Euthanasia of animals - association with veterinarians' suicidal thoughts and attitudes towards assisted dying in humans: a nationwide cross-sectional survey (the NORVET study).

BACKGROUND: Veterinarians are an occupational group with an increased suicide risk. Euthanasing animals may influence both veterinarians' views on assisted dying in humans and their suicide risk. We investigated (I) attitudes towards assisted dying, (II) whether the field of work and the frequency of euthanasing animals were associated with positive attitudes towards human euthanasia, and (III) whether frequently euthanasing animals was associated with serious suicidal thoughts. METHODS: We conducted a nationwide cross-sectional study among veterinarians in Norway (response rate: 75%). Logistic regression models were used to calculate the odds ratios for both positive attitudes towards human euthanasia and serious suicidal thoughts. The analyses were adjusted for socio-demographic and work-related factors. RESULTS: Fifty-five percent of the veterinarians agreed that euthanasia should be permitted for humans with a fatal disease and short life expectancy. Working with companion animals was independently associated with positive attitudes towards human euthanasia (OR = 1.66 (95% CI: 1.23-2.23)), while veterinarians' frequency of euthanasing animals was not. Frequency of euthanasing animals was independently associated with serious suicidal thoughts, OR = 2.56 (95% CI: 1.35-4.87). CONCLUSIONS: Veterinarians' attitudes towards assisted dying in humans did not differ from those of the general population. Veterinarians' frequency of euthanasing animals was not associated with positive attitudes towards euthanasia in humans. However, veterinarians working in companion animal practices were more likely to have positive attitudes towards euthanasia in humans. Moreover, euthanising animals five times or more a week was associated with serious suicidal thoughts. We need more research to infer about causality in these findings.

Occupational stress among Norwegian physicians: A literature review of long-term prospective studies 2007-2019.

AIMS: There are signs of increased stress at work among Norwegian physicians over the last decades, not least among general practitioners (GPs). In this review, we identify trends in both occupational stress and adverse work-related predictors of such stress and burnout in Norwegian physicians. METHODS: We performed an extensive literature search using MEDLINE, Embase and PsycINFO. We included prospective and repeated cross-sectional studies of work stress among Norwegian physicians published in 2007-2019. RESULTS: Nine studies with observation periods of 1-20 years were included. Occupational stress (global measure) among all doctors decreased gradually from medical school to 20 years later. The prevalence of an effort-reward imbalance increased fourfold among GPs during the period 2010-2019. Five studies reported higher levels of occupational stress among female physicians than among their male colleagues. Work-home conflict levels increased after graduation until 10 years after leaving medical school and plateaued thereafter. Physicians who graduated in a later cohort reported lower levels of work-home conflict and less workplace violence. Work-home conflict, low colleague support, number of work hours and workload/low autonomy were all independent predictors of occupational stress. CONCLUSIONS: The reduction in occupational stress during the years after leaving medical school may result from increased competency in clinical work and decreased on-call work. The Co-ordination Act implemented in 2012 may explain the increase in occupational stress among GPs. These findings suggest that both reducing work-home conflict and increasing colleague support are important for doctors' well-being.

Employee silence in health care: Charting new avenues for leadership and management.

ISSUE: Health care management is faced with a basic conundrum about organizational behavior; why do professionals who are highly dedicated to their work choose to remain silent on critical issues that they recognize as being professionally and organizationally significant? Speaking-up interventions in health care achieve disappointing outcomes because of a professional and organizational culture that is not supportive. CRITICAL THEORETICAL ANALYSIS: Our understanding of the different types of employee silence is in its infancy, and more ethnographic and qualitative work is needed to reveal the complex nature of silence in health care. We use the sensemaking theory to elucidate how the difficulties to overcoming silence in health care are interwoven in health care culture. INSIGHT/ADVANCE: The relationship between withholding information and patient safety is complex, highlighting the need for differentiated conceptualizations of silence in health care. We present three Critical Challenge points to advance our understanding of silence and its roots by (1) challenging the predominance of psychological safety, (2) explaining how we operationalize sensemaking, and (3) transforming the role of clinical leaders as sensemakers who can recognize and reshape employee silence. These challenges also point to how employee silence can also result in a form of dysfunctional professionalism that supports maladaptive health care structures in practice. PRACTICE IMPLICATIONS: Delineating the contextual factors that prompt employee silence and encourage speaking up among health care workers is crucial to addressing this issue in health care organizations. For clinical leaders, the challenge is to valorize behaviors that enhance adaptive and deep psychological safety among teams and within professions while modeling the sharing of information that leads to improvements in patient safety and quality of care.

