Home Current Issue Previous Issues Published Ahead-of-Print Collections For Authors Journal Info
Skip Navigation LinksHome > July 2012 - Volume 29 - Issue 7 > Job satisfaction, stress and burnout in anaesthesia: releva...
European Journal of Anaesthesiology:
doi: 10.1097/EJA.0b013e328352816d

Job satisfaction, stress and burnout in anaesthesia: relevant topics for anaesthesiologists and healthcare managers?

Rama-Maceiras, Pablo; Parente, Suzana; Kranke, Peter

Free Access
Article Outline
Collapse Box

Author Information

From the Department of Anaesthesia and Perioperative Medicine, Complejo Hospitalario Universitario A Coruña, Spain (PRM), Department of Anaesthesia, Centro Hospitalar Lisboa Occidental, Alges, Lisboa, Portugal (SP) and Department of Anaesthesia and Critical Care, University Hospital of Würzburg, Oberdürrbacher, Germany (PK)

Correspondence to Pablo Rama-Maceiras, Department of Anaesthesia and Perioperative Medicine, Complejo Hospitalario Universitario A Coruña, C/Xubias de Arriba n° 84, CP 15006, A Coruña, SpainTel: +34 981 178152; e-mail: prmaceiras@wanadoo.es;pablo.rama.maceiras@sergas.es

Published online 2 April 2012

Collapse Box


Job satisfaction is defined as an employee's positive reaction towards his/her work. Changes in health policies, which are seen as a threat to the autonomy of health workers, are associated with a decrease in satisfaction levels, increase burnout among physicians, and may impair the quality and safety of care. The work environment of anaesthesiologists include stressful areas such as the operating theatre, the ICU, and the emergency setting, and this has been linked to higher levels of stress and lower satisfaction. We frequently lack feedback from patients and even our colleagues despite usually working within a team. Nevertheless, job satisfaction and burnout rates in anaesthesia are similar to other specialties. The most relevant factors in job satisfaction are worker autonomy, control of the working environment, recognition of our value, professional relationships, leadership and organisational justice. Although these can be manipulated for good or otherwise, there are additional, less malleable factors such as personality, expectations and motivation of the employee, that play a part. Within organisations there needs to be the will to evaluate employees’ satisfaction, to improve their work environment and to develop strategies and coping mechanisms for professional stress. Personal wellness should also be nurtured, as a satisfactory work-life balance and an adequate social support network might act as a buffer for dissatisfaction and burnout. Improvement in satisfaction might create a positive work climate that would benefit both the safety of our patients and our profession.

This article is accompanied by the following Invited Commentary:

Lindfors P. Reducing stress and enhancing well-being at work: are we looking at the right indicators? Eur J Anaesthesiol 2012; 29:309–310.

Back to Top | Article Outline


‘I am working too hard’

‘I don’t get enough time with my family’

‘I spend too much time on paperwork’

Recent surveys indicate that these are common complaints of physicians.1,2 They all reveal a decrease in job satisfaction. We may find a reason for these comments in recent changes to health systems.3 In particular, the role of the physician has moved from a ‘central position’, in which the autonomy of each individual doctor is not questioned, to a point wherein we are under pressure to deliver results.4 Pressures from cost-containment policies and the demands of patients and society have led to a decrease in the time spent with our patients, a loss of influence in the decision-making process, and a reduction in our permitted margin of error.5 These factors may well have contributed to an increase in stress and a decrease in satisfaction among physicians.1,3,6–8

The current review offers a conceptual framework for job satisfaction and the factors that affect it, and suggests practical measures on how it might be improved, not simply for the sake of the physician[Combining Acute Accent]s well being but also for the safety of our health systems.

Back to Top | Article Outline

Stress at work, dissatisfaction and their consequences

Stress – according to contemporary definitions – is a nonspecific adaptive response intended to maintain the status quo in the face of any challenge or trauma.7 It is not inherently bad when it can be managed with both proper cognitive evaluation (using psychological filters and appraisal of the stress factors, based on our memory and past experiences) and with coping strategies.7 But in the absence of these supports, stress can lead to a decrease in satisfaction and impair our mental and physical health.9 The result may be burnout,10 a syndrome that combines emotional exhaustion (overextended by work), depersonalisation (treating people in an impersonal way), and a sense of low personal accomplishment (feeling of incompetence and lack of achievement at work; Fig. 1).11

Fig. 1
Fig. 1
Image Tools

Burnout plays a key role in the impairment of physicians’ relationships with other members of the health team, disrupting collaboration and setting the scene for depression or substance abuse.12,13 There is an associated trend to quit or decrease work activity,6 further impairing the quality of teamwork and the care delivered.14–16 The final consequence is likely to be an increase in expenditure for the health system17 fuelling in turn greater cost-containment policies and further stress generation, tightening this vicious circle.6

