Skip to main content
Log in

Less work: more burnout? A comparison of working conditions and the risk of burnout by German physicians before and after the implementation of the EU Working Time Directive

  • Original Article
  • Published:
International Archives of Occupational and Environmental Health Aims and scope Submit manuscript

Abstract

Objectives

The present study is a 10-year comparison (1997 vs. 2007) of occupational and health aspects before and after the implementation of the European Working Time Directive on German hospital physicians. A major focus is whether the changes in working conditions are accompanied by a lower risk for burnout.

Methods

Three hundred and twenty-eight physicians from the Medical Register of the city of Hamburg completed the survey in 1997 and 994 physicians in 2007. The response rates were 55.4 and 46.5 %, respectively. All participants filled in a 22-item version of the German translation of the Maslach Burnout Inventory. Results of multivariate covariance analyses are reported.

Results

The work of physicians has changed significantly within the 10-year period, for example, work time decreased by 4.5 h on average to 55.8 h per week in 2007. Junior physicians profited more from this development, but on-call duties increased for senior physicians in particular. The reduced hours were at the expense of fewer rests. Junior, as well as senior, physicians reported significantly higher rates on the burnout scale for emotional exhaustion (mean 21.8, SD 10.7) in the latter survey and senior physicians also on the depersonalization scale (mean 9.7, SD 6.3).

Conclusions

Changes in working conditions in accordance with the European Working Time Directive are not accompanied by reduced strain and risk of burnout for physicians. Rather, our data argue for greater intensification in work, especially for senior physicians. Further studies are suggested in order to explore interventions for a sustainable improvement in the working conditions of physicians.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Ahola K, Gould R, Virtanen M, Honkonen T, Aromaa A, Lönnqvist J (2009) Occupational burnout as a predictor of disability pension: a population-based cohort study. Occup Environ Med 66(5):284–290. doi:10.1136/oem.2008.038935

    Article  CAS  Google Scholar 

  • Bakker AB, Demerouti E (2007) The job demands-resources model: state of the art. J Manag Psychol 22(3):309–328. doi:10.1108/02683940710733115

    Article  Google Scholar 

  • Bakker AB, Demerouti E, Euwema MC (2005) Job resources buffer the impact of job demands on burnout. J Occup Health Psychol 10(2):170–180. doi:10.1037/1076-8998.10.2.170

    Article  Google Scholar 

  • Barth A (1985) Das MBI-D: Erste Untersuchung mit einer deutschen Übersetzung des, Maslach Burnout Inventory‘bei klientenzentrierten Gesprächstherapeuten und Hochschullehrern. Zulassungsarbeit zur staatlichen Ergänzungsprüfung im Fach Psychologie mit Schulpsychologischem Schwerpunkt, Universität Nürnberg

    Google Scholar 

  • Buddeberg-Fischer B, Klaghofer R, Buddeberg C (2005) Stress at work and well-being in junior residents. Z Psychosom Med Psychother 51(2):163–178

    Google Scholar 

  • Buddeberg-Fischer B, Stamm M, Buddeberg C, Klaghofer R (2010) Chronic stress experience in young physicians: impact of person- and workplace-related factors. Int Arch Occup Environ Health 83:373–379

    Article  Google Scholar 

  • Bundesärztekammer (2011) Tätigkeitsbericht 2010 der Bundesärztekammer. http://www.bundesaerztekammer.de/downloads/Taetigkeit2010.pdf. Accessed 5 Dec 2011

  • Cubrilo-Turek M, Urek R, Turek S (2006) Burnout syndrome: assessment of a stressful job among intensive care staff. Coll Antropol 30:131–135

    Google Scholar 

  • Fletcher KE, Underwood W 3rd, Davis SQ, Mangrulkar RS, McMahon LF Jr, Saint S (2005) Effects of work hour reduction on residents’ lives: a systematic review. JAMA 294(9):1088–1100

