:502-7.
• [67]Basu CB, Chen LM, Hollier LH Jr, Shenaq SM. The effect of the Accreditation Council for Graduate Medical Education Duty Hours Policy on plastic surgery resident education and patient care: an outcomes study. Plast Reconstr Surg. 2004;114(7):1878-86.
• [68]Chung R, Ahmed N, Chen P. Meeting the 80-hour work week requirement: what did we cut? Curr Surg. 2004;61(6):609-11.
• [69]Pittner PM Peter JH, Wehr M. Der Zusammenhang von arbeitsbezogenen Belastungsaspekten mit psychosomatischen Beschwerden, Befindlichkeiten und der Arbeitszufriedenheit bei Assistenzärzten in medizinischen Abteilungen von Universitätskrankenhäusern. Zeitschrift für Arbeitswissenschaft. 1984;38(4):227-34.
• [70]Stengel M. Zur Situation von Krankenhausärzten im Spannungsfeld von Arbeit und Freizeit. Zeitschrift für Arbeitswissenschaft. 1991;45:28-35.
• [71]Kaiser R, Kortmann A. Arbeitszeit hessischer A.i.P., Assistenten und Oberärzte. Hess Ärztebl. 2002;2:71-3.
• [72]Bestmann B, Rohde V, Wellmann, Küchler Th. Berufsreport 2003: Geschlechterunterschiede im Beruf. Dtsch Ärztebl. 2004;101:776-9.
• [73]Lockley SW, Cronin JW, Evans EE, Cade BE, Lee CJ, Landrigan CP, Rothschild JM, Katz JT, Lilly CM, Stone PH, Aeschbach D, Czeisler CA; Harvard Work Hours, Health and Safety Group. Effect of reducing interns' weekly work hours on sleep and attentional failures. N Engl J Med. 2004;351(18):1829-37.
• [74]Leifman H, Österberg E, Ramstedt M. Alcohol in Postwar Europe, ECAS II. A discussion of indicators on alcohol consumption and alcohol-related harm. European Comparative Alcohol Study - ECAS. Final report. Stockholm: Edita Ljunglöfs, 2002. Available from: http://www.eurocare.org/btg/policyeu/pdfs/2002-ecasreportII.pdf [24.6.2007]. 
• [75]Coyne JC, Rohrbaugh MJ, Shoham V, Sonnega JS, Nicklas JM, Cranford JA. Prognostic importance of marital quality for survival of congestive heart failure. Am J Cardiol. 2001;88(5):526-9.
• [76]Wood W, Rhodes N, Whelan M. Sex differences in positive well-being: A consideration of emotional style and marital status. Psychological Bulletin. 1989;106(2):249-64.
• [77]Mikulincer M, Shaver PR, Pereg D. Attachment theory and affect regulation: The dynamics, development, and cognitive consequences of attachment-related strategies. Motiv Emot. 2003;27(2):77-102.
• [78]Gensch K, Waltenberger M. Entwicklung der ärztlichen Versorgung in Bayern unter Berücksichtigung des steigenden Anteils an Ärztinnen. München: Bayerisches Staatsinstitut für Hochschulforschung und Hochschulplanung; 2006.
• [79]Kopetsch Th. Ärztestatistik. Berufsanfänger: Mehr als die Hälfte sind Ärztinnen. Dtsch Ärztebl. 2007;104(11):698-704.
• [80]Simmgen M. Why German doctors enjoy British medicine. Clin Med. 2004;4(1):57-9.