This link, between stress, satisfaction and burnout, and their consequences, has been confirmed. Studies indicate that for the same level of stress, good job satisfaction offers some protection against burnout and maintains mental health, compared with poor satisfaction.18–22 Dissatisfied health employees are the most vulnerable to burnout, leading to a reduction in safety23,24 and even in the level to which patients adhere to their treatment.17,25 Conversely, satisfied physicians tend to be more committed to the work of their organisation,26 increase productivity – because job satisfaction is a prerequisite for a good work process27 – and decrease treatment costs as well. Satisfied employees promote satisfied patients.26,28,29 Accordingly, employees’ satisfaction should be a strategic goal of health organisations.3,30

Back to Top | Article Outline

Defining and evaluating job satisfaction and burnout

If ‘job satisfaction’ is defined as an employee's positive affective reaction,9,31 there are immediate problems related to its assessment by quantitative methods. There is no strong evidence as to how such a subjective outcome should be measured and expressed. Studies of stress at work and job satisfaction mainly use questionnaires and scales,14,20,32–34 making adequate comparisons difficult.20 Surveys and questionnaires are usually cross-sectional, which limits the development of causal inferences. Because they are usually designed to assess a priori theories and models of job satisfaction, they are often based on low sample populations, and subjective perceptions are exposed to sampling or participation bias and low response rates, and sometimes exclude relevant factors that affect the final outcome.

The Maslach Burnout Inventory is probably the most widely accepted test of burnout.11 It includes 22 questions relating to the three domains of burnout, and every item is rated on a 7 point Likert-type scale. The total score for each domain is evaluated according to predetermined cutoff scores.14 Scores are considered high if they are in the upper third of the normal distribution. High scores on the emotional exhaustion and depersonalisation domains and low scores on the personal accomplishment scale indicate a high degree of burnout.

Back to Top | Article Outline

Job satisfaction models and theories

A helpful way to consider satisfaction is the Maslow hierarchy of needs (Fig. 2).35 This theory views our needs as a pyramid with the most basic needs at the bottom; as soon as one need has been met, we move to the next level, searching for safety, social acceptance, self-esteem and self-actualisation in the development of our full potential. The Maslow model has been slightly modified for the work setting,3,36 making wages the basic need, and seeing training as reinforcing a feeling of safety. Further up the pyramid, we head towards sense of belonging, recognition and finally new challenges at work.

Fig. 2
Fig. 2
Image Tools

However, Maslow's hierarchy is not the only model for job satisfaction (Fig. 3). The ‘Affect theory’ suggests that job satisfaction is the balance between employee expectations and their achievements,37 the ‘Dispositional theory’ gives a relevant role to the innate characteristics of the employee (that is personality),38 the ‘Two factor theory’ links satisfaction to motivation,39 and the ‘Job characteristics model’ correlates job satisfaction to the tasks, skill variety, autonomy and feedback received.40 Last but not least, the ‘Reciprocal influence theory’ emphasises the relationship between the team members and between managers and employees.41 Similarly for stress, the ‘Job-Demand Control Model’ tells us that stress at work is the balance between workload and the resources available to manage that workload,42 and finally, the ‘Effort-Reward Imbalance Model’ suggests that stress is related to the lack of Organisational Justice, that is, the imbalance between demands and rewards in the work place.43

Fig. 3
Fig. 3
Image Tools

Some of the factors in these theories are employee or physician-related (intrinsic), as seen in Fig. 3, whereas others are related to job characteristics (extrinsic). The latter are considered more malleable when developing organisational strategies to improve satisfaction, but intrinsic factors should also be taken into account. Positively disposed employees develop more realistic expectations about their job and about life in general, and they are usually more satisfied,10,44 whereas negatively disposed individuals who dwell on negative aspects are often less satisfied with their jobs.9,18,44–46 These are arguments for promoting coping strategies tailored to the personality of each employee. 25

Back to Top | Article Outline

Am I at risk for job dissatisfaction or burnout?

Given that stress factors, job characteristics and personality affect satisfaction, it is easy to imagine that physicians working in inadequate environments (demanding jobs, steep hierarchical organisations, larger sized teams and jobs with few opportunities for reward) are more prone to job dissatisfaction. To this we can add overcommitted employees with high expectations, and lack of social support networks.21,22,44,47–49 Other important risk factors are interference with the homework balance,50 poor control over workload,31 lack of resources and lower levels of experience.6,47,51,52 The development of coping mechanisms or a better financial position can explain the lower rate of dissatisfaction among experienced physicians,33 although a ‘survival bias’ after early retirement of dissatisfied physicians leaving a core of more satisfied employees, could also explain the link between satisfaction and experience showed in some surveys.1 Poor health status can also be considered a risk factor because it has been shown to influence work ability, and to be related to burnout.31,53

