The aim of the study was to investigate job size preferences with regard to workload and work engagement in a sample of physicians working in different specialties. The impact of workload on the clinical population as well as on patient safety and quality of care is widely acknowledged and more and more physicians prefer to reduce their job size in order to reduce workload (Norman und Hall 2014; McMurray et al. 2005; Schmit Jongbloed et al. 2017).
Overall, approximately 41% of physicians in this sample are planning to reduce their job size. This is similar to another study, where 35% wanted to work less (Schmit Jongbloed et al. 2017), however, this study consisted of physicians starting medical training. In our sample, physicians deciding to work less are slightly older in comparison to physicians that aim to keep their working arrangements unmodified or prefer to work more. With regard to gender, 43% of all male physicians and 39 % of all women want to reduce their job size. This difference could be explained by the fact that women already work less compared to their male counterparts due to family commitments.
The main reasons for wanting to reduce the overall amount of working hours are having more leisure time, reducing workload or due to care-work. Apart from shortage of health care professionals, physician’s dedication may often lead to increases in workload and burnout. However, Burnout has been shown to be a reason for physician’s decision to resign from medical profession (Dyrbye et al. 2012; Shanafelt et al. 2014). Especially younger physicians see part-time work as a solution to reduce heavy workload, being able to find the balance between work and private life (Schmit Jongbloed et al. 2017).
Studies suggest, that work engagement and work motivation may positively impact (personal) burnout (Ferraro et al. 2020). In our study, multivariate analysis show that work engagement is significantly linked to all three dimensions of workload. Regression models show that work-engagement can reduce patient-related, work-related as well as personal workload. In addition, the desire to work less (i.e. reduce working hours) is linked to higher workload on all three dimensions. With regard to sociodemographic factors, being younger and being female was also significantly related to higher workload. Interestingly, having children was associated with less work-related and less patient-related workload. Previous studies suggest, that having children would increase the overall burden, leading to work-home-conflicts that also influence career decisions of physicians (Dyrbye et al. 2012). Another study has found a significant but inverse relationship between number of children and emotional exhaustion experienced by physicians (Keeton et al. 2007). Therefore, the relationship may depend on the type of burnout under investigation. In addition, future studies may focus on the relevance of the children’s age (i.e. differences in intensity of care being necessary) and include whether this may also be influenced by the partner’s labor situation if the physicians is in a relationship.
For work engagement, significant direct as well as mediation effects were found. In other words, physicians with high levels of workload (patient-related, work-related and personal) express less work engagement and are therefore more likely to plan to reduce their working time. Therefore, work engagement may influence whether high levels of workload and burnout observed in physicians of different specialties may lead to the desire to cut down jobs size. Since a shortage in health care professionals and physicians has been observed, this may increase the shortcoming even more and result in further increase of workload by their colleagues. The concept of work engagement may act as a buffer and should be enhanced by supervisors or health care institutions. Additionally, it has been suggested that interventions, that focus on reducing job demands (i.e. having sufficient time for work) and rather strength resources (i.e. values alignment) have the greatest potential to affect burnout and work engagement (Koranne et al. 2020).
The question remains whether reducing working time may decrease workload or rather increase workload, because physicians do not have sufficient time for their patients and administrative work. In comparison spending more time with the patient, but during less occasions (i.e. less visits by the patient) may also effect workload. Future research should therefore investigate how different working hour arrangements (also including home-office and telehealth) may be useful in decreasing workload and the risk to develop burnout and how interventions that aim to increase work engagement and to anticipate physician shortage.
Results of the work engagement scale show, that the overall scores are lower compared to other studies investigating physicians (Scheepers et al. 2017; Perreira et al. 2018) but goes align with findings from a similar study investigating burnout, work engagement and patient care
(Loerbroks et al. 2017)
. Even though, mediation analysis revealed significant direct as well as mediation effects, the total effect of work-related and personal workload was relatively low. Future research should therefore investigate whether additional factors may contribute and hence, influence this relationship.