    Article  CAS  Google Scholar 

  • Friedrich M, Popov A, Schmitto J, Bireta C, Emmert A, Tirilomis T (2011) Meeting the needs of the European Working Time Directive in German medical profession. Dtsch Med Wochenschr 136:1377–1383

    Article  CAS  Google Scholar 

  • Greenhaus JH, Beutell NJ (1985) Sources of conflict between work and family roles. Acad Manag Rev 10(1):76–88. doi:10.5465/amr.1985.4277352

    Google Scholar 

  • Gundersen L (2001) Physician burnout. Ann Intern Med 135(2):145–148

    Article  CAS  Google Scholar 

  • Hallsten L, Voss M, Stark S, Josephson M (2011) Job burnout and job wornout as risk factors for long-term sickness absence. Work 38(2):181–192. doi:10.3233/WOR201101120

    Google Scholar 

  • Hutter M, Kellogg K, Ferguson C, Abbott W, Warshaw A (2006) The impact of the 80-hour resident workweek on surgical residents and attending surgeons. Ann Surg 243(6):864–875. doi:10.1097/01.sla.0000220042.48310.66

    Article  Google Scholar 

  • Isikhan V, Comez T, Danis MZ (2004) Job stress and coping strategies in health care professionals working with cancer patients. Eur J Oncol Nurs 8:234–244. doi:10.1016/j.ejon.2003.11.004

    Article  Google Scholar 

  • Karasek RA (1979) Job demands, job decision latitude, and mental strain: implications for job design. Admin Sci Quart 24:285–308

    Article  Google Scholar 

  • Kopetsch T (2009) Arztzahlentwicklung: Hohe Abwanderung ins Ausland – sehr geringe Arbeitslosigkeit. Dtsch Arztebl 106(16):A757–A766

    Google Scholar 

  • Kuhn G (2001) Circadian rhythm, shift work, and emergeny medicine. Ann Emerg Med 37:88–98

    Article  CAS  Google Scholar 

  • Maslach C, Jackson S (1981) The measurement of experienced burnout. J Occup Behav 2:99–113

    Article  Google Scholar 

  • Maslach C, Jackson S (1986) Maslach burnout inventory manual, 2nd edn. Consulting Psychologists Press, Palo Alto

    Google Scholar 

  • Maslach C, Schaufeli WB, Leiter MP (2001) Job burnout. Annu Rev Psychol 52:397–422. doi:0066-4308/01/0201-0397$14.00

    Article  CAS  Google Scholar 

  • McManus IC, Winder BC, Gordon D (2002) The causal links between stress and burnout in a longitudinal study of UK doctors. Lancet 359:2089–2090

    Article  CAS  Google Scholar 

  • Michalsen A, Hillert A (2011a) Burn-out in anesthesia and intensive care medicine. Part 1. Clarification and critical evaluation of the term. Anaesthesist 60(1):23–30. doi:10.1007/s00101-009-1659-0

    Article  CAS  Google Scholar 

  • Michalsen A, Hillert A (2011b) Burnout in anesthesia and intensive care medicine. Part 2: Epidemiology and importance for the quality of care. Anaesthesist 60(1):31–38. doi:10.1007/s00101-010-1805-8

    Article  CAS  Google Scholar 

  • Nurminen T (1998) Shift work and reproductive health. Scand J Work Environ Health 24(suppl 3):28–34

    Google Scholar 

  • Nyssen AS, Hansez I, Baele P, Lamy M, De Keyser V (2003) Occupational stress and burnout in anaesthesia. Br J Anaesth 90(3):333–337. doi:10.1093/bja/aeg058

    Article  CAS  Google Scholar 

  • Parshuram CS, Dhanani S, Kirsh JA, Cox PN (2004) Fellowship training, workload, fatigue and physical stress: a prospective observational study. CMAJ 170(6):965–970. doi:10.1053/cmaj.1030442

