{"id":44294,"date":"2019-03-26T11:25:28","date_gmt":"2019-03-26T10:25:28","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=44294"},"modified":"2019-03-26T13:49:58","modified_gmt":"2019-03-26T12:49:58","slug":"job-stressors-faced-by-german-surgeons-are-no-longer-acceptable","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2019\/03\/26\/job-stressors-faced-by-german-surgeons-are-no-longer-acceptable\/","title":{"rendered":"Job stressors faced by surgeons in Germany are no longer acceptable"},"content":{"rendered":"

Undiagnosed burnout and depression is widespread within surgical communities in developed countries. [1, 2] Adequate working conditions\u2014including appropriate workload, satisfactory workplace organisation, and sufficient illness recovery opportunity\u2014are crucial to ensuring the delivery of high quality care, but job stressors, insufficient resource, and the deteriorating mental health of surgeons in Germany are still going unnoticed. [3] Such adverse workplace conditions\u00a0are not only major risk factors for individual health impairment, but also contribute to error rates and medical malpractice; the situation is no longer acceptable.<\/p>\n

Time pressures and concentration requirements are task-inherent, irrespective of surgical discipline. [4] However, hierarchical positions and hospital settings play a part when it comes to goal uncertainty (when one is confronted with conflicting instructions or does not know how tasks can be accomplished) <\/span>and performance constraint (<\/span>when workplace organisation and equipment is inadequate). F<\/span>or example, surgeons at university hospitals, and<\/span>\u00a0<\/span>assistant physicians <\/span>(the term for surgeons in training in Germany)<\/span> across all hospital settings <\/span>demonstrate the highest burnout risks. [4]<\/span><\/p>\n

Assistant physicians\u00a0report high levels of goal uncertainty, performance constraint, and <\/span>emotional exhaustion (a core component of burnout)<\/span>, as well as low levels of job satisfaction and control.\u00a0<\/span><\/p>\n

Surgeons at larger medical centres (university hospitals, tertiary hospitals, etc) also experience high levels of goal uncertainty and performance constraint. Additionally, at larger centres there are fewer opportunities for psychological, social, and organisational support\u2014all of which are crucial to achieving work goals, reducing the physiological and psychological <\/span>impact of job stressors, and stimulating personal growth, learning, and development.\u00a0<\/span><\/p>\n

S<\/span>upportive colleagues and adequate supervisor feedback increase the likelihood of successfully achieving one’s work goals. [5] While we<\/span> would like to strongly encourage <\/span>all health care systems to <\/span>increase assistant physician <\/span>supervision time we are <\/span>sceptical about this <\/span>happening any time soon, especially<\/span> if economic pressures remain as high as they are currently.<\/span><\/p>\n

We can, however, start to a<\/span>ddress the burnout risk in German surgeons b<\/span>y minimising avoidable goal uncertainty and performance constraint. This will require concerted effort by everyone involved in the health care system; f<\/span>undamentally, the system level within healthcare needs a major redesign. [6]<\/span><\/p>\n

 <\/p>\n

\"\"<\/a>Marcel Kern<\/em><\/strong>\u00a0is a PhD candidate and research fellow in the Division of Work & Organizational Psychology at Goethe-University, Frankfurt.\u00a0<\/em>His research includes the positive and negative effects of job stressors and resources, occupational stress and well-being, emotion work and job analysis<\/em>.<\/em><\/p>\n

Competing interests:\u00a0<\/em><\/strong>None<\/em><\/p>\n

\u00a0<\/em><\/p>\n

\"\"<\/a>Alexander Buia<\/em><\/strong>\u00a0is a doctor of medicine at the Asklepios Klinik Langen Clinic for General, Visceral and Thoracic Surgery, Langen<\/em><\/p>\n

Competing interests:\u00a0<\/em><\/strong>None<\/em><\/p>\n

\u00a0<\/em><\/p>\n

 <\/p>\n

\"\"<\/a>Carolin Tonus<\/em><\/strong>\u00a0is a professor at the Asklepios Klinik St. Georg, Clinic for General and Visceral Surgery, Hamburg<\/em><\/p>\n

Competing interests:\u00a0<\/em><\/strong>None<\/em><\/p>\n

 <\/p>\n

 <\/p>\n

\"\"<\/a>Thomas Friedrich Weigel<\/em><\/strong>\u00a0is a doctor of medicine at the Heilig-Geist-Hospital, Clinic for General and Visceral Surgery, Bingen<\/em><\/p>\n

\u00a0<\/em>Competing interests:\u00a0<\/em><\/strong>None<\/em><\/p>\n

\u00a0<\/em><\/p>\n

 <\/p>\n

\"\"<\/a>Ronny Dittmar<\/em><\/strong> was a doctor at the Professional Association of German Surgeons, Berlin. He died on 26 February 2019.<\/em><\/p>\n

Competing interests:\u00a0<\/em><\/strong>None<\/em><\/p>\n

 <\/p>\n

 <\/p>\n

\"\"<\/a>Ernst Hanisch<\/em><\/strong>\u00a0is a professor at the Asklepios Klinik Langen Clinic for General, Visceral and Thoracic Surgery, Langen<\/em><\/p>\n

Competing interests:<\/em><\/strong>\u00a0<\/em>None<\/em><\/p>\n

\u00a0<\/sup><\/em><\/p>\n

 <\/p>\n

\"\"<\/a>Dieter Zapf<\/em><\/strong>\u00a0is a professor Work & Organizational Psychology at the Goethe-University, Frankfurt<\/em><\/p>\n

Competing interests:\u00a0<\/em><\/strong>None<\/em><\/p>\n

 <\/p>\n

 <\/p>\n

Credit for Ronny Dittmar’s photograph: R.Sablotny<\/p>\n

References<\/u><\/strong><\/p>\n

    \n
  1. DeCaporale-Ryan L, Sakran J V., Grant SB, Alseidi A, Rosenberg T, Goldberg RF, et al. The undiagnosed pandemic: Burnout and depression within the surgical community. Curr Probl Surg. 2017; 54:453-502<\/li>\n
  2. Wright AA, Katz IT. Beyond Burnout \u2014 Redesigning Care to Restore Meaning and Sanity for Physicians. N Engl J Med. 2018 Jan 25;378(4):309\u201311.<\/li>\n
  3. Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009; 374:1714-1721<\/li>\n
  4. Kern M, Buia A, Tonus C, Weigel TF, Dittmar R, Hanisch E, et al.Psychological stressors, resources and well-being of surgeons in Germany. A cross-sectional study. Chirurg. 2019;https:\/\/doi.org\/10.1007\/s00104-018-0780-5<\/a><\/li>\n
  5. Bakker AB, Demerouti E. The Job Demands\u2010Resources model: State of the art. J Manag Psychol. 2007 Apr 3;22(3):309\u201328.<\/li>\n
  6. Lemaire JB, Wallace JE. Burnout among doctors. BMJ. 2017 Jul 14;358:j3360.<\/li>\n<\/ol>\n

     <\/p>\n

    \n","protected":false},"excerpt":{"rendered":"

    Undiagnosed burnout and depression is widespread within surgical communities in developed countries. [1, 2] Adequate working conditions\u2014including appropriate workload, satisfactory workplace organisation, and sufficient illness recovery opportunity\u2014are crucial to ensuring […]<\/p>\n

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