Satisfaction appears to be independent of the nature of practice, whether public or private.54 The latter seems to offer higher incomes, greater control over job and organisational justice,55 but public service offers better opportunities for teaching and research,56,57 all sources of greater satisfaction. It is possible that personalities of physicians and the profiles of patients, together with the nature of stress factors, might differ between private and public practice, biasing the results.55

Physicians in leading positions are usually more satisfied in their job, but dysfunctional workplaces show a different pattern, wherein employee satisfaction does not increase as a function of job level.58 The main reasons for higher satisfaction levels seen in managers are achievement of better working conditions, promotional opportunities and autonomy.58 On the contrary, an excess of administrative duties, and involvement in strategic plans, disciplinary actions and budgetary issues, have a negative impact on managers’ satisfaction.49,59

Finally, the role of sex in satisfaction is confused. Some studies have shown lower satisfaction and a higher level of stress among women,14,52 related to greater responsibility in the home or to discrimination in the workplace,31,60 whereas others found no differences between men and women.20,48 The continuing increase in physicians who are women, and in the fraction of part-time workers will merit special attention in the future.14,31

Some of the factors described above will be recognised by anaesthesiologists, and about one quarter of us are at risk of burn-out,47,59 although the figures vary depending on the country and the cutoff being considered.20,33 Satisfaction rates among anaesthesiologists are about 71–75%,31,32 which are similar to other medical specialties56,61 and greater than other hospital staff.62

Back to Top | Article Outline

Job satisfaction in anaesthesia

The main determinants of dissatisfaction for anaesthesiologists are professional stress, the nature of our jobs, and our personalities.

Back to Top | Article Outline
Sources of stress

Through our activities in the operating theatre, the ICU, preoperative assessment, the management of acute and chronic pain, the emergency area and even in quality assurance and management,14 anaesthesiologists provide a service to 50–60% of hospital patients.63,64 All of these areas place high demands on safety, quality of care and efficiency,27,63,65 but they also have obvious and well known sources of stress (Table 1).14,52,66,67 These have been classified into four different domains, difficult medical situations; moments of work overload; decision-making in difficult areas – especially ethical and critical decisions – and problems with lack of respect and recognition.32,68

Table 1
Table 1
Image Tools

Moral distress, which occurs when a caregiver knows the ethically appropriate course of action to take but is unable to act upon it, is common for nurses and anaesthesiologists providing treatment or surgical procedures of little or no benefit.66,69 Typical reactions to moral distress include withdrawal for nurses and anger for physicians, both negatively affecting collaboration in the workplace. Finally, the absence of a well defined and organised department has also been associated with stress.14

Back to Top | Article Outline
Job characteristics

The factors that can improve or impair job satisfaction in anaesthesia are similar to those suggested for other specialties. Improvement requires good relationships with patients and colleagues, recognition at work, autonomy and control over your job, intellectual stimulation and providing good quality care,18,31,32,47 whereas heavy workload, lack of justice, poor recognition or interference with social life are all linked to dissatisfaction.70 Because anaesthesia usually provides the means to achieve a medical outcome rather than being an end itself,14 we are left with the feeling of immediacy and without positive feedback from our patients and colleagues. This is another source of dissatisfaction.14,18 Being well regarded by surgical colleagues and patients, and being provided with adequate assistance contributes to job satisfaction.14,32 Shortage of anaesthesiologists and financial pressures of the health system can make it difficult to get this assistance.71 Also, our role as a support specialty requires team working, wherein conflict72,73 and disruptive behaviour can occur, interfering not only with quality and patient safety, but also with performance and satisfaction of team members.73,74

Back to Top | Article Outline

One interesting Swedish qualitative investigation reveals four nonexclusive ‘types’ of anaesthesiologists, all with different needs in terms of job satisfaction.75 The first group is the so-called ‘professional artists’. They see the patient as a physiological object and find satisfaction solving immediate difficult problems. ‘The Samaritans’ compose the second group; they see the patient as an individual, and their reward is relieving suffering. The third group is ‘the servants’, as they are like helpers for the helpers, and find satisfaction in servicing other actors (mainly the surgeons) in their roles. Finally, last but not least are ‘the coordinators’, those with an innate tendency to organise, to make the system work better.75

A similar survey of residents revealed two additional categories: those ‘following the protocol’, probably the most basic, who found satisfaction seeing the expected results at completion of the procedure or treatment, and those ‘learning from every new patient’, concentrating on their own competence development.76

Back to Top | Article Outline

Job satisfaction: finding solutions

When all the pieces of the puzzle are assembled it would seem that there are at least three main groups of strategies for managing job satisfaction: institutional policies, teaching and learning how to handle the stress factors of our profession, and finally personal and ‘different’ solutions.1,77

