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International Journal for Equity in Health

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Open Access 01-12-2015 | Research

Quality of life of young clinical doctors in public hospitals in China’s developed cities as measured by the Nottingham Health Profile (NHP)

Authors: Ying Liang, Hanwei Wang, Xiaojun Tao

Published in: International Journal for Equity in Health | Issue 1/2015

Abstract

Background

In contemporary Chinese society, obstacles such as frequent violence against medical workers and tense doctor–patient relationships affect the health of Chinese doctors. This study attempted to explore the quality of life (QOL) of young clinical doctors in public hospitals in China’s developed cities to study the psychometric properties of QOL and related risk factors of doctors’ health.

Methods

This study sampled young doctors aged 15–45 in 18 public hospitals of three cities in East China (Shanghai, Nanjing, and Hangzhou, N = 762). The Nottingham Health Profile was used to measure QOL, the dependent variable of this study. Methodologies such as reliability analysis, mean comparison, and exploratory factor analysis were used to study related psychometric properties.

Results

Almost 90 % of young Chinese clinical doctors have a bachelor’s degree or above. Approximately 70.4 % of the doctors have relatively low job titles. Among the sample, 76.1 % have a monthly income ranging from USD 326 to USD 1139, and 91.3 % work over eight hours daily. These respondents have poor sleeping habits and mental functions, but have relatively good physical functions. Being female, low education, low job title, low salary, and long work hours are factors associated with doctors’ poor QOL. Regression analysis results emphasize the great effect of high education on the improvement of QOL.

Conclusions

Young clinical doctors in public hospitals in Chinese developed cities have poor QOL. Reforms on the current medical health system, improving the working environment of doctors and relieve their occupational stress should be required.

Job titles in Chinese public hospitals from a low rank to a high rank are resident doctor, physician, associate chief physician, and chief physician. Doctors must pass an exam and accumulate certain years of working experience to be promoted. The assessment indices mainly refer to the clinical and academic performances of these doctors.

Felton JS. Burnout as a clinical entity—its importance in health care workers. Occup Med. 1998;48(4):237–50. doi:10.1093/occmed/48.4.237 CrossRef

Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377–85. doi:10.1001/archinternmed.2012.3199

Schaufeli WB, Maassen GH, Bakker AB, Sixma HJ. Stability and change in burnout: A 10‐year follow-up study among primary care physicians. J Occup Organ Psychol. 2011;84(2):248–67. doi:10.1111/j.2044-8325.2010.02013.x CrossRef

Williams SP, Zipp GP. Prevalence and Associated Risk Factors of Burnout Among US Doctors of Chiropractic. J Manipulative Physiol Ther. 2014;37(3):180–9. doi:10.1016/j.jmpt.2013.12.008 CrossRefPubMed

Tyssen R, Vaglum P, Grønvold NT, Ekeberg Ø. Suicidal ideation among medical students and young physicians: a nationwide and prospective study of prevalence and predictors. J Affect Disord. 2001;64(1):69–79. doi:10.1016/S0165-0327(00)00205-6 CrossRefPubMed

Hem E, Grønvold NT, Aasland OG, Ekeberg Ø. The prevalence of suicidal ideation and suicidal attempts among Norwegian physicians. Results from a cross-sectional survey of a nationwide sample. Eur Psychiatry. 2000;15(3):183–9. doi:10.1016/S0924-9338(00)00227-3 CrossRefPubMed

Tyssen R, Hem E, Vaglum P, Grønvold NT, Ekeberg Ø. The process of suicidal planning among medical doctors: predictors in a longitudinal Norwegian sample. J Affect Disord. 2004;80(2):191–8. doi:10.1016/S0165-0327(03)00091-0 CrossRefPubMed

Tyssen R, Hem E, Gude T, Grønvold NT, Ekeberg Ø, Vaglum P. Lower life satisfaction in physicians compared with a general population sample. Soc Psychiatry Psychiatr Epidemiol. 2009;44(1):47–54. doi:10.1007/s00127-008-0403-4 CrossRefPubMed

Williams S, Zipp GP, Cahill T, Parasher RK. Prevalence of Burnout Among Doctors of Chiropractic in the Northeastern United States. J Manipulative Physiol Ther. 2013;36(6):376–84. doi:10.1016/j.jmpt.2013.05.025 CrossRefPubMed

10.

Dewa CS, Loong D, Bonato S, Thanh NX, Jacobs P. How does burnout affect physician productivity? A systematic literature review. BMC Health Serv Res. 2014;14(1):325. doi:10.1186/1472-6963-14-325 PubMedCentralCrossRefPubMed

11.

