Effort-reward Imbalance Research Articles

Factors influencing decent work among psychiatric nurses in China: a cross-sectional study

AimsThis study aimed to investigate the current status of decent work among psychiatric nurses and analyze its influencing factors.MethodsIn February 2024, a cross-sectional study was conducted with a cluster sample of 358 nurses from a tertiary Grade A psychiatric hospital in Hangzhou, Zhejiang Province, China. Data were collected using a custom-made nurse demographic scale to gather demographic information. The Effort-Reward Imbalance Questionnaire (ERIQ) was used to assess the imbalance between effort and reward through the effort-reward ratio (ERR). The Social Support Rating Scale (SSRS) measured subjective support, objective support, and support utilization. The Decent Work Perception Scale (DWPS) was used to evaluate nurses’ perceptions of decent work. T-tests, one-way ANOVA, Pearson’s correlation analysis, and multiple linear regression analyses were employed for data analysis.ResultsThe study found that the correlation between decent work and social support was positive (r = 0.360, p < 0.001), while it was negative for effort-reward imbalance (r = -0.584, p < 0.001). Factors influencing perceptions of decent work included years of work experience (β = -0.164, p = 0.046 for < 5 years; β = -0.157, p = 0.040 for > 25 years), social support (β = 0.259, p < 0.001), and the effort-reward imbalance (β=-0.458, p < 0.001). These factors collectively explained 40.2% of the variance in perceptions of decent work. Furthermore, social support plays a mediating role between effort-reward imbalance and decent work (β=-0.062, Bootstrap 95% CI: -0.107, -0.023).ConclusionThe findings suggest that years of work experience, social support, and the effort-reward imbalance are factors influencing decent work among psychiatric nurses. By offering career development opportunities, fostering supportive work environments, and ensuring fair compensation, we can empower psychiatric nurses to navigate job challenges effectively and sustain a sense of decency in their work.

Group psychological counseling to contrast academic burnout: a research protocol for a randomized controlled trial.

Academic burnout is a condition characterized by exhaustion, cynicism, a distant attitude toward studying, and diminished self-efficacy in academic activities. Preliminary scientific findings indicate that interventions designed to alleviate work burnout also hold promise for mitigating academic burnout, however clear evidence based on randomized controlled trials is still missing. This research protocol describes a randomized controlled trial aimed at evaluating the efficacy of an online group psychological intervention to contrast academic burnout. Participants with high levels of burnout will be assigned to a psychological counseling group or a waiting list control group. The research comprises several phases: (T0) Screening, Recruitment, and Randomization; (T1) Baseline assessment (pre-intervention); (T2) Outcome Assessment (post-intervention); and (T3) Follow-up Assessment (3 months post-intervention). The primary outcomes include burnout symptoms, general wellbeing, and academic achievement. Additionally, secondary variables such as effort-reward imbalances, satisfaction/frustration of basic psychological needs, intrapersonal and interpersonal emotion regulation, coping strategies, and social support will be examined. The psychological intervention strategies will encompass psychoeducation, self-awareness enhancement, cognitive restructuring, and promotion of social support. This research protocol is an initial step toward evidence-based psychological interventions to treat academic burnout.

The Effort-Reward Imbalance Questionnaire for Teachers: Psychometric Properties Using the Bifactor ESEM Framework

This study is aimed at validating the French version of the Effort-Reward Imbalance Questionnaire for Teachers. The instrument was pretested before being administered in a large-scale study with elementary school teachers. Dimensionality of the instrument was examined using the bifactor exploratory structural equation modeling (ESEM) framework. The bifactor ESEM model showed the best fitting indices and parameters. Importantly, results suggested the existence of a continuum for ERI data concerning elementary teachers. The instrument showed concurrent validity with several measures of mental health, job satisfaction and work-life balance.

Associations between effort-reward imbalance and risk of burnout among Swedish physicians.