With regard to institutional policies, we could put into practice measures to enhance organisational support (Fig. 4). Promoting the participation of the employee in the decision-making process, and increasing their autonomy and control over the job is considered the ‘big motivator’, and is also the most effective way to improve job satisfaction.3,5,10,18,27,28,78,79 Because individuals dislike being manipulated, unappreciated and disrespected, decisions made by their organisations should be less autocratic and more consultative or even delegative,80,81 encouraging employees to identify problems and suggest solutions.3,20 This creates a challenging environment, wherein employees are more involved and have the chance to train, learn and develop new skills.80

Fig. 4
Fig. 4
Image Tools

Two examples of how this stimulating environment works are seen in job rotation and the role of seniors. Job rotation can promote ‘recycling’ or professional development78 and can increase variety at work, avoiding monotony.18,82 Seniors can act as mentors,51 teaching younger employees to cope with difficult situations,83 and this effort must be rewarded.78 Nonsalary incentives are important in increasing motivation78,84 and employee self-esteem28,80 through both job recognition and professional development, but they must be managed with a great sense of organisational justice (people perception of fairness in the organisation)85 and always with patient benefit in mind.17,86 Economic rewards must be competitive to avoid dissatisfaction, but their role is often secondary because satisfaction solely based on money is often temporary.28

Leaders play a key role in promoting professional wellbeing,87 developing beneficial policies, enhancing team spirit, and acting as role models.28,69,86 They should help the employee to maintain a satisfactory work-life balance, and promote effective communication,14 listening rather than dictating, and flattening the hierarchy.85,88 Communication should be bidirectional to foster trust, mutual understanding and good relationships,69 and should attempt to align both the goals of the workers and the organisation,27,29,89 and encourage the employees to move from ‘expressing constraints’ to ‘constructive problem solving’.90 Managers are usually appointed for their personal medical skills and/or qualifications, but they often lack training in leadership,91 so training programs for managers should also be developed to help with communication and decision-making styles.85

Finally, organisations should learn nontechnical skills (situation awareness, resource management, communication, decision-making, teamwork and leadership92,93) to help employees resolve conflicts and crises.72,94 Incidents in anaesthesia are often related to nontechnical skills,95 and only 45% of physicians considered themselves to have adequate training in these skills.18 Briefings,96 periods of reflection after crises,97 and counselling98 can improve team performance.

Fundamental to any organisation's strategy is periodic assessment of patients’ perceptions, performance and job satisfaction.9,25 They should be assessed every 12–18 months and not longer than 2 years.26,28 Following evaluation, institutions should be prepared to act on the results because exercises of this nature generate a feeling of change that seems less threatening because it originates from colleagues rather than managers.90 Lastly, we must be patient because results are not immediate.9

The second group of strategies involves teaching and learning about stress management for anaesthesiologists, as overload impedes career development and can even impair safety.51 There are two main strategies, either solving problems or converting threats into positive challenges.68,99 Difficult technical and medical situations can be made easier by sharing with helpful colleagues,66 but at times there needs to be an understanding of the limitations of our own profession, and even the limits of our own competence. We must sometimes be prepared for failure. Overload can be managed by prioritising or delegating work and getting help from colleagues, but also learning to say ‘No’ in some circumstances.77 Unfortunately, difficult ethical decisions, conflict and lack of respect are difficult to cope with and must be managed mainly through proper communication and discussion with colleagues.68,73

The last group of solutions are more ‘personal’, but are nevertheless relevant because our lives serve as a buffer for stress.1 If we understand satisfaction to be a subjective reaction, we must learn to increase this feeling through our ‘small daily triumphs’,6 like a patient waking up with a smile on his face or giving you thanks after her complicated postoperative care. Some strategies that can also help to increase personal wellness – a definition that goes beyond the absence of distress and includes achieving success in various aspects of personal and professional life100 – are cultivating your relationships, sharing personal reflections (shared reflective writing), practising meditation, nurturing self-care and developing hobbies.6,101,102 Not surprisingly, these solutions are rarely promoted by health organisations, but they should be put into practice in our personal lives. A change to another specialty or even to other fields of medicine (management, pharmaceutical industry) is still an option,6,103 but it is not always feasible or desirable. Choosing a positive attitude towards our job may sometimes be difficult, but it is usually rewarding, and improves our work environment.104

Back to Top | Article Outline


In this review, we have depicted stress at work, dissatisfaction and burnout as dysfunction within health systems, and shown how the promotion of job satisfaction could help our organisations. Because anaesthesia is not very different from other specialties, we should try to achieve job satisfaction by attention to three areas: improving job characteristics, managing stress and developing personal wellness.

