A measure of daily distress in practising medicine

Existing measures of stress either focus on burnout or frustration and fatigue factors, often referred to as job strain. The objectives of this study were to: establish a reliable measure of distress that is sensitive enough to identify job strain at lower levels of distress and risk of burnout at higher levels of distress; and document levels of distress among the major medical specialties and across varying patterns of clinical practice.

A stratified cross-sectional survey of physicians in Canada was conducted in 2004. Among the eligible population, 2810 physicians (56.7%) responded. Response bias was negligible. Responding physicians completed a 13-item measure of distress. Confirmatory factor analysis was used to establish the measure. Scheffe tests were used to document differences in the levels of distress among specializations and by clinical practice profile.

Factor analysis revealed reliable dimensions of: fatigue (alpha = 0.75) and reaction (alpha = 0.73). The distress measure was reliable (alpha = 0.82). Emergency physicians (n = 4.51), surgeons (n = 4.35), and general practitioners (n = 4.33) reported the highest levels of distress, while administrative physicians (n = 3.30), community health (n = 3.35), and clinical specialists (n = 3.46) reported the lowest levels of distress. Physicians with clinical and administrative responsibilities reported the highest levels of distress (n = 4.40), compared with purely clinical physicians (n = 3.94) and clinician-academics (n = 3.98).

Some specializations are associated with more distress than others. Administrative duties appear to add to distress for all physicians. Counterintuitively, adding academic as well as administrative responsibilities appears to add less distress than adding administrative duties alone. Academic duties are viewed as advancing medicine.