Professional help-seeking behaviour for mental health problems among veterinarians in Norway: a nationwide, cross-sectional study (The NORVET study).

BACKGROUND: Veterinarians have a relatively high prevalence of mental health problems; however, research on professional help-seeking is limited. The main purpose of the present study was to investigate the prevalence of mental health problems and professional help-seeking behaviour for such problems, and the independent factors associated with help-seeking behaviour among veterinarians in Norway. METHOD: This cross-sectional study included all veterinarians in Norway (response rate 75%, 70% women). Logistic regression was used to calculate odds ratios (OR) for professional help-seeking for mental health problems. Analyses were controlled for socio-demographic, individual (personality trait reality weakness, SCL-5, attitudes toward mental illness), and work-related factors (work field, job stress). RESULTS: The prevalence of self-reported mental health problems in need of treatment was 30% (746/2494), significantly higher among women than men (36% vs. 15%). Fifty-four percent had sought professional help, women significantly more often (56%) than men (41%). Among veterinarians with serious suicidal thoughts, 50% (69/139) had sought help. Veterinarians most frequently related mental health problems to work problems (47%), women significantly more often (49%) than men (34%). Factors significantly associated with help-seeking were being female, OR = 2.11 (95% CI: 1.24-3.60), working with production animals, OR = 0.35 (0.13-0.98), public administration, OR = 2.27 (1.15-4.45), academia/research, OR = 4.78 (1.99-11.47) or 'other' fields, OR = 2.79 (1.23-6.32), and attitudes toward mental illness, OR = 1.32 (1.03-1.68). CONCLUSIONS: Thirty percent of veterinarians in Norway reported mental health problems in need of treatment, and only half of them had sought professional help. A low degree of help-seeking was also seen among those with serious suicidal thoughts. Being female, positive attitudes toward treatment of mental illness, working in public administration, academia/research and 'other' field were associated with more help-seeking, while working in production animal practice was associated with less help-seeking. Interventions to increase help-seeking behaviour for mental health problems among veterinarians are warranted.

Effect of burnout among physicians on observed adverse patient outcomes: a literature review.

BACKGROUND: Physician burnout has potentially harmful effects for both physicians and their patients. Despite relationships between physician burnout and lowered patient satisfaction and clinician-rated adverse patient outcomes, there is scarce literature regarding effects on objective patient outcomes. This study aimed to examine the relationship between physician burnout and observed adverse patient outcomes via a review of the literature. METHODS: A search was performed on the MEDLINE, EMBASE and PsychINFO databases, using keywords and Medical Subject Headings. The identified studies were in English, published from 2007 to 2019, measured burnout among physicians using the Maslach Burnout Inventory (MBI), and included observed adverse patient outcomes. In total, 360 eligible articles were identified, and 11 were included in the final review. All included studies measured patient outcomes by observed clinical measures (e.g. quality of care and medical errors). RESULTS: Four studies found a clear significant relationship between physician burnout and observed adverse patient outcomes, while 6 did not. One study found a significant relationship with one of the MBI subscales. Burnout was, in contrast to depression, only partly associated with observed patient outcomes. CONCLUSIONS: This review illustrates the need for a validation of physician burnout measured by MBI with respect to observed patient outcomes. Further studies are required to investigate the effects of physician burnout on observed quality of their patient care.

Have medical students' attitudes towards clinical communication skills changed over a 12- year period? A comparative long-term study.