The high prevalence of burnout among Swedish physicians may have several possible effects on individuals and society. However, further investigations of work-related factors associated with the risk of burnout among Swedish physicians are needed. We aimed to study the associations between psychosocial work factors, based on the effort-reward imbalance (ERI) model, and the risk of burnout among Swedish physicians. A representative sample of 7200 Swedish physicians was invited in 2021. Data were gathered through questionnaires, with a response rate of 41%. Logistic regression models were used to study the associations between exposure to ERI and the risk of burnout. Approximately 62% of Swedish physicians were exposed to a high ERI. Exposure to a high ERI was associated with 11 times increased risk (95% confidence interval 6.5-20.0) of burnout in adjusted models. Large variations in the prevalence of ERI and risk of burnout across sociodemographic and occupational factors were identified, particularly across different clinical specialties. A majority of Swedish physicians were exposed to high levels of work-related stress, strongly associated with an increased risk of burnout. This population-based cross-sectional study underlines the need to further study variations of work-related stress across clinical specialties and to monitor occupational health among physicians longitudinally.

Validation of the Hungarian version of the 6-item turnover intention scale among elderly care workers

This research examines the psychometric characteristics and reliability of the 6-item turnover intention scale (TIS-6) by Bothma and Roodt (SA J Hum Resour Manag 11:a507, 2013) on a Hungarian sample. The internal validity of the TIS-6 was assessed using data from 269 Hungarian elderly care institution workers. Confirmatory factor analysis was performed to analyse the structural validity. Convergent and discriminant validity were examined with questions on job characteristics and using the Maslach Burnout Inventory and Effort-Reward Imbalance Scale. IBM SPSS 28.0 software was used for the statistical analysis, and the results were considered significant at p < 0.05. The internal consistency of the questionnaire's scale proved to be acceptable (α = 0.826). Convergent validity was confirmed by the relationships between the components of the questionnaire and burnout (rs = 0.512; p < 0.001; rs = 0.419; p < 0.001) and workplace stress (rs = 0.565; p < 0.001; rs = 0.310; p < 0.001). There were significant differences between the TIS-6 scores among the groups with different degrees of burnout (p < 0.001), which indicated adequate discriminant validity of the questionnaire. The structural validity of the questionnaire was acceptable, and the scale questions fit well. The Hungarian version of the TIS-6 scale is a valid and reliable tool for assessing turnover intention among elderly care institution workers in Hungary.

Job satisfaction and turnover of the first group of rural-oriented tuition-waived medical students in Guangxi, China: a mixed-method study

BackgroundIn 2010, China launched a rural-oriented tuition-waived medical education (RTME) programme to train more general practitioners (GPs) to meet the needs of the rural health workforce. Motivating and maintaining GPs is an important consideration for the shortage in the rural health workforce. This study aimed to investigate job satisfaction and turnover among the first group of rural-oriented tuition-waived medical students (RTMSs) who had completed a three-year compulsory service in Guangxi, as well as the factors affecting RTMSs turnover.MethodsThis study adopted a mixed-method approach. A quantitative survey of 129 RTMSs was analysed (81.6% response rate), and qualitative interviews were conducted with 30 stakeholders, including 18 RTMSs, six administrators of the County Health Bureau, and six administrators of township health centers (THCs). A t-test, chi-square test, Fisher’s exact test, and logistic regression analysis were used to examine the quantitative data, and thematic analysis was used to analyse the qualitative data.ResultsAmong the 129 participants, the turnover rate was high, with 103 RTMSs reporting turnover (79.84%). Interpersonal relationships scored the highest in job satisfaction (3.63 ± 0.64) among RTMSs, while working conditions were rated the lowest (2.61 ± 0.85). Marital status (odds ratio [OR] = 0.236, 95% confidence interval [95%CI] = 0.059–0.953, P = 0.043), only child status (OR = 8.660, 95%CI = 1.714–43.762, P = 0.009), and job return satisfaction (OR = 0.290, 95%CI = 0.090–0.942, P = 0.039) were significantly associated with turnover. Univariate analyses showed that income had a significant influence on turnover, but the relationship gone by multivariable; however it was deemed important in the qualitative study. Qualitative analysis revealed that turnover was influenced by the working atmosphere, effort-reward imbalance, professional competence, and opportunities for training and promotion.ConclusionsThis study provides insights for the policymakers about the priority areas for retaining GPs in rural locations and provides reference values for the retention of GPs in other regions with a shortage of rural health workers. For RTMSs to continue providing services to rural areas, the government should improve their salaries, balance their income and workload, provide more opportunities for training and career promotion, and managers should recognise their efforts and create an optimistic working atmosphere.

