Stress level among the medical practitioners of public and private sector: a comparative insight

7/31/2019 Stress level among the medical practitioners of public and private sector: a comparative insight

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Int. J. Indian Culture and Business Management, Vol. 4, No. 1, 2011 1

Copyright 2011 Inderscience Enterprises Ltd.

Stress level among the medical practitioners of publicand private sector: a comparative insight

Shilpi Goyal*

RIMT-IMCT,

Mandi Gobindgarh 147301, Punjab, India

Fax: +91 1765 250041

E-mail: [email protected]

*Corresponding author

O.P. Goyal and Anu Singh Lather

GGSIP University,

Delhi 110006, IndiaE-mail: [email protected]

E-mail: [email protected]

Abstract: The review of literature on occupational stress and its adverseconsequences emphasises the importance of its assessment and management.The recognition of the harmful physical and psychological effects of stress,

both on individuals and organisations has been widely studied. However,empirical research on the sources of stress among Indian doctors is scarce.Most research studies reported in leading journals have been done on doctorsfrom countries other than India. Keeping in view the gaps in research, this

paper aims to get an insight into the various stressors in the occupational life ofthe medical practitioners and to make a comparison of the stress levels in the

public and private sector in India. A self-designed pre-tested questionnaire hasbeen used for the purpose of the study. The study has been conducted on 200

medical practitioners from public as well as private sector hospitals in the stateof Punjab in northern India.

Keywords: medical practitioners; public sector hospitals; private sectorhospitals; stressors; stress.

Referenceto this paper should be made as follows: Goyal, S., Goyal, O.P. andLather, A.S. (2011) Stress level among the medical practitioners of public and

private sector: a comparative insight, Int. J. Indian Culture and BusinessManagement, Vol. 4, No. 1, pp.112.

Biographical notes: Shilpi Goyal has received MBA in Human ResourcesManagement and is pursuing PhD in the area of Human ResourcesManagement at GGS Indraprastha University, Delhi, India. She is working as aFaculty at RIMT-IMCT, Mandi Gobindgarh, Punjab (India) since last two

years. She has published her research papers in referred journals of repute andhas attended many national/international level conferences. Her areas ofinterest are human resources, applied psychology, organisational behaviour andorganisational development.


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2 S. Goyal, O.P. Goyal and A.S. Lather

O.P. Goyal is a Professor and a Director at GGSIP University, Delhi, India. Hehas a wide experience of teaching and research of more than 40 years. He hassuccessfully supervised more than 20 PhD scholars. He has been on the boardof many corporate and educational institutes. He has worked at the university

level in various capacities such as Dean-Academics, Dean Research andDirector-Corporates, etc. He has published a large number of research papers innational/international journals of repute.

Anu Singh Lather is a Professor of Management in the University School ofManagement Studies at GGS Indraprastha University, Delhi, India. She is anHRD professional and OD expert. She has to her credit teaching, research andcorporate training experience for 20 years. Her research papers have been

published in various international and national journals of repute. In addition,she has been contributing papers/articles/presentations in various national andinternational conferences, seminars and conclaves.

1 Introduction

Causes and effects of occupational stress have received research attention for several

decades although increasing focus has been paid to it during the 1990s as organisations

and individual workers attempt to adapt to accelerating rates of change. The impact of

stress on the economic health of the organisation and the mental and physical health of

the individual have been well documented (e.g. Cooper, 1994; Cooper and Marshall,

1976; Quick and Quick, 1984).

Occupational stress has become more common today, because of the ever increasing

job demands of organisations from the employees. The term stress has typically been

used to refer both to the adjustive demands placed on an organism and to the organisms

internal biological and psychological response to such demands. The adjustive demands

are referred to as stressors and the effects they create within an organism as stress.

According to Neufeld, stress is a by-product of poor or inadequate coping.

Stress is a medical term that describes how the human body reacts when it fears it is

under attack. Stress can be caused by mental or physical conditions, or, a combination of

both. When the human body fears it is under attack it automatically responds. The pulse

rate increases, blood flow to the brain and to major muscle groups increases, and

adrenaline and other stimulants are released into the blood stream. All these relate to the

human instinct for fight or flight when attacked. The extra blood flow and stimulants

get the body ready for physical activity.

2 Review of literature

All occupations have the capacity to be stressful, but some occupations and organisations

are potentially more stressful than others. Cranwell-Ward (1987) identified organisations

within the service industry, those with high technology and those undergoing structural

job changes as potentially more stressful than others. Thus the study of occupational

stress in the service sector is an important area of research, which can identify the causes

of stress and may suggest coping strategies so as to strike a balance among the

employees professional and family life.


