title: Psychosocial factors in GP work: the effects of taking a GP position or leaving GP work.
abstract: BACKGROUND
  We examined the effects of leaving public sector general practitioner (GP) work and of taking a GP position on changes in work-related psychosocial factors, such as time pressure, patient-related stress, distress and work interference with family. In addition, we examined whether changes in time pressure and patient-related stress mediated the association of employment change with changes of distress and work interference with family.
  
  
  METHODS
  Participants were 1705 Finnish physicians (60% women) who responded to surveys in 2006 and 2010. Analyses of covariance were conducted to examine the effect of employment change to outcome changes adjusted for gender, age and response format. Mediational effects were tested following the procedures outlined by Baron and Kenny.
  
  
  RESULTS
  Employment change was significantly associated with all the outcomes. Leaving public sector GP work was associated with substantially decreased time pressure, patient-related stress, distress and work interference with family. In contrast, taking a position as a public sector GP was associated with an increase in these factors. Mediation tests suggested that the associations of employment change with distress change and work interference with family change were partially explained by the changes in time pressure and patient-related stress.
  
  
  CONCLUSIONS
  Our results showed that leaving public sector GP work is associated with favourable outcomes, whereas taking a GP position in the public sector is associated with adverse effects. Primary health-care organizations should pay more attention to the working conditions of their GPs, in particular, to time pressure and patient-related stress.
authors.affiliation: National Institute for Health and Welfare, Helsinki, Finland. tarja.heponiemi@thl.fi
authors.forename: Tarja
authors.initials: T
authors.lastname: Heponiemi
authors.forename: Anne
authors.initials: A
authors.lastname: Kouvonen
authors.forename: Anna-Mari
authors.initials: AM
authors.lastname: Aalto
authors.forename: Marko
authors.initials: M
authors.lastname: Elovainio
mesh_terms: D000704:Analysis of Variance; D002321:Career Choice; D003220:Conflict, Psychological; D004651:Employment / Q000523:psychology / Q000706:statistics & numerical data; D005190:Family / Q000523:psychology; D005260:Female; D005387:Finland; D058005:General Practitioners / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D010558:Personnel Loyalty; D010563:Personnel Turnover / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D011320:Primary Health Care; D017149:Private Sector / Q000706:statistics & numerical data; D011446:Prospective Studies; D011594:Psychometrics; D017150:Public Sector / Q000706:statistics & numerical data; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires; D000078329:Workforce; D016526:Workload / Q000523:psychology*