Longitudinal associations of effort-reward imbalance and overcommitment with burnout symptoms among Italian university students

BackgroundBurnout symptoms are highly prevalent among university students. The effort-reward imbalance (ERI) model is predictive for workers’ mental health. This study aims to investigate the associations of ERI and overcommitment with burnout symptoms among students. MethodsAn Italian version of the Oldenburg Burnout Inventory-Student (OLBI-S) and the Effort-Reward Imbalance-Student Questionnaire (ERI-SQ) were administered to assess burnout symptoms (range: 16–64), effort (range: 2–8), reward (range: 5–20) and overcommitment (range: 5–20) among 545 students twice with six months of follow-up. ERI (range: 0.25–4) was estimated multiplying the effort/reward ratio by a correction factor to account the difference in items investigating effort and reward. A between-within linear regression model was used to investigate whether ERI and overcommitment were associated with burnout symptoms (between individuals) and whether individual changes in ERI and overcommitment during the follow-up were associated with changes in burnout symptoms (within individuals). ResultsHigher levels of ERI (β: 10.13, 95 % CI: 9.21–11.05) and overcommitment (β: 1.09, 95 % CI: 0.95–1.23) were associated with higher levels of burnout symptoms. An increase in ERI (β: 4.93, 95 % CI: 3.02–6.84) and overcommitment (β: 0.92, 95 % CI: 0.59–1.26) within individuals was associated with an increase in burnout symptoms. DiscussionThis study supports the validity of the ERI model in the university setting. ERI and overcommitment may be determinants of burnout symptoms among university students. Interventions at individual and environmental level may aim to decrease ERI and overcommitment to tackle the burden of burnout among students. Future research may investigate the drivers of students’ ERI and overcommitment among students.

Job Stress Evaluation of Private Banking Employees in Indonesia through the Job Demand-Control Support Model and the Effort-Reward Imbalance Model

Job Stress Evaluation of Private Banking Employees in Indonesia through the Job Demand-Control Support Model and the Effort-Reward Imbalance Model

Impact of Effort-Reward Imbalance and Burnout on the Compliance with Standard Precautions among Nurses and Midwives in Lebanese Hospitals.

Effort-reward imbalance (ERI) refers to the situation where there is a mismatch between the effort that healthcare workers (HCWs) put into their work and the rewards they receive in return. Burnout, on the other hand, is a psychological syndrome characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment. This study aimed to assess the impact of ERI and burnout on the compliance with standard precautions (SPs) among nurses and midwives in Lebanese hospitals under the economic crisis and after the COVID-19 pandemic. Cross-sectional correlational study, based on self-administered questionnaire data, measuring the compliance with SPs, ERI, and burnout, in addition to the relationship between these factors, was performed among 409 nurses and midwives, working in Lebanese hospitals. ERI was significantly associated with exposure to burnout among nurses and midwives, and burnout was found to be a significant predictor of nurses and midwives' self-reported adherence with SPs. This study highlights the contribution of ERI and burnout to the chain of infection by decreased adherence to infection control SPs of nurses and midwives.

Does job stress mediate the risk of work disability due to common mental disorders among social workers compared with other health and social care, education, and non-human service professionals? A prospective cohort study of public sector employees in Finland.