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Stress level among the medical practitioners 3

Stress spares none, not even those who advise how to prevent it (Shah and Kanwar,

1999).

Stress refers to the causes and the effects of feelings of pressure. How we cope with

these pressures often is determined by our own levels of resistance and what else is goingon at the time. Thus, the interplay of constraints, demands and supports is endlessly

variable and, as such, it makes research into the area complex. Stress, therefore, may be

defined as a response to the perceived relationship between the demands on us and our

ability to cope. The factors which cause stress at work can be grouped into various

categories: factors intrinsic to the job; role in the organisation; relationships at work;

career development; organisational structure and climate; extra-organisational sources of

stress. Consideration of the various dimensions of these stress categories has been

considered in depth elsewhere (see e.g. Cooper and Cartwright, 1994; Cooper and

Marshall, 1976, 1978; Cooper et al., 1988; French and Caplan, 1972; Sworder, 1981), as

has the applicability of various potential work stressors in a retail management context

(Broadbridge, 1998a).

Research into the incidence of stress in a variety of occupational sectors has received

academic attention (e.g. Bogg and Cooper, 1995; Burke and Greenglass, 1995; Kahn andCooper, 1993; Worrall and Cooper, 1995). Within service sector, however, it is a

relatively under-developed area (see e.g. Broadbridge, 1998a,b; Lusch and Jaworski,

1991). Also, less attention has been paid to stress arising from the work-home interface

with a few notable exceptions (Frone et al., 1992; Ginn and Sandell, 1997; Lewis and

Cooper, 1983, 1988; Swanson et al., 1998).

Research by Pleck et al. (1980) revealed that a substantial proportion of employed

adults report conflict between their work and family roles. Glowinkowski and Cooper

(1985) propose three hypotheses to explain the workfamily relationship. The first is

spillover, where the events of one environment affect the other; the second is

compensation, where the individual attempts to compensate in one environment for what

is lacking in the other and the third is where both environments can be described as

independent.

In turn, stress (either derived from work or home) can create problems in theworkplace, and has a variety of outcomes. These may be quantifiable factors such as

absenteeism (Cooper, 1994; Cooper and Cartwright, 1994) and labour turnover (Terborg,

1985) both of which are high within retailing. However, they also incorporate the less

quantifiable outcomes of stress such as the people who physically turn up for work but

are unable to contribute fully because of their stress-related problems (Cooper, 1994).

Such forms of stress may result in irrational thinking and rigidity of views, faulty

decision making, communication breakdowns (Quick and Quick, 1984), interpersonal

conflict, general time wasting and avoidance of responsibilities or tasks (Adams, 1980)

and job dissatisfaction (Cooper, 1983). All such forms of stress manifestation are

important as they contribute to deficient work performance and loss of productivity, not

only from the individuals under stress, but also potentially from those who have to work

with them.

Job-related stress and its adverse consequences are taking a toll on Indian employees

in all sectors and the health sector is no exception.

Research has suggested that physicians jobs are more stressful than many other types

of work, but sources of job stress of physicians have rarely been measured systematically.

The job of the medical practitioners is such that they are so engrossed in their task of

treating their patients that their own health becomes a secondary consideration. Keeping


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in view the gaps in research in the health sector, the following study is proposed to be

undertaken in the public and private sector hospitals in the state of Punjab in northern

India and to evaluate the level of stress among the medical practitioners working therein.

3 Research objectives and methodology

3.1 Objective of the study

The primary objectives of the study are:

to assess the level of stress among the medical practitioners in the selected publicand private sector hospitals in the state of Punjab in northern India

to gain an insight into the major stressors and making a comparison of the stresslevels between the two sectors.

3.2 Scope of the study

The scope of the study has been limited to the medical practitioners working in the public

and private sector hospitals in the state of Punjab in northern India.

3.3 Hypothesis of the study

For achieving the aforesaid objectives, the following null and alternate hypotheses were

framed.

Ho: There is no significant difference between the stress levels of medical practitioners in

the public and private sector hospitals.

HA: The medical practitioners of private sector hospitals experience a higher level of

stress as compared to those working in public sector hospitals.

3.4 Research methodology

The exploratory research design has been used to obtain the relevant results for the

problem at hand. Survey approach has been adopted to collect primary data. A self-

designed, pre-tested questionnaire has been used as the tool for data collection. The tool

was tested for reliability and validity. The questionnaire has high-content validity as the

framing of questions was done by involving professional judgement of the academicians

and experts in the area of stress management. The value of Cronbach alpha was found to

be 0.82, which indicates a high degree of reliability.