BACKGROUND: Attitudes towards learning clinical communication skills at the end of medical school are likely to reflect the students' training and motivation for the continued development of their skills as doctors. Students from two Norwegian medical schools, one with a traditional, and the other with an integrated curriculum, were approached in 2003 and 2015; with regard to changes in students' attitudes towards acquiring communication skills in two diverse learning environments. This comparison might reveal the effects of the training programs from a long-term perspective, as neither of the medical schools made any major curriculum changes within the study period. METHODS: The samples comprised final-year medical students. Two separate cross-sectional surveys performed 12 years apart (2003 and 2015) used items from the Communication Skills Attitude Scale in addition to age and gender. The traditional curriculum included only theoretical teaching and no contact with patients was made during the first 2 to 2.5 years of medical school. However, the integrated curriculum combined training in theoretical and clinical communication skills with early patient contact from the beginning. RESULTS: Attitudes improved from the first to the second survey at both schools, however, students from the integrated school reported more positive attitudes than those from the traditional school. Female students from the integrated school contributed the most to the difference in attitudes in both surveys. CONCLUSIONS: Students in both traditional and integrated curricula improved their attitudes from the first to the second assessment. However, compared with the traditional curriculum, the integrated one fostered even higher levels of positive attitudes towards acquiring communication skills, and a pronounced influence was observed on female students. These findings suggest that an educational program with greater emphasis on improving attitudes among male students may be required.

Life satisfaction in Norwegian medical doctors: a 15-year longitudinal study of work-related predictors.

BACKGROUND: Despite many recent studies on burn-out and dissatisfaction among American medical doctors, less is known about doctors in the Scandinavian public health service. The aims of this study were to analyse long-term work-related predictors of life satisfaction among established doctors in Norway and to identify predictors in a subgroup of doctors who reported a decline in life satisfaction. METHODS: Two nationwide cohorts of doctors (n = 1052), who graduated medical school 6 years apart, were surveyed at graduation from medical school (T1, 1993/94 and 1999), and 4 (T2), 10 (T3), and 15 (T4) years later. Work-related predictors of life satisfaction (three items) obtained at T2 to T4 were analysed. Individual and lifestyle confounders were controlled for using mixed-models repeated-measures analyses, and logistic regression analyses were applied to identify predictors of the decrease in life satisfaction. RESULTS: Ninety per cent (947/1052) responded at least once, and 42% (450/1052) responded at all four times. Work-related predictors of higher life satisfaction in the adjusted model were work-home stress (ß = - 0.20, 95% confidence interval [CI] = - 0.25 to - 0.16, p < 0.001), perceived job demands (ß = - 0.10, CI = - 0.15 to - 0.05, p < 0.001), and colleague support (ß = 0.05, CI = 0.04 to 0.07, p < 0.001). The new adjusted individual predictors that we identified included female gender, reality weakness trait, and problematic drinking behaviour. Neuroticism trait and low colleague support predicted a decrease in life satisfaction. CONCLUSIONS: Work-home stress, perceived job demands, and colleague support were the most important predictors of life satisfaction related to doctors' work. When personality traits were controlled for, female doctors were more satisfied with their life than male doctors. These findings suggest that improving work-related factors with targeted interventions, including a supportive work environment, may increase life satisfaction among doctors.

Change in subjective well-being over 20 years at two Norwegian medical schools and factors linked to well-being today: a survey.

BACKGROUND: There is a lack of studies on factors in the curriculum, study environment and individual differences that can promote well-being among medical students as a response to the frequent reports on the negative health effects of study demands among medical students worldwide. OBJECTIVE: This study investigates differences in well-being among today's Norwegian medical students compared with students 20 years ago, the most important predictors of well-being today, and whether there have been any changes in the levels of some of these factors since the period analysed. METHODS: We analysed cross-sectional survey data among all medical students (63.9%, N = 1044/1635) at two medical faculties with different curriculums (traditional and integrated) in Norway in 2015 (STUDMED 2015). We used comparison data from a longitudinal survey among medical students from the same medical faculties in 1993 to 1999: the NORDOC project (T1 = 89%, T2 = 72% and T3 = 68%). Differences in subjective well-being and correlates by demographic, curriculum, and study environment factors among the present students were tested by t-tests and stepwise linear regression analysis. RESULTS: Students today scored lower on their levels of subjective well-being than students 20 years ago. The difference was found among female and males in different study stages. The final model showed that subjective well-being today was associated with self-esteem (ß = .98, p < .001) and social support from medical school friends (ß = .22, p < .001), a partner (ß = .08, p = .020) or other family members (ß = .04, p = .041), as well as perception of medical curriculum and environment (ß = -.38, p < .001), personal competence (ß = -.40, p < .001), finance/accommodation (ß = -.22, p < .001) and perceived exam stress (ß = -.26, p < .001). CONCLUSIONS: The results show a decrease in subjective well-being among medical students and, in particular, among female students. The faculties should pay attention to the factors identified in the study environment and curriculum associated with subjective well-being in order to promote their student's well-being and stimulate health and academic performance.