If you are a manager, try to develop policies in your institution or department to promote the ‘big four’: to create an adequate environment that fosters communication, to increase participation and autonomy of the employees, to promote control over work to avoid overload, and try to recognise the achievements of the workers, making them feel secure, needed and appreciated.

If you are an employee, do not moan continually about every shortcoming, and even if you believe that the system is never going to change, try to make change yourself. You can improve your sense of wellbeing by learning how to manage stress better, how to balance personal and professional goals, how to develop personal wellness strategies or simply find reward in the gratitude of those patients who think that their outcome was better because you were there. Finally, remember that although medicine needs a scientific and rationale basis, its physicians are human beings, with passions and emotions,105 which can be harnessed to help us get job and life satisfaction, even in this current time of crisis.

Back to Top | Article Outline

We would like to thank Gordon Lyons, Nieves Molíns and Rebecca Ramanathan for their assistance with the manuscript.

There are no financial support or sponsorship declared.

There are no conflicts of interest declared.

The present review article is based on a talk given at the Euroanaesthesia 2011 in Amsterdam organised by Subcommittee No. 1 ‘Evidence-based practice and quality improvement’ (Scientific Committee of the European Society of Anaesthesiology) with the title: ‘How to run a successful anaesthesia department’.

Back to Top | Article Outline


1. Bogue RJ, Guarneri JG, Reed M, et al. Secrets of physician satisfaction. Study identifies pressure points and reveals life practices of highly satisfied doctors. Physician Exec 2006; 32:30–39.

2. Bovier PA, Perneger TV. Predictors of work satisfaction among physicians. Eur J Public Health 2003; 13:299–305.

3. Benson SG, Dundis SP. Understanding and motivating healthcare employees: integrating Maslow's hierarchy of needs, training and technology. J Nurs Manag 2003; 11:315–320.

4. Rosenstein AH, Mudge-Riley M. The impact of stress and burnout on physician satisfaction and behaviors. Physician Exec 2010; 36:16–18.20, 22–23.

5. Marton KI. The secret to satisfaction: empowerment for all. West J Med 2001; 174:18–19.

6. Cassella CW. Burnout and the relative value of dopamine. Anesthesiology 2011; 114:213–217.

7. Jackson SH. The role of stress in anaesthetists’ health and well being. Acta Anaesthesiol Scand 1999; 43:583–602.

8. Shanafelt T. Burnout in anesthesiology: a call to action. Anesthesiology 2011; 114:1–2.

9. Faragher EB, Cass M, Cooper CL. The relationship between job satisfaction and health: a meta-analysis. Occup Environ Med 2005; 62:105–112.

10. Grau A, Suner R, Garcia MM. Burnout syndrome in health workers and relationship with personal and environmental factors. Gac Sanit 2005; 19:463–470.

11. Maslach C, Jackson S. Maslach Burnout Inventory, 2nd ed. Palo Alto California: Consulting Psycologist's Press; 1986.

12. Devi S. Doctors in distress. Lancet 2011; 377:454–455.

13. Rosenstein AH, O’Daniel M. Impact and implications of disruptive behavior in the perioperative arena. J Am Coll Surg 2006; 203:96–105.

14. Kluger MT, Townend K, Laidlaw T. Job satisfaction, stress and burnout in Australian specialist anaesthetists. Anaesthesia 2003; 58:339–345.

15. Williams ES, Konrad TR, Scheckler WE, et al. Understanding physicians’ intentions to withdraw from practice: the role of job satisfaction, job stress, mental and physical health. Healthcare Manage Rev 2010; 35:105–115.

16. Landon BE, Reschovsky JD, Pham HH, Blumenthal D. Leaving medicine: the consequences of physician dissatisfaction. Med Care 2006; 44:234–242.

17. Williams ES, Skinner AC. Outcomes of physician job satisfaction: a narrative review, implications, and directions for future research. Healthcare Manage Rev 2003; 28:119–139.

18. Ramirez AJ, Graham J, Richards MA, et al. Mental health of hospital consultants: the effects of stress and satisfaction at work. Lancet 1996; 347:724–728.

19. Visser MR, Smets EM, Oort FJ, De Haes HC. Stress, satisfaction and burnout among Dutch medical specialists. CMAJ 2003; 168:271–275.

20. Kinzl JF, Knotzer H, Traweger C, et al. Influence of working conditions on job satisfaction in anaesthetists. Br J Anaesth 2005; 94:211–215.

21. Chia AC, Irwin MG, Lee PW, et al. Comparison of stress in anaesthetic trainees between Hong Kong and Victoria, Australia. Anaesth Intensive Care 2008; 36:855–862.

22. Chiron B, Michinov E, Olivier-Chiron E, et al. Job satisfaction, life satisfaction and burnout in French anaesthetists. J Health Psychol 2010; 15:948–958.