The respondents were directed to indicate their responses on five-point Likert scale.

The total score for each respondent has been calculated by adding the scores of each

factor. Secondary data has been collected from various sources such as websites, books,

journals, magazines, etc. A sample of 200 respondents, (out of which 50% of the sample

is from the public and the other half is from the private sector hospitals) has been selected

on a random basis.

Data have been tabulated in the form of tables to get a better insight of the

relationship between various variables.


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The following model has been used to check the significance of the hypothesis.

1 2

2 2

1 1 2 2 1 2 1 22 1/ 1 /

x xt

x x x x n n n n

where 1x is the mean of the first sample; 2x is the mean of the second sample; n1 is the

number of observations in the first sample and n2 is the number of observations in the

second sample.

Degree of freedom is calculated as follows:

1 2 2v n n

In the present study, t-test has been used to test the significance between the means of

two independent samples, i.e. public and private sector.

4 Analysis and discussion

The data thus collected with the help of questionnaires were subjected to some statistical

tools for reaching at suitable results and conclusions. The results have been tabulated in

Table 1.

The participants in the proposed study were medical practitioners working in the

public and private sector hospitals in the state of Punjab in northern India. Half of the

respondents in the sample were from the public sector and the other half were from

the private sector. The sample was composed of 64% males and 36% females. About

46% of the sample belonged to the age group of 3040 years, 26% to the age group of

4050 years and the remaining 28% to the age group of 5060 years.

As revealed by the data in Table 2, only 4% of the total number of respondents in the

public sector experienced low-stress levels whereas the number was nil in case of the

private sector. The percentage of respondents who experienced moderate level of stresswas significantly higher in the public sector as compared to that in the private sector. The

results were found to be equally contrasting in case of high level of stress. In this case,

the percentage of respondents experiencing high level of stress was approximately double

in the private sector as compared to the public sector. The results clearly indicate that the

medical practitioners of the private sector experience a much higher level of stress as

compared to those working in the public sector. The reasons for the stress may be

different in both the sectors but the results clearly point out to a higher level of stress in

the private sector as compared to that in the public sector.

Table 1 Demographic profile of the respondents

S. no. Demographic variable Number of respondentsPercentage of

respondents

1 GenderMale 128 64

Female 72 36

2 Age group (years)

3040 92 46

4050 52 26

5060 56 28


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Table 2 Comparison of stress levels among the medical practitioners in the public and privatesector hospitals

Level of stress

Low Moderate High

SectorNo. of

respondents% of

respondentsNo. of

respondents% of

respondentsNo. of

respondents% of

respondents

Public 4 4 66 66 30 30

Private 0 0 44 44 56 56

Table 3 Stress level among male and female medical practitioners of public and private sectors

Level of stress

Low Moderate High

Sector GenderNo. of

respondents% of

respondentsNo. of

respondents% of

respondentsNo. of

respondents% of

respondents

Male 4 6.25 38 59.3 22 34.3Public

Female 0 0 28 77.7 8 22.2

Male 0 0 28 43.7 36 56.2Private

Female 0 0 16 44.4 20 55.5

Stress is found to be significantly higher among male practitioners working in private

sector hospitals in comparison to their colleagues working in public sector hospitals

(Table 3). The medical practitioners working in the private sector hospitals have to work

for long hours. They are even required to work at odd hours.

The figures in Table 3 indicate that it is the male practitioners of the private as well as

the public sector who are more stressed as compared to their female counterparts. One

probable reason for this finding could be that the female practitioners do not work for

long and at odd hours in the hospitals as they have to handle family tasks in a different

manner than their male counterparts. Thus, the level of occupational stress experienced

by the female practitioners is lesser as compared to their male colleagues who spend

relatively more time at work, especially in the private sector.

As indicated by the figures in Table 4, the medical practitioners who experienced

low-stress levels was almost negligible and only a meagre percentage (7.14%) of the

respondents in this category belonged to the age group of 5060 years. Maximum

percentage of the respondents (65.5%) experiencing moderate stress levels was found to

be in the age group of 3040 years. High-stress level was experienced almost equally by

respondents of all the age groups. Thus the respondents do not seem to differ much in

experiencing low- and high level of stress whereas the respondents in the age group of

3040 years report more stress, may it be moderate or high.

When analysed department wise, it was observed that the medical practitioners ofplastic surgery, psychiatry, neurology and gynaecology experienced maximum moderate

level of stress and practitioners working in the urology, eye and physiotherapy

departments reported highest level of stress. The various reasons for stress have been

found to be impatience on the part of the patients, fear of getting infected, odd working

hours and inability to help the patient sometimes in spite of the best efforts (Table 5).