Clarke D, Singh R. Life events, stress appraisals, and hospital doctors’ mental health. N Z Med J. 2004;117(1204):U1121.http://www.nzma.org.nz/journal/117-1204/1121/

12.

Baldwin PJ, Dodd M, Wrate RM. Young doctors’ health—II. Health and health behaviour. Soc Sci Med. 1997;45(1):41–4. doi:10.1016/S0277-9536(96)00307-3 CrossRefPubMed

13.

Buddeberg-Fischer B, Klaghofer R, Stamm M, Siegrist J, Buddeberg C. Work stress and reduced health in young physicians: prospective evidence from Swiss residents. Int Arch Occup Environ Health. 2008;82(1):31–8. doi:10.1007/s00420-008-0303-7 CrossRefPubMed

14.

Tyssen R, Vaglum P. Mental health problems among young doctors: an updated review of prospective studies. Harv Rev Psychiatry. 2002;10(3):154–65. doi:10.1080/10673220216218 CrossRefPubMed

15.

Starostina EG, Moshnyaga EN. Emotional burn-out in medical doctors in the Moscow region. Eur Psychiatry. 2007;22:S41. doi:10.1016/j.eurpsy.2007.01.163

16.

Porto GG, Carneiro SC, Vasconcelos BC, Nascimento MM, Leal JLF. Burnout syndrome in oral and maxillofacial surgeons: a critical analysis. Int J Oral Maxillofac Surg. 2014;43(7):894–9. doi:10.1016/j.ijom.2013.10.025 CrossRefPubMed

17.

Pienaar J, Willemse SA. Burnout, engagement, coping and general health of service employees in the hospitality industry. Tour Manage. 2008;29(6):1053–63. doi:10.1016/j.tourman.2008.01.006 CrossRef

18.

Zwack J, Schweitzer J. If every fifth physician is affected by burnout, what about the other four? Resilience strategies of experienced physicians. Acad Med. 2013;88(3):382–9. doi:10.1097/ACM.0b013e318281696b

19.

Ling L, Qin S, Shen LF. An investigation about learning burnout in medical college students and its influencing factors. Int J Nurs Sci. 2014;1(1):117–20. doi:10.1016/j.ijnss.2014.02.005

20.

Panagopoulou E, Montgomery A, Benos A. Burnout in internal medicine physicians: Differences between residents and specialists. Eur J Intern Med. 2006;17(3):195–200. doi:10.1016/j.ejim.2005.11.013 CrossRefPubMed

21.

Ogundipe OA, Olagunju AT, Lasebikan VO, Coker AO. Burnout among doctors in residency training in a tertiary hospital. Asian Journal of Psychiatry. 2014; http://dx.doi.org/10.1016/j.ajp.2014.02.010

22.

Andrade-Nascimento M, Barros DS, Nascimento Sobrinho CL. Professional burnout syndrome among intensive care physicians in salvador. Braz Eur Psychiatry. 2013;28:1. http://dx.doi.org/10.1590/S0104-42302009000600009

23.

Yang T, Zhang H, Shen F, Li J. W, Wu MC. Appeal from Chinese doctors to end violence. Lancet, 2013; 382(9906): 1703-1704. doi:10.1016/S0140-6736(13)62401-0

24.

Wada K, Yoshikawa T, Goto T, Hirai A, Matsushima E, Nakashima Y, et al. Association of depression and suicidal ideation with unreasonable patient demands and complaints among Japanese physicians: a national cross-sectional survey. Int J Behav Med. 2011;18(4):384–90. doi:10.1007/s12529-010-9132-7

25.

Yip WCM, Hsiao WC, Chen W, Hu S, Ma J, Maynard A. Early appraisal of China’s huge and complex health-care reforms. The Lancet. 2012;379(9818):833–42. doi:10.1016/S0140-6736(11)61880-1 CrossRef

26.

Zhou Z, Zhu L, Zhou Z, Li Z, Gao J, Chen G. The effects of China’s urban basic medical insurance schemes on the equity of health service utilisation: evidence from Shaanxi Province. Int J Equity Health. 2014;13(1):23. doi:10.1186/1475-9276-13-23

27.

Meng Q, Xu L, Zhang Y, Qian J, Cai M, Xin Y, et al. Trends in access to health services and financial protection in China between 2003 and 2011: a cross-sectional study. The Lancet. 2012;379(9818):805–14. doi:10.1016/S0140-6736(12)60278-5

28.

