Stress and burnout have been identified as one of the main problems affecting physicians’ wellbeing [20, 21, 30] and have been linked to depression [31] or anxiety [9, 22, 32–35]. Growing burnout reduces physicians’ performance, productivity, the quality of care delivered, and increases their likelihood to quit. Contrary to what has been said, results from the present study indicate that physicians are, on average, less anxious, happier, and more satisfied with their lives than lawyers or accountants during the four-year period of analysis. This applies to analyses that exclude hourly wages as covariate and in those cases where hourly wages were included, most estimates for physicians are not significant.
The analysis of anxiety as a metric for SWB in the present research, reported lower levels for physicians than accountants without controlling for hourly wages (Table 5). Barely, hours of work were associated with higher anxiety (models 5.1–5.2) and the further breakdown of hours did not report significant results for physicians but did for lawyers and accountants. This is observed in most models conditioned on occupation (Additional file 4), and contradicts main findings published in previous studies that reported high levels of stress and burnout of physicians.
Johnson et al [33] compared salaried workers (employees) among 26 occupations in the UK using a general questionnaire in occupational stress and found that physicians are worse off than accountants, ranking lower on psychological wellbeing (17.82 vs 17.47) and job satisfaction (25.66 vs 18.74). In APS, focussing on salaried workers only demands controlling for hourly wages as APS data does not report earnings of self-employed workers. When there is a large proportion of self-employed workers, this could ease a comparison of estimates for those professionals in their occupations, but this needs to be taken with caution as there is no causal relationship. This is important for GPs where approximately 70% are self-employed (known as partner GPs) compared to 29% of lawyers, 25% of accountants and only 2% of hospital doctors.
Satisfaction is an important issue in physicians´ wellbeing. Numerous studies have investigated physicians´ job satisfaction [12, 36–38], but most analyses rely on self-collected data from own questionnaires and there is little evidence looking at overall satisfaction using SWB variables. Overall, physicians are satisfied with their jobs as Joyce et al (2011) reported (85.7% physicians). Van Ham et al surveyed evidence on job satisfaction of GPs [12] and concluded that low income, long hours of work, administrative burden or heavy workloads could worsen satisfaction and were some factors to look after for physicians. If physicians are happy and satisfied with their jobs, then they will be less likely to quit their jobs. In this study, physicians are more satisfied with their lives than accountants or lawyers as pooled models report (Table 4, models 4.1–4.2), but results for GPs are not significant (models 4.3–4.5). This non-statistical significance of hours of work on SWB controlling for hourly wages does not enable to conclude if salaried physicians are more satisfied than accountants as it is corroborated in those with full sample.
Income has been associated with higher happiness and satisfaction [39] and reduces anxiety [15]. The association between income and happiness has been studied thoroughly concluding that the impact of income variables on happiness is more noticeable in low-income workers. Also, research has confirmed the existence of diminishing marginal utility of income when workers ascend in the earnings distribution. The incorporation of earnings variables in the analysis, via hourly wages, in the framework of this analysis bolsters that income increases happiness and satisfaction and decreases anxiety in pooled models and accountants. Hourly wages are negatively associated with satisfaction of GPs in conditioned models (Table 4) and agrees on existing evidence on retention of physicians´ workforce [40, 41].
Controlling for hourly wages in APS restricts to salaried workers, However, in the UK approximately 70% of GPs are self-employed. The exclusion of hourly wages in the analysis, therefore, allow us to test SWB including both self-employed and salaried [42–44] and provide a relevant insight on the SWB of self-employed GPs as they represent approximately 70% of all primary care physicians. In the context of the analysis developed here, estimates suggest that physicians are happier, more satisfied with their lives and less anxious than other workers. This is relevant for two main reasons. Firstly, self-employed are happier than salaried workers because self-employed have greater autonomy [42]. However, other studies focused on salaried UK GPs concluded that salaried are as satisfied as self-employed, more satisfied with their wages and weekly hours, but more stressed than self-employed [45]. Secondly, salaried GPs account for 30–35% of total GP headcount but the proportion of female workers is the largest among all occupations.
Feminization is an important issue in the medical profession [46–48]. Occupations with greater proportion of female workers are characterised by a large proportion working part-time [47] and hours of work tend to be lower compared to other occupations. In the context of the study performed, estimates from show that females are more anxious than males overall and more satisfied (model 4.5) but female GPs are unhappier and less satisfied with their lives (models 2.1–2.2). The higher levels of anxiety of female workers and their magnitude are consistent with existing literature and within the estimated range [15].
Despite the growing feminization in the medical profession, physicians have reported working long hours and having heavy workloads. Heavy workloads and long hours have been associated with lower happiness and life satisfaction [49], increasing anxiety and, consequently, positively correlated with job stress [31], occupational stress [30] and burnout [50] or sickness absence [23]. In the framework of this study, the aggregate measure of total hours of work proposed is significant though nearly to zero. This contradicts existing evidence that corroborates an association between working long hours and growing levels of anxiety, stress, and job dissatisfaction [5, 11]. The further breakdown into basic and overtime hours in main job and hours in second job is more informative. Hours in second job are not associated with changes in wellbeing levels, except for accountants (see Additional files 2–3).
Overtime hours have been associated with increasing anxiety, depression, or stress or burnout [10, 17–19]. Estimates obtained in the present analysis conveyed that overtime work (pooled model) increases anxiety by 1.3% of a SD (model 5.5) for hospital doctors, lawyers, and accountants, but not for GPs (see Additional file 4). However, the existing evidence is not conclusive. Some studies did not find any relationship between work hours of hospital doctors [51] while others did find that overtime hours had negative impact on anxiety increasing the probability of suffering from depression [52] with higher anxiety resulting from increasing burnout. Van der Hulst and Geurts (2001) showed that when overtime exceeded the regular daily work hours (8 hours), workers were more likely to suffer from burnout especially those working 12 hours or more. However, they only considered full-time workers and overtime work could be agreed for both full-time and part-time workers.
Not all workers have contracted their desired number of hours and there are some professionals who work under/over their desired levels of hours. Underemployment refers to workers who are working below their optimal number of hours and report wanting to work more hours than at present. Two types of workers have been identified being underemployment. Firstly, young workers or with low educational levels [53]. Secondly, part-time workers usually work fewer than 30 hours per week [54] and have lower levels of wellbeing [55]. Table 4 showed that underemployment is negatively correlated with life satisfaction for lawyers and accountants but not for physicians (Additional file 3) and it is negatively with anxiety levels for the same professionals (Additional file 4). Results for physicians are not statistically significant. When workers are working fewer hours than desired there is room to increase their hours of work and increase the total hours of those professionals. Allowing doctors to increase working hours could be an efficient solution to tackle the shortage of physicians in the short run.
There are some limitations in this work. Hourly wages in second job were not included as covariate. The proportion of salaried physicians working in a second job was small and did not impact hugely in results. A further limitation is the absence of income variables for self-employed workers which could have made possible to test whether self-employed are happier than salaried [42] with more accurate results.