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The results of the calculated mean show that the most contributing factor towards

stress among the medical practitioners of public sector hospitals is the time factor

(Table 6). The doctors complained that they do not get enough time to do things for

which they have a great liking. They were not able to devote time to their families. Thecalculated value of mean for the time factor is 3.94. The next most stress causing factors

are the high expectations of the patients, impatience on the part of the patients, and

working at odd hours. The mean value of these factors is 3.80. These are followed by the

factors such as the fear of getting infected with some diseases from the patients, lack of

proper medical equipments in the hospitals and inability to help the patients in spite of

their best efforts. The values of the mean of these factors are 3.70, 3.68 and 3.64,

respectively.

Table 4 Comparison of stress levels among the medical practitioners of different age groups inpublic and private sector hospitals

Level of stress

Sector Low Moderate High

Agegroup(years)

No. ofrespondents

% ofrespondents

No. ofrespondents

% ofrespondents

No. ofrespondents

% ofrespondents

3040 0 0 52 65.5 40 43.4

4050 0 0 30 57.6 22 42.3

5060 4 7.14 28 50 24 42.8

Table 5 Stress level among the medical practitioners of different departments

Level of stress

Low Moderate High

Department

No. of

respondents

% of

respondents

No. of

respondents

% of

respondents

No. of

respondents

% of

respondents

Plastic surgery 0 0 12 100 0 0

Skin 0 0 4 33.33 8 66.66

ENT 0 0 12 50 12 50

Dental 0 0 16 57.1 12 42.8

Psychiatry 0 0 12 100 0 0

Physiotherapy 0 0 4 20 16 80

Gynaecology 0 0 16 80 4 20

Eye 0 0 0 0 12 100

Medicine 0 0 24 75 8 25

Urology 0 0 0 0 12 100

Surgery 0 0 4 50 4 50

Neurology 0 0 8 100 0 0


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Table 6 Stress among medical practitioners of public and private sector hospitals (N= 200)

Public sector(N = 100)

Private sector(N = 100)

Stressor Mean SD Mean SD

Heavy workload 3.36 1.20 3.64 0.980

Working at odd hours 3.80 1.03 4.28 0.726

Lack of proper compensation 2.98 1.26 3.28 1.155

Lack of growth and development 3.30 1.41 3.12 1.113

Impatience of patients 3.80 1.01 4.12 0.518

Long working hours 3.30 1.30 3.44 0.808

Dealing with patients having incurable diseases 2.7 1.24 3.80 0.899

High expectations of the patients 3.80 1.19 4.0 0.752

Inability to do things of ones likings 3.94 0.79 3.72 0.877

Lack of trust on the patients part 3.60 1.33 4.02 0.816

Lack of proper equipments 3.68 1.11 2.84 1.161

Inability to make the patients understand 2.98 1.39 3.54 0.968

Lack of time to upgrade knowledge 2.74 1.0 3.12 0.956

Patients go to other doctors 2.84 1.30 2.52 1.068

Lack of cooperation from the peers 2.92 1.47 2.96 1.317

Fear of getting infected 3.70 0.88 3.56 0.857

Feeling helpless to help certain patients 3.64 1.24 4.20 0.752

Lack of time for family 3.30 1.12 3.44 0.988

Compromise with values and standards 2.80 1.32 2.72 1.288

Ignorance of patients 3.56 1.10 3.78 0.733

It was also found that in case of private sector hospitals, working at odd hours causes

the maximum stress among the doctors working therein. The calculated mean value of thefactor is 4.28, which is even higher than the highest mean value in the public sector. The

second most stress causing factor is the inability to help the patients in spite of their best

efforts. Other factors such as impatience on the part of the patients, lack of trust among

patients and their high expectations are also potential stressors in the private sector.

The respective mean values of these factors are 4.12, 4.02 and 4.0.

After the calculation of mean for the responses given by the doctors of both private

and public sector, it is also revealed that the private sector doctors are more stressed than

the doctors of public sector. The total mean value of all the stressors for the private sector

is 70.1 whereas this value for the public sector is 66.66.

4.1 Application of t-test

As reflected by Table 7, the CV > TV. Thus the results are significant and the nullhypothesis, there is no significant difference between the stress levels of medical

practitioners in the public and private sector hospitals, is rejected and the alternate

hypothesis, the medical practitioners of private sector hospitals experience a higher level

of stress as compared to those working in public sector hospitals, stands confirmed.