Hu S, Tang S, Liu Y, Zhao Y, Escobar ML, Ferranti D. Reform of how health care is paid for in China: challenges and opportunities. The Lancet. 2008;372(9652):1846–53. doi:10.1016/S0140-6736(08)61368-9 CrossRef

29.

Lim MK, Yang H, Zhang T, Zhou Z, Feng W, Chen Y. China’s evolving health care market: how doctors feel and what they think. Health Policy. 2004;69(3):329–37. doi:10.1016/j.healthpol.2004.01.001 CrossRefPubMed

30.

Fu J, Sun W, Wang Y, Yang X, Wang L. Improving job satisfaction of Chinese doctors: the positive effects of perceived organizational support and psychological capital. Public Health. 2013;127(10):946–51. doi:10.1016/j.puhe.2012.12.017 CrossRefPubMed

31.

Wang JN, Sun W, Chi TS, Wu H, Wang L. Prevalence and associated factors of depressive symptoms among Chinese doctors: a cross-sectional survey. Int Arch Occup Environ Health. 2010;83(8):905–11. doi:10.1007/s00420-010-0508-4 CrossRefPubMed

32.

Wu H, Zhao Y, Wang JN, Wang L. Factors associated with occupational stress among Chinese doctors: a cross-sectional survey. Int Arch Occup Environ Health. 2010;83(2):155–64. doi:10.1007/s00420-009-0456-z CrossRefPubMed

33.

Sun W, Fu J, Chang Y, Wang L. Epidemiological study on risk factors for anxiety disorder among Chinese doctors. J Occup Health. 2012;54(1):1–8. doi:http://doi.org/10.1539/joh.11-0169-OA CrossRefPubMed

34.

Wu H, Liu L, Wang Y, Gao F, Zhao X, Wang L. Factors associated with burnout among Chinese hospital doctors: a cross-sectional study. BMC Public Health. 2013;13(1):786. doi:10.1186/1471-2458-13-786 PubMedCentralCrossRefPubMed

35.

Chen X, Tan X, Li L. Health problem and occupational stress among Chinese doctors. Chin Med. 2013;4:1. doi:10.4236/cm.2013.41001 CrossRef

36.

Liang Y. The strengths perspective and system theory Two perspectives of social work. Academia Bimestrie. 2013;4:70–8.

37.

Keyes CLM. Mental illness and/or mental health? Investigating axioms of the complete state model of health. J Consult Clin Psychol. 2005;73(3):539. http://dx.doi.org/10.1037/0022-006X.73.3.539 CrossRefPubMed

38.

WHO, definition of Health, Retrieved July 15, 2015 from http://www.who.int/trade/glossary/story046/en/

39.

Orley J, Saxena S, Herrman H. Quality of life and mental illness. Reflections from the perspective of the WHOQOL. Br J Psychiatry. 1998;172(4):291–3. doi:10.1192/bjp.172.4.291 CrossRefPubMed

40.

Felce D, Perry J. Quality of life: Its definition and measurement. Res Dev Disabil. 1995;16(1):51–74. doi:10.1016/0891-4222(94)00028-8 CrossRefPubMed

41.

McEwen J. The Nottingham health profile, (Walker SR, Rosser RM. Ed.) Quality of life assessment: key issues in the 1990s. London: Springer Netherlands, 1993: 111-130.

42.

Saxena S, Orley J, WHOQOL Group. Quality of life assessment: the World Health Organization perspective. Eur Psychiatry. 1997;12:263s–6s. doi:10.1016/S0924-9338(97)89095-5

43.

Wilson IB, Cleary PD. Linking clinical variables with health-related quality of life: A conceptual model of patient outcomes. JAMA. 1995;273(1):59–65. doi:10.1001/jama.1995.03520250075037.CrossRefPubMed

44.

Morris J, Perez D, McNoe B. The use of quality of life data in clinical practice. Qual Life Res. 1997;7(1):85–91. doi:10.1023/A:1008893007068 CrossRef

45.

Patrick DL, Erickson P. Assessing health-related quality of life for clinical decision-makin. In: Walker SR, Rosser RM, editors. Quality of life assessment: Key issues in the 1990s. London: Springer Netherlands; 1993. p. 11–63.CrossRef

46.