This study aimed to investigate (i) the risk of work disability (>10-day sickness absence spell or disability pension) due to common mental disorders (CMD) among social workers compared with other health and social care, education, and non-human service professionals and (ii) whether the risk was mediated by job stress. A cohort of 16 306 public sector professionals in Finland was followed using survey data from baseline (2004 or if not available, 2008) on job stress [job strain or effort-reward imbalance (ERI)] and register data on work disability due to CMD from baseline through 2011. A Cox proportional hazards model was used to analyze the risk of work disability due to CMD between three occupation-pairs in a counterfactual setting, controlling for age, sex, job contract, body mass index, alcohol risk use, smoking, and physical inactivity. Social workers' job stress was at higher level only when compared to education professionals. Thus, the mediation hypothesis was analyzed comparing social workers to education professionals. Social workers had a higher risk of work disability due to CMD compared with education professionals [hazard ratio (HR) 2.08, 95% confidence interval (CI) 1.58-2.74]. This HR was partly mediated by job strain (24%) and ERI (12%). Social workers had a higher risk of work disability than non-human service professionals (HR 1.54, 95% CI 1.13-2.09), but not compared with other health and social care professionals. Job stress partly mediated the excess risk of work disability among social workers only in comparison with education professionals.

Effort-reward imbalance and common mental disorders among public sector employees of Iran: a cross-sectional analysis

BackgroundThe effort-reward imbalance (ERI) model is a widely used theoretical model to measure stress in the workplace. The objective of this study was to investigate the relationship between ERI and three common mental disorders: major depressive disorder (MDD), generalized anxiety disorder (GAD), and obsessive-compulsive disorder (OCD).MethodsIn this cross-sectional analysis, the study sample consisted of 4453 baseline participants of the Employees’ Health Cohort Study of Iran (EHCSIR). Trained psychologists utilized the Persian version of the Composite International Diagnostic Interview (CIDI-2.1) during the baseline assessment to identify common mental disorders. Additionally, the validated Persian version of the 23-item ERI questionnaire was employed to assess effort, reward, overcommitment, and effort-reward ratio. To examine the association of ERI components with three common mental disorders (MDD, GAD, and OCD) over the past twelve months, multiple logistic regression analyses were conducted.ResultsThe prevalence of effort-reward imbalance in the study sample was 47.1%. Higher ERI score was significantly associated with MDD (OR: 3.43, 95% CI: 2.30–5.13), GAD (OR: 2.42, 95% CI: 1.27–4.63), and OCD (OR: 2.23, 95% CI:1.19–4.19). The study participants who reported higher scores on work overcommitment had a higher likelihood of having MDD (OR: 1.16, 95% CI:1.10–1.23), GAD (OR: 1.07, 95% CI: 1.01–1.14), and OCD (OR: 1.19, 95% CI: 1.09–1.29).ConclusionsAccording to the study’s findings, work-related stress, as determined by the ERI model, is a significant factor in the development of common mental disorders among employees in the public sector.

Job stress and chronic low back pain: incidence, number of episodes, and severity in a 4-year follow-up of the ELSA-Brasil Musculoskeletal cohort.

We investigated the association between job stress, as assessed by the effort-reward imbalance model, and the incidence of chronic low back pain (CLBP) over a 4-year period. A total of 1733 participants from the ELSA-Brasil Musculoskeletal cohort, who were free from LBP at baseline (2012-2014), were included. Episodes of LBP in the past 30 days, intensity, and the presence of disability were investigated in annual telephone follow-ups (2015-2018). Chronic LBP was defined as episodes of LBP lasting >3 months with at least moderate intensity. We analyzed the incidence of at least one episode of CLBP (yes/no), the number of CLBP episodes (0, 1, ≥2), and CLBP severity/disability (absent, nondisabling, severe/disabling). The association between these outcomes and tertiles of the effort-to-reward ratio, as well as each dimension of the effort-reward imbalance model, was investigated using multinomial logistic and Poisson regression models adjusting for sociodemographic and occupational variables. The cumulative incidence of CLBP over 4 years was 24.8%. High effort-reward imbalance increased the chances of experiencing multiple CLBP episodes and severe/disabling CLBP by 67% (95% confidence interval [CI]: 1.12-2.47) and 70% (95% CI: 1.14-2.53), respectively. High overcommitment increased the incidence of CLBP by 23% (95% CI: 1.01-1.50) and the chances of multiple CLBP episodes and severe/disabling CLBP by 67% (95% CI: 1.11-2.50) and 57% (95% CI: 1.05-2.34), respectively. These results indicate that exposure to job stress is associated with a higher incidence, a greater number of episodes, and increased severity of CLBP over a 4-year period. If this association is causal, measures aimed at reducing exposure to job stress are likely to alleviate the burden of CLBP.

