Job stress among GPs: associations with practice organisation in 11 high-income countries

Job stress among GPs is an issue of growing concern.

To investigate whether the structural and organisational features of GPs' practices were associated with job stress in 11 countries.

Secondary analysis of the 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians, an international cross-sectional study. A total of 11 Western countries participated in the 2015 edition.

Random samples of practising GPs were drawn from government or private lists in each country (N = 12 049). Job stress was measured by the question: 'How stressful is your job as a GP?' (5-point Likert scale). Numerous practices' organisation and functioning characteristics were considered. Multilevel mixed-effects ordered logistic regression was performed.

The prevalence of job stress varied from 18% to 59% according to country. Job stress was higher among GPs aged 45-54 years (middle age) (odds ratio [OR] 1.35, 95% confidence interval [CI] = 1.07 to 1.70) and those practising in an urban area (OR 1.23, 95% CI = 1.15 to 1.31). It was also associated with a high weekly workload (OR 2.88, 95% CI = 2.38 to 3.50) if >50 hours/week workload, large administrative burden (OR 1.65, 95% CI = 1.44 to 1.89), long delays in receiving hospital discharge, poor possibilities in offering same-day appointments (OR 1.74, 95% CI = 1.18 to 2.56), and performance assessment (OR 1.15, 95% CI = 1.05 to 1.24). Finally, long consultations (OR 0.64, 95% CI = 0.53 to 0.76) and working with a case manager attached to the practice were associated with a lower job stress. The vast majority of results were consistent across the countries.

Heavy workloads and time pressure are clearly associated with GP job stress. However, organisational changes such as employing case managers and allowing longer consultations could potentially reduce this burden.