Work-home balance in two cohorts of Norwegian doctors. / Jobb­hjem-balanse i to kohorter av norske leger.

BACKGROUND: Stress linked to the balance between work and home, so-called work-home interface stress, may affect the health and life situation of doctors. Reports have shown an increase in job-related stress among Norwegian doctors. We wished to investigate the development trends for this type of stress in the period 2003-14. MATERIAL AND METHOD: Work-home interface stress was measured with the aid of three questions from a validated scale, on which the respondents reported their level of stress on a scale from 1 (no stress) to 5 (very high level of stress). The measurements were made 10 and 15 years after graduation in two cohorts of doctors who had received their training within six years of each other. We used the t-test and chi-square test to compare the cohorts and to compare gender within each cohort, and linear regression analysis to adjust for any confounding factors. RESULTS: Doctors who had graduated later (later cohort, n = 248) reported significantly lower levels of work-home interface stress than doctors who had completed their studies six years earlier (early cohort, n = 197) (average score (standard deviation) 2.2 (1.0) vs. 2.6 (1.0), p = 0.001). This correlation remained significant after adjusting for other explanatory variables, such as gender (woman), number of children, weekly working hours and collegial and partner support. Fifteen years after graduation there were no differences between the cohorts in terms of perceived work-home interface stress. Within the cohorts there were no significant gender differences at any point of measurement. After adjustment for partner support and working hours, being a woman gave a significantly increased risk of experiencing work-home interface stress. INTERPRETATION: Doctors who graduated later, experienced less work-home interface stress than those who had received their training earlier. The experience of stress was buffered in women who perceived their partner as supportive and had reduced working hours.

Factors associated with low vs increased perceived mastery of clinical work over ten years of practice: a prospective study of Norwegian doctors.

BACKGROUND: A higher sense of mastery of doctors' clinical work could benefit not only their own mental health but also their work performance and patient care. However, we know little about factors associated with perceived mastery of clinical work among physicians. Our aim was therefore to study characteristics of those with stable low levels and of those with increased levels of mastery over a period of ten years of medical practice. METHODS: N = 631 doctors were surveyed in their final year of medical school in 1993/94 (T1) and 10 (T2), 15 (T3) and 20 (T4) years later. Low and increased perceived mastery of clinical work were measured between T2, T3 and T4. Response rates for all items measuring low and increased mastery were 238/522 (46%) and 256/522 (49%) respectively. The following explanatory variables were included: demographics, medical school factors, personality and contextual work-related and non-work-related factors. RESULTS: N = 73 (31%) of the doctors reported stable low mastery from T2 to T4. The following variables were significantly associated with low mastery in the adjusted analyses: vulnerability (OR: 1.30, P < .000, CI: 1.12 to 1.50), drinking alcohol to cope with stress during medical school (OR: 2.66, P = .04, CI: 1.03 to 6.85) and social support (OR: 0.78, P = .002, CI: 0.66 to 0.91). N = 39 (15%) reported increased mastery during the ten-year period from T2 to T4. Perceived job demands (OR: 0.66, P = .02, CI: 0.45 to 0.98) and taking up a leading position (OR: 3.04, P = .01, CI: 1.31 to 7.07) were associated with increased mastery after adjustment. CONCLUSIONS: Stable low sense of mastery over time is associated with having a vulnerable personality, a history of having used alcohol to cope with stress during medical school and lack of contemporary social support. Conversely, increased sense of mastery is associated with taking up a leading position and having the perception that job demands are decreasing over time. These findings indicate that perceived mastery of clinical work may not be a trait, but a state modifiable over time.

Contextual Factors and Mental Distress as Possible Predictors of Hazardous Drinking in Norwegian Medical Doctors: A 15-Year Longitudinal, Nationwide Study.