23. Balch CM, Shanafelt TS. Dynamic tension between success in a surgical career and personal wellness: how can we succeed in a stressful environment and a ‘culture of bravado’? Ann Surg Oncol 2011; 18:1213–1216.

24. Shanafelt TD, Balch CM, Bechamps G, et al. Burnout and medical errors among American surgeons. Ann Surg 2010; 251:995–1000.

25. Scheurer D, McKean S, Miller J, Wetterneck T. U.S. physician satisfaction: a systematic review. J Hosp Med 2009; 4:560–568.

26. Collins KS, Collins SK, McKinnies R, Jensen S. Employee satisfaction and employee retention: catalysts to patient satisfaction. Healthcare Manag (Frederick) 2008; 27:245–251.

27. Arakelian E, Gunningberg L, Larsson J. Job satisfaction or production? How staff and leadership understand operating room efficiency: a qualitative study. Acta Anaesthesiol Scand 2008; 52:1423–1428.

28. Geyer S. Hand in hand: patient and employee satisfaction. Trustee 2005; 58:12–14.19.

29. Lebbin M. Back to basics 2. How satisfied are your employees? Making the employee/patient satisfaction connection. Trustee 2007; 60:4.

30. Brown S, Gunderman RB. Viewpoint: enhancing the professional fulfillment of physicians. Acad Med 2006; 81:577–582.

31. Lindfors PM, Meretoja OA, Toyry SM, et al. Job satisfaction, work ability and life satisfaction among Finnish anaesthesiologists. Acta Anaesthesiol Scand 2007; 51:815–822.

32. Jenkins K, Wong D. A survey of professional satisfaction among Canadian anesthesiologists. Can J Anaesth 2001; 48:637–645.

33. Morais A, Maia P, Azevedo A, et al. Stress and burnout among Portuguese anaesthesiologists. Eur J Anaesthesiol 2006; 23:433–439.

34. Hackman JR, Oldham G. Development of the job diagnostic survey. J Appl Psychol 1975; 60:159–170.

35. Maslow AH. Motivation and Personality. New York: Harper and Row; 1954.

36. Maslow AH. The Maslow Business Reader. Deborah Stephens, editor. New York: John Wiley & Sons; 2000.

37. Locke EA. The nature and causes of job satisfaction. In: Dunnette MD, editor. Handbook of Industrial and Organizational Psychology. Chicago: Rand McNally College; 1976. p. 1297–1349.

38. Judge TA, Locke EA, Durham CC, Kluger AN. Dispositional effects on job and life satisfaction: the role of core evaluations. J Appl Psychol 1998; 83:17–34.

39. Hackman JR, Oldham G. Motivation through the design of work: test of a theory. Organizational Behav Human Perform 1976; 16:250–279.

40. Oldham G, Hackman JR, Pearce J. Conditions under which employees respond positively to enriched work. J Appl Psychol 1976; 61:395–403.

41. Likert R. New patterns of management. New York: McGraw-Hill; 1961.

42. Karasek R, Theorell T. Health work: stress, productivity and the reconstruction of working life. New York: Basic Books; 1990.

43. Siegrist J. Adverse health effects of high-effort/low-reward conditions. J Occup Health Psychol 1996; 1:27–41.

44. Clarke IM, Morin JE, Warnell I. Personality factors and the practice of anaesthesia: a psychometric evaluation. Can J Anaesth 1994; 41:393–397.

45. McManus IC, Keeling A, Paice E. Stress, burnout and doctors’ attitudes to work are determined by personality and learning style: a twelve year longitudinal study of UK medical graduates. BMC Med 2004; 2:29.

46. Meeusen VC, Brown-Mahoney C, van DK, et al. Personality dimensions and their relationship with job satisfaction amongst Dutch nurse anaesthetists. J Nurs Manag 2010; 18:573–581.

47. Lederer W, Kinzl JF, Trefalt E, et al. Significance of working conditions on burnout in anesthetists. Acta Anaesthesiol Scand 2006; 50:58–63.

48. Hyman SA, Michaels DR, Berry JM, et al. Risk of burnout in perioperative clinicians: a survey study and literature review. Anesthesiology 2011; 114:194–204.

49. De Oliveira GS Jr, Almeida MD, Ahmad S, et al. Anesthesiology residency program director burnout. J Clin Anesth 2011; 23:176–182.

50. Thomas NK. Resident burnout. JAMA 2004; 292:2880–2889.

51. Larsson J, Rosenqvist U, Holmstrom I. Being a young and inexperienced trainee anesthetist: a phenomenological study on tough working conditions. Acta Anaesthesiol Scand 2006; 50:653–658.

52. Lindfors PM, Nurmi KE, Meretoja OA, et al. On-call stress among Finnish anaesthetists. Anaesthesia 2006; 61:856–866.

53. Lindfors PM, Meretoja OA, Luukkonen RA, et al. Suicidality among Finnish anaesthesiologists. Acta Anaesthesiol Scand 2009; 53:1027–1035.

