Psychosocial challenges facing physicians of today

Fundamental changes in the organization, financing, and delivery of health care have added new stressors or opportunities to the medical profession. T hese new potential stressors are in addition to previously recognized exter nal and internal ones. The work environment of physicians poses both psycho social, ergonomic, and physico-chemical threats. The psychosocial work envi ronment has, if anything, worsened. Demands at work increase at the same ti me as influence over one's work and intellectual stimulation from work decr ease. In addition, Violence and the threat of violence is anoher major occu pational health problem physicians increasingly face. Financial constraint, managed care and consumerism in health care are other factors that fundame ntally change the role of physicians. The rapid deployment of new informati on technologies will also change the role of the physician towards being mo re of an advisor and information provider. Many of the minor health problem s will increasingly be managed by patients themselves and by non-physician professionals and practitioners of complementary medicine. Finally, the eco nomic and social status of physicians are challenged which is reflected in a slower salary increase compared to many other professional groups. The pi cture painted above may be seen as uniformly gloomy. In reality, that is no t the case. There is growing interest in and awareness of the importance of the psychosocial work environment for the delivery of high quality care. P hysicians under stress are more likely to treat patients poorly, both medic ally and psychologically. They are also more prone to make errors of judgme nt. Studies where physicians' work environment in entire hospitals has been assessed, results fed-back, and physicians and management have worked with focused improvement processes, have demonstrated measurable improvements i n the ratings of the psychosocial work environment. However, it becomes cle ar from such studies that quality of the leadership and the physician team impact on the overall work atmosphere. Physicians unaware of the gears of t he department as well as the hospital, that do not receive management perfo rmance feedback, and who do not get annual performance appraisals and caree r guidance, rate their psychosocial environment as more adverse than their colleagues. There is also a great need to offer personally targeted compete nce development plans. Heads of department and senior physicians rate their work environment as of higher quality than more junior and mid-career phys icians. More specifically, less senior physicians perceive similar work dem ands as their senior colleagues but rate influence over work, skills utiliz ation, and intellectual stimulation at work as significantly worse. In orde r to combat negative stressors in the physicians' work environment, enhance ment initiatives should be considered both at the individual, group, and st ructural level. Successful resources used by physicians to manage the stres s of everyday medicine should be identified.: Physicians are a key group to ensure a well-functioning health care system. In order to be able to chang e and adapt to the ongoing evolution of the Western health care system, mor e focus needs to be put on the psychosocial aspects of physicians' work. (C ) 2000 Elsevier Science Ltd. All nights reserved.