BACKGROUND: We have previously identified long-term individual predictors of hazardous drinking in doctors, but longitudinal studies on contextual factors (work and life stress) and mental distress being independently linked to hazardous drinking over the first 15 years of a medical career are lacking. METHODS: Two nationwide cohorts of Norwegian doctors (n = 1,052) from all 4 Norwegian universities were surveyed in their final year of medical school (1993/1994 and 1999) (T1), and 4 (T2), 10 (T3), and 15 (T4) years later. Hazardous drinking was measured using a validated 9-item version of the Alcohol Use Disorder Identification Test. Work-related and other predictors were analysed using generalized estimating equations. RESULTS: Ninety percent (947/1,052) responded at least once, and 42% (450/1,052) responded at all 4 time points. Hazardous drinking was reported by 16% at T1, 14% at T2 and T3, and 15% at T4. Life events (p = 0.009) and mental distress (p = 0.002) were adjusted predictors of hazardous drinking, in addition to male gender, no religious activity, drinking to cope with tension, and low conscientiousness. CONCLUSIONS: Doctors' work-related stress was not linked to hazardous drinking, but life events, mental distress, and drinking to cope were. Prevention should target mental distress and drinking to cope with tension.

Risk Factors Measured During Medical School for Later Hazardous Drinking: A 10-year, Longitudinal, Nationwide Study (NORDOC).

AIMS: To investigate the prevalence and temporal patterns of hazardous drinking and risk factors during medical school for future hazardous drinking among doctors. METHODS: Two cohorts of graduating medical students (N = 1052) from all four Norwegian universities (NORDOC) were surveyed in their final year of medical school training (1993/94 and 1999) (T1) and again 4 (T2) and 10 (T3) years later. Longitudinally, 53% (562/1052) of the sample responded at all three time points. Hazardous drinking was defined as drinking five or more drinks during one session at least 2-3 times per month. Predictors of hazardous drinking, identified by logistic regression models after controlling for cohort, included a parental history of alcohol problems, having children, no religious activity, use of alcohol to cope with tension and some personality traits. RESULTS: There was a significant decline in the prevalence of hazardous drinking from T1 (14%) to T2 (10%) but not from T2 to T3 (8%). Approximately 23% of hazardous drinkers at T1 remained hazardous drinkers at T3 (N = 18). At T2, significant adjusted predictors included male gender (OR = 2.0, P = 0.04), use of alcohol as a coping strategy (OR = 2.2, P = 0.03) and hazardous drinking at T1 (OR = 9.8, P < 0.001). The significant adjusted predictors at T3 included older age (OR = 1.1, P = 0.01), male gender (OR = 3.6, P = 0.002) and hazardous drinking at T1 (OR = 7.5, P < 0.001). CONCLUSIONS: Hazardous drinking and drinking to cope with tension during medical school were the most important predictors of later hazardous drinking and should be targets of preventive efforts in medical schools.

Do work-related factors contribute to differences in doctor-certified sick leave? A prospective study comparing women in health and social occupations with women in the general working population.

BACKGROUND: Doctor -certified sick leave is prevalent in the health and social sector. We examined whether the higher risk of doctor-certified sick leave in women in health and social occupations compared to women in other occupations was explained by particular work-related psychosocial and mechanical risk factors. METHODS: A randomly drawn cohort aged 18-69 years from the general population in Norway was surveyed in 2009 (n = 12,255, response at baseline = 60.9 %), and was followed up in the national registry of social transfer payments in 2010. Eligible respondents were women registered with an active employee relationship for ≥100 actual working days in 2009 and 2010 (n = 3032). Using this sample, we compared health and social workers (n = 661) with the general working population (n = 2371). The outcome of interest was long-term sick leave (LTSL) ≥21 working days during 2010. Eight psychosocial and eight mechanical factors were evaluated. RESULTS: After adjusting for age, previous LTSL, education and working hours/week, women in health and social occupations had a higher risk for LTSL compared with women in the general working population (OR = 1.42, 95 % CI = 1.13-1.79; p = 0.003). After adjusting for psychosocial and mechanical factors, 70 % of the excess risk for LTSL was explained compared with the initial model. The main contributory factors to the increased risk were threats of violence and violence, emotional demands and awkward lifting. CONCLUSIONS: Psychosocial and mechanical factors explained much of the excess risk for LTSL in women in health and social occupations compared with working women in general. Psychosocial risk factors were the most important contributors.

The good doctor - strong and persevering. / Den gode legen ­ sterk og utholdende.