Using Heart Rate Variability to Assess Nurses' Stress During the COVID-19 Pandemic.

This study aimed to assess subjective and objective parameters of stress among nurses during the COVID-19 pandemic and to examine the recovery effect of a day off. In this prospective observational trial, we measured heart rate variability (using a wearable device) and perceived stress levels on 3 working days and 1 day off. We obtained the following data using an online questionnaire: working conditions, COVID-19-related problems, depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), effort-reward imbalance, and work-family conflict in a sample of German nurses (N = 41). When comparing working days with a day off, we observed a significant difference for physical load (Cohen's d = 0.798, P < .001), mental load (Cohen's d = 0.660, P = .001), emotional exhaustion (Cohen's d = 0.945, P < .001), and overburdening (Cohen's d = 0.585, P = .002) with higher scores on working days. Regarding heart rate variability, we did not find a difference. Correlational analyses revealed a significant association between being afraid to get infected with COVID-19 and lower heart rate variability (r = -0.336, P = .045) and between being afraid to infect relatives and lower heart rate variability (r = -0.442, P = .007). Furthermore, a higher total sum score of work-family conflict was significantly associated with lower heart rate variability (r = -0.424, P = .01). As heart rate variability observations were different from those regarding subjectively perceived stress, further studies are needed to evaluate and differentiate the influence of work stress and other types of stress on heart rate variability.

Burnout symptoms in elite athletes: Assessing the role of effort–reward imbalance, support and emotions

Drawing on theories from the sociology of work and organizations, such as Leiter and Maslach's concept of burnout and Siegrist's model of effort–reward imbalance, this paper argues that burnout symptoms in elite sport are related to a mismatch of investment and gratification. Building on data from a sample of German elite athletes ( N = 312), findings show that high time investments for training and competitions, the experience of time and role conflicts and negative emotions related to daily training are associated with more burnout symptoms, while sporting success, social support and training-related positive emotions are associated with lower burnout scores. Vulnerability to burnout is increased in situations that qualify as gratification crises, in which athletes perceive that high time commitment does not pay off in terms of sporting success.

Effort–reward imbalance and sleep quality in railway locomotive stewards: a cross-sectional study

ObjectiveTo assess the correlation between the effort–reward imbalance (ERI) and sleep quality among railway locomotive stewards.DesignCross-sectional study.SettingLanzhou Bureau Group, China Railway, between July and August 2022.ParticipantsRailway locomotive stewards.Primary and secondary...

The Relationship Between Work-Related Stress and Depression: A Scoping Review.

Work-related stress is highly prevalent. Recent systematic reviews concluded on a significant association between common work-related stress measures and depression. Our scoping review aims to explore whether work-related psychosocial stress is generally associated with depression or depressiveness, the extent and methodology of the primary research undertaken on this topic and to elucidate inconsistencies or gaps in knowledge. We searched for literature in Pubmed, PsycInfo and Web of Science including full reports in seven languages published between 1999 and 2022 and applied the PRISMA statement for scoping reviews criteria. Of 463 primarily identified articles, 125 were retained after abstract and full-text screening. The majority report significant associations between work-related stress and depression. Cross-sectional studies are most prevalent. Sufficient evidence exists only for job strain and effort-reward imbalance. Most studies are from Asia, North America and Europe. The health sector is the most studied. Several research gaps such as the lack of interventional studies were identified. The consistency of most studies on the significant association between work-related stress and depression is remarkable. More studies are needed to improve evidence and to close research gaps.

