title: Exploring public sector physicians' resilience, reactions and coping strategies in times of economic crisis; findings from a survey in Portugal's capital city area.
abstract: Evidence is accumulating on the impact of the recent economic crisis on health and health systems across Europe. However, little is known about the effect this is having on physicians - a crucial resource for the delivery of healthcare services. This paper explores the adaptation to the crisis of public sector physicians and their ability to keep performing their functions, with the objective of gaining a better understanding of health workers' resilience under deteriorating conditions.
  
  
  
  We conducted a survey among 484 public primary care and hospital physicians in Portugal's capital city area and explored their perceptions of the crisis, adaptation and coping strategies. We used ordinal and logistic regression models to link changes in hours worked and intentions to migrate with physicians' characteristics and specific answers.
  
  
  
  We found little evidence of physicians changing their overall allocation of working time before and after the crisis, with their age, types of specialisation, valuation of job flexibility and independence significantly associated with changes in public sector hours between 2010 and 2015. Being divorced, not Portuguese, of younger age, and working a high number of hours per week, were found to increase the probability of physicians considering migration, the same as having a poor opinion of recent government health policies. On the other hand, enjoying their current working environment, not wanting to disrupt provision of service, and leisure time were found to protect against scaling down public sector hours or considering migration.
  
  
  
  Our work on Portuguese physicians contributes to the debate on health workers' resilience, showing the value of understanding the influence of personal characteristics and opinions on their adaptation to changing circumstances, before designing policies to improve their working conditions and retention.
authors.affiliation: UEI SPIB, Universidade Nova de Lisboa, Rua da Junqueira 100, Lisbon, Portugal. g.russo@qmul.ac.uk.|Centre for Primary Care and Public Health, Queen Mary University of London, 58 Turner Street, Yvonne Carter building, London, E1 2AB, UK. g.russo@qmul.ac.uk.
authors.forename: Giuliano
authors.initials: G
authors.lastname: Russo
authors.affiliation: Centre for Mathematics, University of Trás os Montes e Alto Douro, Vila Real, Portugal.
authors.forename: Carlos André
authors.initials: CA
authors.lastname: Pires
authors.affiliation: Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal.
authors.forename: Julian
authors.initials: J
authors.lastname: Perelman
authors.affiliation: UEI SPIB, Universidade Nova de Lisboa, Rua da Junqueira 100, Lisbon, Portugal.|Centro de Estatística e Aplicações da Universidade de Lisboa, Lisbon, Portugal.
authors.forename: Luzia
authors.initials: L
authors.lastname: Gonçalves
authors.affiliation: Nova Business School, Universidade Nova de Lisboa, Lisbon, Portugal.
authors.forename: Pedro Pita
authors.initials: PP
authors.lastname: Barros
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001291:Attitude of Health Personnel; D057172:Economic Recession; D004641:Emigration and Immigration; D005260:Female; D006291:Health Policy / Q000191:economics; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology / Q000706:statistics & numerical data; D008875:Middle Aged; D058007:Physicians, Primary Care / Q000523:psychology / Q000706:statistics & numerical data; D011174:Portugal; D017150:Public Sector; D011795:Surveys and Questionnaires; D016526:Workload
keywords: Health services Portugal; Health services economic crisis; Physicians and economic crisis; Physicians resilience and coping strategies; Portugal’s healthcare system