BACKGROUND: In today's society, doctors are confronted with a number of opposing interests, from other colleagues, patients and employers. The development and regulation of the medical profession have been widely studied. However, less research has been devoted to the doctors' own perception of what it means to be a good doctor. MATERIAL AND METHOD: We conducted eight focus-group interviews and three individual interviews among senior consultants and specialty registrars in the areas of surgery, psychiatry and internal medicine in two different hospitals. Total N = 48, of which 56 % were women. The interviews were analysed with the aid of systematic text condensation. RESULTS: «Professional dedication¼ demonstrated through «a high degree of attendance in the workplace¼ and «a high work capacity¼ were key topics for good doctors. Having a «high work capacity¼ was defined as being willing to go to great lengths, work overtime and work effectively. The senior consultants perceived their job as doctors more as a «lifestyle¼, while the specialty registrars more frequently regarded their work as a «job¼. INTERPRETATION: Norwegian hospital doctors wish to appear dedicated to their profession. They can demonstrate this by showing great willingness to work intensively and effectively with patients, while also going to great lengths to be available beyond normal working hours.

The hospital doctor of today - still continuously on duty. / Dagens sykehuslege ­ fremdeles alltid på vakt.

BACKGROUND: Norwegian hospital doctors emphasise the value of working hard and efficiently and of a high degree of attendance in the workplace. This helps establish social norms that guide behaviour within the professional culture. It is important to examine what consequences these values may entail when the doctor also needs to cater to his or her own needs. MATERIAL AND METHOD: We conducted eight focus-group interviews and three individual interviews among a total of 48 senior consultants and specialty registrars working in the areas of surgery, psychiatry and internal medicine. Total N = 48; 56 % women. The interviews were analysed with the aid of systematic text condensation. RESULTS: When Norwegian hospital doctors wish to appear as good doctors, they see that this entails consequences for the interrelationships with colleagues, the management and the work-life balance. Conflicts of interest arose between senior consultants and specialty registrars. Management initiatives to deal with absence, adaptation of the job to the life stage of each individual doctor and increased management involvement among doctors were among the measures proposed. INTERPRETATION: Better mutual knowledge between doctors and management with regard to each other's values and responsibilities could constitute key premises for structural changes, for example in terms of better planning of leaves of absence and opportunities for adaptation of work schedules to the life stage of the persons concerned.

Psychosocial and organizational risk factors for doctor-certified sick leave: a prospective study of female health and social workers in Norway.

BACKGROUND: Doctor-certified sick leave differs substantially across sectors, and among health and social workers, in particular, there is an increased risk. Previous studies have shown that work environmental factors contribute to sick leave. Hence, the identification of specific organizational and psychosocial risk factors for long- term sick leave, taking into account potential confounding related to mechanical risk factors such as lifting and awkward body postures, will be of importance in the work of prevention. METHODS: A randomly drawn population sample of Norwegian residents was interviewed about working conditions in 2009 (n = 12,255; response rate 60.9%). Female health and social care workers (n = 925) were followed in a national registry for subsequent sickness absence during 2010. The outcome of interest was doctor-certified sick leave of 21 days or more (long-term sick leave). Eleven work-related psychosocial and organizational factors were evaluated. RESULTS: In total, 186 persons (20.1%) were classified with subsequent long-term sick leave. After thoroughly adjusting for competing explanatory variables, the most consistent predictors for long-term sick leave were violence and threats of violence (OR = 1.67; 95% CI 1.14-2.45). The estimated population attributable risk for violence and threats of violence was 13%. CONCLUSIONS: The present study among female health and social care workers revealed a substantial relationship between self-reported violence and threats of violence and subsequent long- term sick leave.

The impact of economic factors on migration considerations among Icelandic specialist doctors: a cross-sectional study.

BACKGROUND: Globalization has facilitated the employability of doctors almost anywhere in the world. In recent years, the migration of doctors seems to have increased. However, we lack studies on doctors' migration from developed countries. Because the economic recession experienced by many countries might have affected the migration of doctors, research on this topic is important for the retention of doctors. Iceland was hit hard by the economic recession in 2008. Therefore, we want to explore how many specialist doctors in Iceland have considered migrating and whether economic factors at work and in private life, such as extensive cost-containment initiatives at work and worries about personal finances, are related to doctors' migration considerations. METHODS: In 2010, all doctors in Iceland registered with the Icelandic Medical Association were sent an electronic cross-sectional survey by email. The 467 specialists who participated in this study represent 55% of all specialist doctors working in Iceland. Information on doctors' contemplation of migration was available from responses to the question: "Have you considered moving and working abroad?" The predictor variables in our logistic regression model are perceived cost-containment initiatives at work, stress related to personal finances, experience of working abroad during vacations, job dissatisfaction, job position, age, and gender. RESULTS: Sixty-three per cent of Iceland's specialist doctors had considered relocation abroad, 4% were moving in the next year or two, and 33% had not considered relocating. Logistic regression analysis shows that, controlling for age, gender, job position, job satisfaction, and experience of working abroad during vacations, doctors' migration considerations were significantly affected by their experiences of cost-containment initiatives at work (odds ratio (OR) = 2.0, p < 0.01) and being stressed about personal finances (OR = 1.6, p < 0.001). Age, job satisfaction, and working abroad during vacations also had an effect, whereas job position did not. CONCLUSIONS: Economic factors affect whether specialist doctors in Iceland consider migration. More studies on the effect of economic recession on migration by doctors are needed.