The associations of psychosocial work exposures with suicidal ideation in the national French SUMER study

BackgroundThe literature remains scarce on the work-related risk factors for suicide and suicidal ideation. The objectives were to explore the associations of psychosocial work exposures with suicidal ideation in a nationally representative sample of the working population. MethodsThe study was based on the sample of 25,977 employees (14,682 men and 11,295 women) of the national French 2016–17 SUMER survey. The outcome was suicidal ideation assessed using the PHQ-9 instrument. Psychosocial work exposures included various factors from the job strain and effort-reward imbalance models, and other concepts. Statistical analyses were performed using weighted methods, including weighted logistic regression models. Other occupational exposures and covariates were considered. Gender differences were tested. ResultsThe prevalence of suicidal ideation was 3.5 % without any difference between genders. Psychosocial work exposures were found to be associated with suicidal ideation. The strongest association was observed between workplace bullying and suicidal ideation. Associations were also found between job strain model factors, job insecurity, low esteem, work-family conflict, ethical conflict, teleworking, and low meaning, and suicidal ideation. The associations were in general similar for men and women. LimitationsThe study had a cross-sectional design and no causal interpretation could be done. A reporting bias and a healthy worker effect may be suspected. ConclusionPsychosocial work exposures played a major role in suicidal ideation. More research may be needed to confirm our results, as suicidal ideation is an important warning signal for suicide prevention. More primary prevention towards the psychosocial work environment may be useful to reduce suicidal ideation at the workplace.

A Natural Language Processing-Based Classification and Mode-Based Ranking of Musculoskeletal Disorder Risk Factors

This research explores the intricate landscape of Musculoskeletal Disorder (MSD) risk factors, employing a novel fusion of Natural Language Processing (NLP) techniques and mode-based ranking methodologies. Enhancing knowledge of MSD risk factors, their classification, and their relative severity is the main goal of enabling more focused preventative and treatment efforts. The study benchmarks eight NLP models, integrating pre-trained transformers, cosine similarity, and various distance metrics to categorize risk factors into personal, biomechanical, workplace, psychological, and organizational classes. Key findings reveal that the Bidirectional Encoder Representations from Transformers (BERT) model with cosine similarity attains an overall accuracy of 28%, while the sentence transformer, coupled with Euclidean, Bray–Curtis, and Minkowski distances, achieves a flawless accuracy score of 100%. Using a 10-fold cross-validation strategy and performing rigorous statistical paired t-tests and Cohen’s d tests (with a 5% significance level assumed), the study provides the results with greater validity. To determine the severity hierarchy of MSD risk variables, the research uses survey data and a mode-based ranking technique parallel to the classification efforts. Intriguingly, the rankings align precisely with the previous literature, reaffirming the consistency and reliability of the approach. “Working posture” emerges as the most severe risk factor, emphasizing the critical role of proper posture in preventing MSD. The collective perceptions of survey participants underscore the significance of factors like “Job insecurity”, “Effort reward imbalance”, and “Poor employee facility” in contributing to MSD risks. The convergence of rankings provides actionable insights for organizations aiming to reduce the prevalence of MSD. The study concludes with implications for targeted interventions, recommendations for improving workplace conditions, and avenues for future research. This holistic approach, integrating NLP and mode-based ranking, contributes to a more sophisticated comprehension of MSD risk factors and opens the door for more effective strategies in occupational health.

The overall fractions of coronary heart diseases and depression attributable to multiple dependent psychosocial work factors in Europe.

The literature is nonexistent on the assessment of overall fractions of diseases attributable to multiple dependent psychosocial work factors. The objectives of the study were to calculate the overall fractions of coronary heart diseases (CHD) and depression attributable to multiple dependent psychosocial work factors in 35 European countries. We used already published fractions of CHD and depression attributable to each of the following psychosocial work factors: job strain, effort-reward imbalance, job insecurity, long working hours, and workplace bullying. We took all exposures and their correlations into account to calculate overall attributable fractions. Wald tests were performed to test differences in these overall attributable fractions between genders and between countries. The overall fractions of CHD and depression attributable to all studied psychosocial work factors together were found to be 8.1% [95% CI: 2.0-13.9] and 26.3% [95% CI: 16.2-35.5] respectively in the 35 European countries. There was no difference between genders and between countries. Our study showed that the overall fractions attributable to all studied psychosocial work factors were substantial especially for depression. These overall attributable fractions may be particularly useful to evaluate the burden and costs attributable to psychosocial work factors, and also to inform policies makers at European level.

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

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. 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. 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. 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.