Wright EP, Selby PJ, Crawford M, Gillibrand A, Johnston C, Perren TJ, et al. Feasibility and compliance of automated measurement of quality of life in oncology practice. J Clin Oncol. 2003;21(2):374–82. doi:10.1200/JCO.2003.11.044

47.

Velikova G, Booth L, Smith AB, Brown PM, Lynch P, Brown JM, et al. Measuring quality of life in routine oncology practice improves communication and patient well-being: a randomized controlled trial. J Clin Oncol. 2004;22(4):714–24. doi:10.1200/JCO.2004.06.078

48.

He M, Wang Q, Zhu S, Tan A, He Q, Chen T, et al. Health-related quality of life of doctors and nurses in China: findings based on the latest open-access data. Qual Life Res. 2012;21(10):1727–30. doi:10.1007/s11136-011-0088-0

49.

NBSC. 2014 statistical yearbook. Beijing: China Statistics Press; 2014. retrieved from http://www.stats.gov.cn/tjsj/ndsj/2014/indexch.htm.

50.

Hunt SM, McKenna SP, McEwen J, Williams J, Papp E. The Nottingham Health Profile: subjective health status and medical consultations. Social Science & Medicine. Med Psychol Med Sociol. 1981;15(3):221–9. doi:10.1016/0271-7123(81)90005-5

51.

Kohlmann T, Bullinger M, Kirchberger-Blumstein I. German version of the Nottingham Health Profile (NHP): translation and psychometric validation. Sozial-und Praventivmedizin. 1996;42(3):175–85. doi:10.1007/BF01300568 CrossRef

52.

Wiklund I. The Nottingham Health Profile--a measure of health-related quality of life. Scandinavian journal of primary health care. Supplement. 1989;1:15–8.

53.

Hunt SM, McEwen J, McKenna SP. Measuring health status: a new tool for clinicians and epidemiologists. J R Coll Gen Pract. 1985;35(273):185–8.PubMedCentralPubMed

54.

Jenkinson C, Fitzpatrick R, Argyle M. The Nottingham Health Profile: an analysis of its sensitivity in differentiating illness groups. Soc Sci Med. 1988;27(12):1411–4. doi:10.1016/0277-9536(88)90207-9 CrossRefPubMed

55.

Mitchell RA, Imperial E, Zhuo D, Lu Y, Watts G, Kelleher P, et al. A cross-cultural assessment of perceived health problems in the elderly. Disabil Rehabil. 1992;14(3):133–5. doi:10.3109/09638289209165848

56.

Li J, Fielding R. The measurement of current perceived health among Chinese people in Guangzhou and Hong Kong, southern China. Qual Life Res. 1995;4(3):271–8. doi:10.1007/BF02260866 CrossRefPubMed

57.

Xu D, Sun B, Wan X, Ke Y. Reformation of medical education in China. The Lancet. 2010;375(9725):1502–4. doi:10.1016/S0140-6736(10)60241-3

58.

Sun S, Wang W. Violence against Chinese health-care workers. The lancet. 2011;377(9779):1747. doi:10.1016/S0140-6736(11)60732-0 CrossRef

59.

OECD health Statistics yearbook 2014, Human care resources, physicians, density per 1 000 population, Retrieved July 15 2015 from http://www.oecd.org/els/health-systems/oecd-health-statistics-2014-frequently-requested-data.htm

60.

Firth-Cozens J. Interventions to improve physicians’ well-being and patient care. Soc Sci Med. 2001;52(2):215–22. doi:10.1016/S0277-9536(00)00221-5 CrossRefPubMed

61.

Schernhammer ES, Colditz GA. Suicide rates among physicians: a quantitative and gender assessment (meta-analysis). Am J Psychiatry. 2004;161(12):2295–302. http://dx.doi.org/10.1176/appi.ajp.161.12.2295 CrossRefPubMed

62.

Liang Y, Cao R. Is the health status of female victims poorer than males in the post-disaster reconstruction in China: a comparative study of data on male victims in the first survey and double tracking survey data. BMC Womens Health. 2014;14(1):18. doi:10.1186/1472-6874-14-18 PubMedCentralCrossRefPubMed

63.

Liang Y, Guo M. Utilization of health services and health-related quality of life research of rural-to-urban migrants in China: a cross-sectional analysis. Social Indicators Research, 2014; 1–19. doi:10.1007/s11205-014-0585-y

64.

Liang Y, Wu W. Exploratory analysis of health-related quality of life among the empty-nest elderly in rural China: An empirical study in three economically developed cities in eastern China. Health Qual Life Outcomes. 2014;12(1):59. doi:10.1186/1477-7525-12-59 PubMedCentralCrossRefPubMed

65.