Physicians' perceptions of quality of care, professional autonomy, and job satisfaction in Canada, Norway, and the United States.

BACKGROUND: We lack national and cross-national studies of physicians' perceptions of quality of patient care, professional autonomy, and job satisfaction to inform clinicians and policymakers. This study aims to compare such perceptions in Canada, the United States (U.S.), and Norway. METHODS: We analyzed data from large, nationwide, representative samples of physicians in Canada (n = 3,213), the U.S. (n = 6,628), and Norway (n = 657), examining demographics, job satisfaction, and professional autonomy. RESULTS: Among U.S. physicians, 79% strongly agreed/agreed they could provide high quality patient care vs. only 46% of Canadian and 59% of Norwegian physicians. U.S. physicians also perceived more clinical autonomy and time with their patients, with differences remaining significant even after controlling for age, gender, and clinical hours. Women reported less adequate time, clinical freedom, and ability to provide high-quality care. Country differences were the strongest predictors for the professional autonomy variables. In all three countries, physicians' perceptions of quality of care, clinical freedom, and time with patients influenced their overall job satisfaction. Fewer U.S. physicians reported their overall job satisfaction to be at-least-somewhat satisfied than did Norwegian and Canadian physicians. CONCLUSIONS: U.S. physicians perceived higher quality of patient care and greater professional autonomy, but somewhat lower job satisfaction than their colleagues in Norway and Canada. Differences in health care system financing and delivery might help explain this difference; Canada and Norway have more publicly-financed, not-for-profit health care delivery systems, vs. a more-privately-financed and profit-driven system in the U.S. None of these three highly-resourced countries, however, seem to have achieved an ideal health care system from the perspective of their physicians.

Mindfulness training for stress management: a randomised controlled study of medical and psychology students.

BACKGROUND: Distress and burnout among medical and psychology professionals are commonly reported and have implications for the quality of patient care delivered. Already in the course of university studies, medicine and psychology students report mental distress and low life satisfaction. There is a need for interventions that promote better coping skills in students in order to prevent distress and future burnout. This study examines the effect of a seven-week Mindfulness-Based Stress Reduction (MBSR) programme on mental distress, study stress, burnout, subjective well-being, and mindfulness of medical and psychology students. METHODS: A total of 288 students (mean age = 23 years, 76% female) from the University of Oslo and the University of Tromsø were randomly allocated to an intervention or control group. The control group continued with their standard university courses and received no intervention. Participants were evaluated using self-reported measures both before and after the intervention. These were: the 'General Health Questionnaire, Maslach Burnout Inventory Student version, Perceived Medical School Stress, Subjective Well-being, and Five Facet Mindfulness Questionnaire' and additional indices of compliance. RESULTS: Following the intervention, a moderate effect on mental distress (Hedges'g 0.65, CI = .41, .88), and a small effect on both subjective well-being (Hedges'g 0.40, CI = .27, .63) and the mindfulness facet 'non-reacting' (Hedges'g 0.33, CI = .10, .56) were found in the intervention group compared with the control group. A higher level of programme attendance and reported mindfulness exercises predicted these changes. Significant effects were only found for female students who additionally reported reduced study stress and an increase in the mindfulness facet 'non-judging'. Gender specific effects of participation in the MBSR programme have not previously been reported, and gender differences in the present study are discussed. CONCLUSION: Female medical and psychology students experienced significant positive improvements in mental distress, study stress, subjective well-being and mindfulness after participating in the MBSR programme. TRIAL REGISTRATION: NCT00892138.