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Table 7 Significance of the mean of two groups

Mean value of the 1st group, i.e. private sector 70.10

Mean value of the 2nd group, i.e. private sector 66.66

SD 7.8444

Value of the t-test (CV) 3.10

Degrees of freedom 198

Table value (TV) of tat 5% LOS 1.645

5 Major findings of the study

After a detailed analysis of the data, the important findings of the study can be enlisted as

follows:

The moststress causing factor among the doctors ofgovernment hospitalsis the

time factor. They complain that they do not get enough time to do things for whichthey have great liking. On the other hand, the most stress causing factor among the

doctors ofprivate hospitalsis that they have to work at odd hours also. Doctors of

public sector have more complaints regarding the time factor. Most of the doctors

complain that they do not get enough time for their families.

The leaststress causing factor among the doctors ofgovernment sectoris when theyhave to deal with patients having incurable diseases whereas the least stress causing

factor among the doctors ofprivate hospitalsis the fact that more patients go to other

doctors.

The private sector doctors are living more stressful life than the doctors of publicsector. Doctors working in private hospitals experience more stress in their

profession than the doctors who work in government hospitals.

The female doctors have more of moderate level of stress but on the other hand, maledoctors have more of high level of stress.

Both male and female doctors of private sector experience high-stress level whereasthe doctors of public sector suffer from more of moderate level of stress.

The doctors of age group 5060 have comparatively low-stress level than the doctorsof other age groups such as 3040 and 4050.

The maximum number of doctors agrees to this fact that their workload is too heavyand they have to work at odd hours also which acts as a major source of stress among

them.

Almost every doctor gets irritated because of the impatience shown by the patients

and maximum number of doctors gets upset when they have to deal with patientshaving incurable diseases.

Almost half of the doctors agree to this fact that expectations of the patients fromthem act as a source of stress for them.


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About 70% of the doctors get disturbed when they see lack of trust in their patientstowards them.

Lack of proper medical equipments act as a hindrance in working effectively and

efficiently for doctors but this factor is a cause of stress only in case of governmenthospitals whereas doctors working in private hospitals do not face such problems.

Almost half of the doctors get irritated when they are not able to make their patientsunderstand what they want to say. About 70% of the doctors strongly agree to the

fact that they get upset when they are not able to help their patients even after their

best efforts.

Most of the doctors tended to disagree to the fact that they get upset when theirpatients go to other doctors.

Maximum number of doctors has a fear in their mind that they might get infectedwith some disease from their patients, which cause stress for them.

About 38% of the doctors agree that sometimes they have to compromise with theirvalues and standards to fulfil the needs of their profession.

More than half of the doctors agree that the ignorance on the part of the patientsirritates them sometimes.

6 Recommendations

Although stress is an inbuilt characteristic of the job of the medical practitioners, the

organisations could prove to be of some help in reducing the amount of stress

experienced if they implement the following recommended strategies:

The medical practitioners should be encouraged to participate in several

conferences/seminars related to their field. This would not only help them to upgradetheir knowledge but also would bring about a change in their busy schedules.

The medical practitioners should be sensitised to stress by providing them certaintraining programmes. Some sessions such as occupational stress workshops can be

arranged. These workshops would help to identify some of the most important

organisational and personal concerns causing stress.

Feedback should be obtained on these sessions which would further be helpful indemonstrating the need for additional programmes or activities.

The organisations should ensure that the medical practitioners do not workcontinuously for more than two shifts. They should be given proper rest pauses

within their shifts as well.

7 Contribution of the study

The study would help the academicians to develop some quantitative aspects related to

the measurement of stress. It would help the medical practitioners to gain an insight into


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the various factors that cause stress and to identify the most important stress element for

themselves. This would prove to be helpful in sensitising the practitioners to the

occupational stress. This study would also help the policy makers to design some policies

for the alleviation of occupational stress, which is inherent in the job of the medicalpractitioners.

8 Limitations of the study and directions for future research

A major limitation of the current study is its limited scope. The scope for the study can be

extended to include medical practitioners from other states and regions. The study can

also be undertaken in different countries so that a comparative analysis can be carried out

and measures that have proved effective in combating stress in one country may be used

in other countries as well. There is a need to explore possibilities for multiplicative

interactions among the various stressors and the levels of stress. Eventually, weighting

factors might be developed to reflect the relative contribution of the various factors to the

total stress.

Acknowledgements

The authors wish to acknowledge the anonymous reviewers for their valuable feedback

and suggestions for improving the quality of this paper. We would like to express our

deep sense of gratitude to all those who have contributed towards the development of this

paper.

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Stress level among the medical practitioners of public and private sector: a comparative insight