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

BACKGROUND: Job stress among GPs is an issue of growing concern. AIM: To investigate whether the structural and organisational features of GPs’ practices were associated with job stress in 11 countries. DESIGN AND SETTING: 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. METHOD: 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. RESULTS: 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. CONCLUSION: 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.