title: Working conditions and effort-reward imbalance of German physicians in Sweden respective Germany: a comparative study.
abstract: OBJECTIVE
  Work stress among physicians is a growing concern in various countries and has led to migration. We compared the working conditions and the work stress between a migrated population of German physicians in Sweden and a population of physicians based in Germany. Additionally, specific risk factors for work stress were examined country wise.
  
  
  METHODS
  Using a cross-sectional design, 85 German physicians employed in Sweden were surveyed on working conditions and effort-reward imbalance and compared with corresponding data on 561 physicians working in Germany. Multiple linear regression analyses were applied on both populations separately to model the associations between working conditions and effort-reward ratio (ERR), adjusted for a priori confounders.
  
  
  RESULTS
  German physicians in Sweden had a significantly lower ERR than physicians in Germany: mean (M) = 0.47, standard deviation (SD) = 0.24 vs. M = 0.80, SD = 0.35. Physicians in Sweden worked on average 8 h less per week and reported higher work support and responsibility. Multivariate analyses showed in both populations a negative association between work support and the ERR (β = -0.148, 95% CI -0.215 to (-0.081) for physicians in Sweden and β = -0.174, 95% CI -0.240 to (-0.106) for physicians in Germany). Further significant associations with the ERR were found among physicians in Sweden for daily breaks (β = -0.002, 95% CI -0.004 to (-0.001)) and among physicians in Germany for working hours per week (β = 0.006, 95% CI 0.002-0.009).
  
  
  CONCLUSIONS
  Our findings show substantial differences in work stress and working conditions in favor of migrated German physicians in Sweden. To confirm our results and to explain demonstrated differences in physicians' work stress, longitudinal studies are recommended.
authors.affiliation: Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig Maximilians University Munich, Ziemssenstr. 1, 80336, Munich, Germany, johan.ohlander@med.uni-muenchen.de.
authors.forename: Johan
authors.initials: J
authors.lastname: Ohlander
authors.forename: Matthias
authors.initials: M
authors.lastname: Weigl
authors.forename: Raluca
authors.initials: R
authors.lastname: Petru
authors.forename: Peter
authors.initials: P
authors.lastname: Angerer
authors.forename: Katja
authors.initials: K
authors.lastname: Radon
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D005858:Germany / Q000208:ethnology; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000208:ethnology* / Q000209:etiology*; D010820:Physicians / Q000523:psychology* / Q000706:statistics & numerical data; D012201:Reward; D013315:Stress, Psychological / Q000208:ethnology* / Q000209:etiology*; D011795:Surveys and Questionnaires; D013548:Sweden; D014937:Work / Q000523:psychology*; D017132:Workplace / Q000523:psychology