54. Mache S, Vitzthum K, Nienhaus A, et al. Physicians’ working conditions and job satisfaction: does hospital ownership in Germany make a difference? BMC Health Serv Res 2009; 9:148.

55. Heponiemi T, Kuusio H, Sinervo T, Elovainio M. Job attitudes and well being among public vs. private physicians: organizational justice and job control as mediators. Eur J Public Health 2011; 21:520–525.

56. Bell DJ, Bringman J, Bush A, Phillips OP. Job satisfaction among obstetrician-gynecologists: a comparison between private practice physicians and academic physicians. Am J Obstet Gynecol 2006; 195:1474–1478.

57. Cox M, Kupersmith J, Jesse RL, Petzel RA. Commentary: building human capital – discovery, learning, and professional satisfaction. Acad Med 2011; 86:923–924.

58. Aronson KR, Laurenceau JP, Sieveking N, Bellet W. Job satisfaction as a function of job level. Adm Policy Ment Health 2005; 32:285–291.

59. De Oliveira GS Jr, Ahmad S, Stock MC, et al. High incidence of burnout in academic chairpersons of anesthesiology: should we be taking better care of our leaders? Anesthesiology 2011; 114:181–193.

60. Dyrbye LN, Shanafelt TD, Balch CM, et al. Relationship between work-home conflicts and burnout among American surgeons: a comparison by sex. Arch Surg 2011; 146:211–217.

61. Glasheen JJ, Misky GJ, Reid MB, et al. Career satisfaction and burnout in academic hospital medicine. Arch Intern Med 2011; 171:782–785.

62. Nyssen AS, Hansez I, Baele P, et al. Occupational stress and burnout in anaesthesia. Br J Anaesth 2003; 90:333–337.

63. Clergue F. Time to consider nonphysician anaesthesia providers in Europe? Eur J Anaesthesiol 2010; 27:761–762.

64. De Robertis E, Tomins P, Knape H. Anaesthesiologists in emergency medicine: the desirable manpower. Eur J Anaesthesiol 2010; 27:223–225.

65. Mellin-Olsen J, Staender S, Whitaker DK, Smith AF. The Helsinki declaration on patient safety in anaesthesiology. Eur J Anaesthesiol 2010; 27:592–597.

66. Elpern EH, Silver MR. Improving outcomes: focus on workplace issues. Curr Opin Crit Care 2006; 12:395–398.

67. Coomber S, Todd C, Park G, et al. Stress in UK intensive care unit doctors. Br J Anaesth 2002; 89:873–881.

68. Larsson J, Rosenqvist U, Holmstrom I. Enjoying work or burdened by it? How anaesthetists experience and handle difficulties at work: a qualitative study. Br J Anaesth 2007; 99:493–499.

69. Booij LH. Conflicts in the operating theatre. Curr Opin Anaesthesiol 2007; 20:152–156.

70. Jonsson S. Psychosocial work environment and prediction of job satisfaction among Swedish registered nurses and physicians: a follow-up study. Scand J Caring Sci 2011. doi: 10.1111/j.1471-6712.2011.00924.x. [Epub ahead of print]

71. Meeusen V, van Zundert A, Hoekman J, et al. Composition of the anaesthesia team: a European survey. Eur J Anaesthesiol 2010; 27:773–779.

72. Rogers DA, Lingard L. Surgeons managing conflict: a framework for understanding the challenge. J Am Coll Surg 2006; 203:568–574.

73. Danjoux MN, Lawless B, Hawryluck L. Conflicts in the ICU: perspectives of administrators and clinicians. Intensive Care Med 2009; 35:2068–2077.

74. Manser T. Teamwork and patient safety in dynamic domains of healthcare: a review of the literature. Acta Anaesthesiol Scand 2009; 53:143–151.

75. Larsson J, Holmstrom I, Rosenqvist U. Professional artist, good Samaritan, servant and co-ordinator: four ways of understanding the anaesthetist's work. Acta Anaesthesiol Scand 2003; 47:787–793.

76. Larsson J, Holmstrom I, Lindberg E, Rosenqvist U. Trainee anaesthetists understand their work in different ways: implications for specialist education. Br J Anaesth 2004; 92:381–387.

77. Shanafelt T, Chung H, White H, Lyckholm LJ. Shaping your career to maximize personal satisfaction in the practice of oncology. J Clin Oncol 2006; 24:4020–4026.

78. Kapur PA. The impact of new-generation physicians on the function of academic anesthesiology departments. Curr Opin Anaesthesiol 2007; 20:564–567.

79. Lederer W, Traweger C, Kinzl JF. The professional image anticipated by anaesthesiologists. Acta Anaesthesiol Belg 2004; 55:355–359.