    Article  Google Scholar 

  • Prins JT, Gazendam-Donofrio SM, Tubben BJ, Van Der Heijden FM, Van De Wiel HB, Hoekstra-Weebers JE (2007) Burnout in medical residents: a review. Med Educ 41(8):788–800. doi:10.1111/j.1365-2923.2007.02797.x

    Article  Google Scholar 

  • Robeznieks A (2011) Shift work. Mod Healthc 41(30):6–7

    Google Scholar 

  • Rupert PA (2009) Work-family conflict and burnout among practicing psychologists. Prof Psychol Res Pr 40(1):54–61. doi:10.1027/1614-0001.30.1.6

    Article  Google Scholar 

  • Sharma A, Sharp D, Walker L, Monson J (2008) Stress and burnout in colorectal and vascular surgical consultants working in the UK national health service. Psychooncology 17:570–576

    Article  CAS  Google Scholar 

  • Siegrist J (1996) Adverse health effects of high effort-low reward conditions. J Occup Health Psych 1(1):27–41

    Article  CAS  Google Scholar 

  • Simoens S, Hurst J (2006) The supply of physician services in OECD countries OECD health working papers, 21

  • Spielberg P (2011) EU-Arbeitszeitrecht. Kein einheitliches Bild. Dtsch Arztebl 108(14):A807–A808

    Google Scholar 

  • SVR (2009) Qualifikation und Migration: Potenziale und Personalpolitik in der „Firma“ Deutschland. http://www.svr-migration.de/content/wp-content/uploads/2009/05/090528_druckfassung_qualifikation-und-migration.pdf. Accessed 12 Jan 2012

  • Tan P, Hogle NJ, Widmann WD (2012) Limiting PGY 1 residents to 16 hours of duty: review and report of a workshop. J Surg Educ 69(3):355–359. doi:10.1016/j.jsurg.2011.10.013

    Article  Google Scholar 

  • Thomas NK (2004) Resident burnout. JAMA 292(23):2880–2889

    Article  CAS  Google Scholar 

  • Voltmer E (2009) Abwanderung von Ärzten ins Ausland: Psychosoziale Belastungen werden zu wenig thematisiert. Dtsch Arztebl 106(8):A365–A366

    Google Scholar 

  • Wegner R (2007) Die beruflichen Belastungen von Hamburger Krankenhausärzten. Hamb Arztebl 31:314–318

    Google Scholar 

  • Wegner R, Wein C (2002) Zur Eignung des Maslach-Burnout-Inventory (MBI) bei arbeitsmedizinischen Erhebungen. In: Rindt (ed) DokBd DGAUM 42, Fulda, pp 319–321

  • Wegner R, Kostova P, Poschadel B, Baur X (2007) Arbeitsbelastung und Beanspruchung von Hamburger Krankenhausärzten. Weniger Stunden, mehr Arbeit. Hamb Arztebl 11:515–518

    Google Scholar 

  • Wegner R, Kostova P, Poschadel B, Manuwald U, Baur X (2009) Belastungen und Beanspruchungen von Krankenhausärzten/-innen: Ergebnisse einer aktuellen Erhebung. Arbeitsmed Sozialmed Umweltmed 44(7):389–398

    Google Scholar 

  • Wismar M et al (2011) Health professional mobility and health systems: evidence from 17 European countries. Euro Observer 13(2):1–4

    Google Scholar 

Download references

Acknowledgments

The current study contains parts of the doctoral thesis of Petya Kostova. We are grateful to the Hamburg Medical Register for their support.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Astrid Richter.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Richter, A., Kostova, P., Baur, X. et al. Less work: more burnout? A comparison of working conditions and the risk of burnout by German physicians before and after the implementation of the EU Working Time Directive. Int Arch Occup Environ Health 87, 205–215 (2014). https://doi.org/10.1007/s00420-013-0849-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00420-013-0849-x

Keywords

Navigation