Enabling Work-life Balance, Health and Well-being Summary of MABEL Research to Date and Future Research Agenda MABEL workshop – 25 May 2017 Guyonne Kalb

Introduction Brief overview of past research Future research plans A lot can be done based on the data we already have or will be collecting this year But additional data on mental health and stress would extend the possible research questions Seek funding from different sources Outside of medical workforce research to access alternative funding sources E.g. as part of a broader research agenda on work-life balance /gender/mental health in the Australian population

Introduction Key aims of future research are to inform policies: preventing doctors’ burnout, and suboptimal choices by women and other doctors with caring responsibilities or health issues, leading to a more efficient and effective workforce, thus increasing access to care and quality of care.

Past research Hours worked choices for GPs and Specialists by gender [2] Hours worked choices and public-private work setting choice for Specialists by gender [1] Hours worked choices and on-call (yes/no) choice for GPs by gender [3] Hours worked/participation choice around childbirth by doctor type and gender (to be finalised) Not surprisingly, gender and family composition are very important in hours and other work choices Links to work-life balance and job/life satisfaction

Past research Life/job satisfaction By location (few differences)[22]/doctor type (hospital doctors/specialists in training are less satisfied) [20] Work-life balance is an important component Only half of GPs have good WLB, less for those working more hours, with less flexibility, poorer leisure opportunities, better for women/gen X GPs [21] Low job satisfaction associated with: poor health, trained outside Australia, poor opportunities for professional development, and long hours [7] Potential consequences are indicated by the association with a preference to reduce work hours and an intention to leave the medical workforce

Past research Workplace aggression Very high: in previous 12 months, verbal or written aggression (70.6%) & physical aggression (32.3%) [16] Low prevalence of environmental interventions such as: duress alarms, optimised clinician escape in consulting and treatment areas, and after-hours and off-site safety strategies [13] Particularly in private room settings Differs by gender, impacts on job satisfaction, life satisfaction, self-rated health, participation intentions [16, 10, 5]

Future research plans Changing expectations (e.g. around work-life balance) of the next generation with more female doctors may influence specialty, hours and other work choices A healthy and happy workforce is important, so understanding the factors influencing health (physical and mental) and job/life satisfaction is paramount Key questions are: How do gender, having a family, and changing work-life balance expectations influence medical care? How do doctors’ health and well-being influence their workforce participation, distribution and quality of care? What support do doctors need to remain healthy, happy and productive?

Future research plans We will have 10 waves of data next year, there is a lot that we can do with that: Use the longitudinal aspect to get at causal relationships. Some specific questions of interest: What is the immediate and long term impact of having a (newborn) child on workforce participation, specialty choice, and location of practice? What are the differences by gender and specialty? How does workplace and training flexibility influence career paths and workforce participation? Is doctor’s health and well-being changing over time, and why? To what extent does poor health and well-being influence hours worked, rural distribution, specialty choice, medical malpractice complaints and litigation, practice patterns and provision of low value care?

Future research plans First two questions can be done without extra data collection Last two questions can be done partly with existing data but would benefit from additional information through questions on mental health and stress (similar to those in Beyondblue survey) Currently only overall self-rated health (including physical and mental health) Additional questions like the often used Kessler 10 would also allow comparison to other populations

References Cheng TC, Kalb G & Scott A. Public, private, or both? Analysing factors influencing the labour supply of medical specialists, under review. Kalb G, Kuehnle D, Scott A, Cheng TC & Jeon S-H. What factors affect doctors' hours decisions: Comparing structural discrete choice and reduced-form approaches, under review. Broadway B, Kalb G, Li J & Scott A. 2017. Do Financial Incentives Influence GPs' Decisions to Do After-hours Work? A Discrete Choice Labour Supply Model. Health Economics, DOI: 10.1002/hec.3476 Schurer S, Kuehnle D, Scott A & Cheng TC. 2016. A man's blessing or a woman's curse? The family-earnings gap of doctors. Industrial Relations: A Journal of Economy and Society. 55(3): 385-414. Hills, DJ. 2016. Associations between Australian clinical medical practitioner exposure to workplace aggression and workforce participation intentions. Australian Health Review. 40: 36–42. Cheng TC, Powdthavee N & Oswald AJ. 2015. Longitudinal evidence for a midlife nadir in human beings: Results from four data sets. The Economic Journal, DOI: 10.1111/ecoj.12256. Joyce C & Wang WC. 2015. Job satisfaction among Australian doctors: the use of latent class analysis. Journal of Health Services Research & Policy, 20(4): 224-230. Joyce CM, Wang WC & Cheng TC. 2015. Changes in doctors' working hours: A longitudinal analysis. Medical Care Research and Review, 72(5): 605-621.

References Joyce C, Wang WC & McDonald H. 2015. Retirement patterns of Australian doctors aged 65 years and older. Australian Health Review, 39(5:) 582-587. Hills D & Joyce C. 2014. Workplace aggression in clinical medical practice: Associations with job satisfaction, life satisfaction and self-rated health. Medical Journal of Australia, 201(9): 535-540. Hills D & Joyce C. 2013. Personal, professional and work factors associated with Australian clinical medical practitioners' experiences of workplace aggression. Annals of Occupational Hygiene, 57(7), 898-912. Hills D & Joyce C. 2013. A review of research on the prevalence, antecedents, consequences and prevention of workplace aggression in clinical medical practice. Aggression and Violent Behavior: A Review Journal, 18(5), 554-569. Hills D, Joyce C & Humphreys J. 2013. Workplace aggression prevention and minimisation in Australian clinical medical practice - a national study. Australian Health Review, 37(5): 607-613. Scott A, Witt J, Humphreys J, Joyce C, Kalb G, Jeon SH & McGrail M. 2013. Getting doctors into the bush: General practitioners preferences for rural location. Social Science and Medicine, 96: 33–44.

References Cheng TC, Scott A, Jeon S, Kalb G, Humphreys J & Joyce C. 2012. What factors influence the earnings of general practitioners and medical specialists? Evidence from the Medicine in Australia: Balancing Employment and Life survey. Health Economics, 21(11): 1300-1317. Hills D, Joyce C & Humphreys J. 2012. A national study of workplace aggression in Australian clinical medical practice. Medical Journal of Australia, 197(6): 336-340. McGrail M, Humphreys J, Joyce C & Scott A. 2012. International medical graduates mandated to practice in rural Australia are highly unsatisfied: Results from a national survey of doctors. Health Policy, 108(2): 133-139. Sivey P, Scott A, Witt J, Joyce C & Humphreys J. 2012. Junior doctors' preferences for specialty choice. Journal of Health Economics, 31(6): 813–823. Hills D, Joyce C & Humphreys J. 2011. Prevalence and prevention of workplace aggression in Australian clinical medical practice. Australian Health Review, 35(3): 253-261. Joyce C, Schurer S, Scott A, Humphreys J & Kalb G. 2011. Australian doctors' satisfaction with their work: Results from the MABEL longitudinal survey of doctors. Medical Journal of Australia, 194(1): 30-33. Shrestha D & Joyce C. 2011. Aspects of work-life balance of Australian general practitioners: Determinants and possible consequences. Australian Journal of Primary Health, 17:40-47. McGrail M, Humphreys J, Scott A, Joyce C & Kalb G. 2010. Professional satisfaction in general practice: Does it vary by size of community? Medical Journal of Australia, 193(2): 94-98.