80. Spivey CA, Chisholm-Burns MA, Murphy JE, et al. Assessment of and recommendations to improve pharmacy faculty satisfaction and retention. Am J Health Syst Pharm 2009; 66:54–64.

81. Manthous CA, Hollingshead AB. Team science and critical care. Am J Respir Crit Care Med 2011; 184:17–25.

82. Ho WH, Chang CS, Shih YL, Liang RD. Effects of job rotation and role stress among nurses on job satisfaction and organizational commitment. BMC Health Serv Res 2009; 9:8.

83. Kluger MT, Bryant J. Job satisfaction, stress and burnout in anaesthetic technicians in New Zealand. Anaesth Intensive Care 2008; 36:214–221.

84. Nohria N, Groysberg B, Lee LE. Employee motivation: a powerful new model. Harv Bus Rev 2008; 86:78–84.160.

85. Phillips JM, Douthitt EA, Hyland MM. The role of justice in team member satisfaction with the leader and attachment to the team. J Appl Psychol 2001; 86:316–325.

86. Scotti DJ, Harmon J, Behson SJ. Links among high-performance work environment, service quality, and customer satisfaction: an extension to the healthcare sector. J Healthc Manag 2007; 52:109–124.

87. Chiok Foong LJ. Leadership behaviours: effects on job satisfaction, productivity and organizational commitment. J Nurs Manag 2001; 9:191–204.

88. Reader TW, Flin R, Mearns K, Cuthbertson BH. Interdisciplinary communication in the intensive care unit. Br J Anaesth 2007; 98:347–352.

89. Ford RC, Sivo SA, Fottler MD, et al. Aligning internal organizational factors with a service excellence mission: an exploratory investigation in healthcare. Healthcare Manage Rev 2006; 31:259–269.

90. Hamelin BL, Lavoie-Tremblay M, Viens C, Lefrancois L. Engaging healthcare workers in improving their work environment. J Nurs Manag 2007; 15:313–320.

91. Vagts DA, Mutz CW. Leading an intensive care unit: we need more than medical knowledge!. Crit Care Med 2011; 39:1835–1836.

92. Flin R, Patey R, Glavin R, Maran N. Anaesthetists’ nontechnical skills. Br J Anaesth 2010; 105:38–44.

93. Reader T, Flin R, Lauche K, Cuthbertson BH. Nontechnical skills in the intensive care unit. Br J Anaesth 2006; 96:551–559.

94. Boet S, Bould MD, Bruppacher HR, et al. Looking in the mirror: self-debriefing versus instructor debriefing for simulated crises. Crit Care Med 2011; 39:1377–1381.

95. Koetsier E, Boer C, Loer SA. Complaints and incident reports related to anaesthesia service are foremost attributed to nontechnical skills. Eur J Anaesthesiol 2011; 28:29–33.

96. Einav Y, Gopher D, Kara I, et al. Preoperative briefing in the operating room: shared cognition, teamwork, and patient safety. Chest 2010; 137:443–449.

97. Lindberg EB. Increased job satisfaction after small group reflection on an intensive care unit. Dimens Crit Care Nurs 2007; 26:163–167.

98. Ro KE, Gude T, Tyssen R, Aasland OG. Counselling for burnout in Norwegian doctors: one year cohort study. BMJ 2008; 337:a2004.

99. Smith AF. Reaching the parts that are hard to reach: expanding the scope of professional education in anaesthesia. Br J Anaesth 2007; 99:453–456.

100. Shanafelt TD, Sloan JA, Habermann TM. The well being of physicians. Am J Med 2003; 114:513–519.

101. Guest RS, Baser R, Li Y, et al. Cancer surgeons’ distress and well being, II: modifiable factors and the potential for organizational interventions. Ann Surg Oncol 2011; 18:1236–1242.

102. Weiner EL, Swain GR, Wolf B, Gottlieb M. A qualitative study of physicians’ own wellness-promotion practices. West J Med 2001; 174:19–23.

103. Lazarus A. Fall in love with medicine again. Med Econ 2011; 88:59–61.

104. Greenawald MA, Bogdewic SP. Rejuvenate your practice. Med Econ 2011; 88:55–56.62–63.

105. Brook RH. A physician = emotion + passion + science. JAMA 2010; 304:2528–2529.

Cited By:

This article has been cited 1 time(s).

European Journal of Anaesthesiology (EJA)
Reducing stress and enhancing well-being at work: are we looking at the right indicators?
Lindfors, P
European Journal of Anaesthesiology (EJA), 29(7): 309-310.
PDF (73) | CrossRef
Back to Top | Article Outline

anaesthetist; job satisfaction; professional burnout; psychological; stress

© 2012 European Society of Anaesthesiology


Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.