[Stress at work among military doctors: a preliminary study].
OBJECTIVE
This preliminary study examined the sources of work stress in military physicians.


METHODS
Forty-eight medical doctors (24 military and 24 civilian) completed a questionnaire on stressors at the work place. The participation in the study was anonymous and voluntary. Out of 24 military physicians, 14 were military general practitioners (mean age 40.5, 14 female), and 10 were consultants of different specialties (mean age 43.5, 7 male and 3 female). Civilian physicians included 13 general practitioners working at primary health care system (mean age 37, 3 male and 10 female), and 11 consultants of different specialties working at out of hospital practice (average age 37, 6 male and 5 female). The questionnaire included items aiming to obtain demographic characteristics (sex, age, marital status, children, academic degree, clinical specialty, work place, average time in practice, average time at current position) and 37 items to determine occupational stressors. The stressors were related to work management, professional demands, interpersonal and patient-doctor relationship. Differences in recognizing work stressors between the groups of civilian and military physicians were statistically analyzed by using chi-squared-test.


RESULTS
The leading work stressors identified by military physicians were inadequate salary, being bypassed for promotion, inadequate continuous education, poor resources, poor communication with superiors, poor management, trouble with superiors, excessive paperwork, unpredictable situations, and 24-hour standby. Civilian physicians reported inadequate salary, poor resources, poor management, misinformed patients, lack of co-workers, lack of time, unpredictable situations, exposure to indictment, dealing with incurable patients and exposure to public criticism and judgment. In comparison with civilian physicians, military physicians significantly more frequently reported inadequate salary (p<0.01), being bypassed for promotion (p<0.005), poor communication with superiors (p<0.05) and inadequate continuing education (p<0.025). In the group of military physicians, military general practitioners identified more stressors with a higher frequency. Nine out of top ten stressors were reported by at least one half of military general practitioners. Poor communication with superiors (12/14), lack of appropriate continuing education (10/14) and trouble with superiors (9/14) were predominantly reported by military general practitioners.


CONCLUSIONS
Our preliminary study has suggested that military physicians, especially military general practitioners, recognize more stressors and at higher frequency than civilian physicians. The ten leading stressors reported by the two study groups differed, however, both groups reported inadequate salary, poor resources, poor management and unpredictable situations among the first ten. Many studies tackling occupational stress in physicians, suggest that they are at risk of work stress. Several studies have found job stress to be a significant source of distress for military personnel during peacetime assignment. However, to our knowledge, no studies on work stress in military physicians have been published. Some of the most important stressors identified by our military physicians, such as poor resources, poor management, excessive paperwork, unpredictable situations and 24-hour standby are well known stressors the physicians are dealing with. Compared with studies on work stress in military personnel, our group more frequently reported inadequate salary, being bypassed to promotion, poor communication and trouble with their superiors.


CONCLUSIONS
Our preliminary results suggest that military physicians recognize different stressors and to a greater extent than civilian physicians. The reported stressors suggest specific professional environment of military physicians. Stress at work needs careful and thorough consideration, not only because it can cause health problems and emotional suffering in military physicians, but also because it can diminish the quality of medical care that they are expected to provide. The stressors that are remediable should be identified and the job stress reduction procedures should be performed.
Knezević
Bojana
B
Klinicki bolnicki centar Zagreb. bojana.knezevic@inet.hr
Belosević
Ljiljana
L
D000328:Adult; D017523:Croatia; D005260:Female; D006801:Humans; D008297:Male; D008887:Military Medicine; D010820:Physicians / Q000523:psychology*; D013315:Stress, Psychological / Q000209:etiology*; D011795:Surveys and Questionnaires