Rout U, Rout R, Rout JK. Stress, mental health and satisfaction among women doctors in England. Eur Psychiatry. 2008;23:S88–9.CrossRef

66.

Zhou Y, Zhou L, Fu C, Wang Y, Liu Q, Wu H, Zhang R, Zheng L. Socio-economic factors related with the subjective well-being of the rural elderly people living independently in China. Int J Equity Health. 2015;14(1):5. doi:10.1186/s12939-015-0136-4

67.

Tang TLP. Income and quality of life: Does the love of money make a difference? J Bus Ethics. 2007;72(4):375–93. doi:10.1007/s10551-006-9176-4 CrossRef

68.

Sonnentag S, Zijlstra FR. Job characteristics and off-job activities as predictors of need for recovery, well-being, and fatigue. J Appl Psychol. 2006;91(2):330. http://dx.doi.org/10.1037/0021-9010.91.2.330 CrossRefPubMed

69.

Baldwin PJ, Dodd M, Wrate RW. Young doctors' health—I. How do working conditions affect attitudes, health and performance?. Soc Sci Med, 1997; 45(1): 35-40. doi:10.1016/S0277-9536(96)00306-1

70.

Tyssen R, Røvik JO, Vaglum P, Grønvold NT, Ekeberg Ø. Help-seeking for mental health problems among young physicians: is it the most ill that seeks help? Soc Psychiatry Psychiatr Epidemiol. 2004;39(12):989–93. doi:10.1007/s00127-004-0831-8 CrossRefPubMed

71.

Ross CE, Van Willigen M. Education and the subjective quality of life. J Health Soc Behav. 1997;38(3):275–97.CrossRefPubMed

72.

Ross CE, Mirowsky J. Refining the association between education and health: The effects of quantity, credential, and selectivity. Demography. 1999;36(4):445–60. doi:10.2307/2648083 CrossRefPubMed

73.

Zheng P, Faunce T, Johnston K. Public hospitals in China: privatisation, the demise of universal health care and the rise of patient-doctor violence. J Law Med. 2006;13(4):465–70.PubMed

74.

Liang Y, Lu P. Medical insurance policy organized by Chinese government and the health inequity of the elderly: longitudinal comparison based on effect of New Cooperative Medical Scheme on health of rural elderly in 22 provinces and cities. Int J Equity Health. 2014;13(1):1–15. doi:10.1186/1475-9276-13-37 CrossRef

75.

Yip W, Hsiao WC. The Chinese health system at a crossroads. Health Aff. 2008;27(2):460–8. doi:10.1377/hlthaff.27.2.460 CrossRef

76.

Zhang X, Sleeboom-Faulkner M. Tensions between medical professionals and patients in mainland China. Camb Q Healthc Ethics. 2011;20(03):458–65. http://dx.doi.org/10.1017/S0963180111000144 CrossRefPubMed

77.

Hesketh T, Wu D, Mao L, Ma N. Violence against doctors in China. BMJ. 2012;345, e5730. doi:10.1136/bmj.e5730

78.

Liu C, Liu W, Wang Y, Zhang Z, Wang P. Patient safety culture in China: a case study in an outpatient setting in Beijing. BMJ Qual Saf. 2013;23(7):556–64. doi:10.1136/bmjqs-2013-002172 PubMedCentralCrossRefPubMed

79.

Arnetz JE, Arnetz BB. Violence towards health care staff and possible effects on the quality of patient care. Soc Sci Med. 2001;52(3):417–27. doi:10.1016/S0277-9536(00)00146-5 CrossRefPubMed

80.

Liu Y. China’s public health-care system: facing the challenges. Bull World Health Organ. 2004;82(7):532–8. http://dx.doi.org/10.1590/S0042-96862004000700011

81.

Liang Y. Citizen Governance in the green community: Partnership between green volunteers and social workers. Jiangsu Social Sciences. 2013;4:114–20.

Title: Quality of life of young clinical doctors in public hospitals in China’s developed cities as measured by the Nottingham Health Profile (NHP)
Authors: Ying Liang
Hanwei Wang
Xiaojun Tao
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: International Journal for Equity in Health / Issue 1/2015
Electronic ISSN: 1475-9276
DOI: https://doi.org/10.1186/s12939-015-0199-2

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Quality of life of young clinical doctors in public hospitals in China’s developed cities as measured by the Nottingham Health Profile (NHP)

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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