1. Maria Kopp MD, PhD, Szilvia Ádám, Zsuzsa Győrffy Semmelweis University Institute of Behavioural Sciences www.behsci.sote.hu Gender equality in medical profession?

2. Main topics: Health care is responsible for the prevention of chronic work related stress (the crucial role of Prof Lennart Levi). What about work related chronic stress among female physicians? Health care is responsible for the prevention of chronic work related stress (the crucial role of Prof Lennart Levi). What about work related chronic stress among female physicians? Work-family role conflict: how would be possible to solve it? Work-family role conflict: how would be possible to solve it? Negative discrimination against educated women, in this case against female physicians Negative discrimination against educated women, in this case against female physicians What are the effective preventive steps? What are the effective preventive steps? Which are the protective factors?

3. effort reward demands / obligations - labour income - career mobility / job security - esteem, respect motivation (‘overcommitment‘) motivation (‘overcommitment‘) The model of effort-reward imbalance according to Johannes Siegrist (1996) Extrinsic components Intrinsic component

4. Work related chronic stress: Not the challanges, but the third, exhaustion phase of stress process means high risk Karasek,R, Theorell,T.(1990) 1. Workload 2. Lack of control 3. Low social support Johannes Siegrist (1996) High effort/low reward, overcommitment

5. Comparison of female physicians and other female professionals in 2002: Compared to male physicians the situation of female physicians is more disadvantaged in several respect Compared to male physicians the situation of female physicians is more disadvantaged in several respect Severe depression, hopelessness and suicidal ideation were significantly more prevalent among them Severe depression, hopelessness and suicidal ideation were significantly more prevalent among them They could have less social support in difficult life situations They could have less social support in difficult life situations

6. Paradox of satisfaction with life and happiness In 2006 only 75 % of male physicians, 82 % of female physicians answered, that they are satisfied with their life (6 or more in a 1-10 score) In 2006 only 75 % of male physicians, 82 % of female physicians answered, that they are satisfied with their life (6 or more in a 1-10 score) Among non medical professionals 80 % of men and 83 % of women were satisfied with their life Among non medical professionals 80 % of men and 83 % of women were satisfied with their life On the other side, 91 % of male physicians and only 75 % of female physicians regarded themselves happy (6 or more in a 1-10 score) On the other side, 91 % of male physicians and only 75 % of female physicians regarded themselves happy (6 or more in a 1-10 score) Among the non-medical professionals these rates were 83 % among men and 85 % among women. Among the non-medical professionals these rates were 83 % among men and 85 % among women.

7. Female physicians experience significantly higher level and prevalence of work-family conflict compared to men Szilvia Ádám, Zsuzsa Győrffy

8. Work-family Conflict is a Significant Predictor of Somatic and Psychological Morbidity Including Burnout Using binomial and linear regression analyses, work-family conflict was the strongest predictor of Using binomial and linear regression analyses, work-family conflict was the strongest predictor of other (originally not listed) psychiatric/psychological diseases, other (originally not listed) psychiatric/psychological diseases, neurological diseases, neurological diseases, depression, depression, urological diseases, urological diseases, hypertension, hypertension, gastrointestinal diseases, gastrointestinal diseases, neoplasms, neoplasms, other (originally not listed) cardiovascular diseases, other (originally not listed) cardiovascular diseases, anxiety, anxiety, gynaecological diseases, gynaecological diseases, burnout (emotional exhaustion, depersonalization, personal accomplishment) burnout (emotional exhaustion, depersonalization, personal accomplishment) For example, one unit increase in perceived work-family conflict would increase the probability of developing depression by almost 4.5 times. For example, one unit increase in perceived work-family conflict would increase the probability of developing depression by almost 4.5 times.

9. Significantly Lower Prevalence of Job Satisfaction among Female Physicians Compared with Men Female physicians Male physicians Difference test (df) High level of job satisfaction N (%) 121 (55.3) 132 (65.7) χ 2 =4.8 (1)* * p<.05

10. Gender disparity in the level of burnout among female and male physicians Female physicians Mean (SD) Male physicians Mean (SD) Difference test (df) Burnout Emotional exhaustion 20.8 (10.8) 16.6 (11.3) t= -3.9 (418)*** Depersonalization 5.0 (4.9) 5.3 (5.1) NS a Personal accomplishment 35.3 (7.6) 35.7 (8.2) NS a a NS: Not significant *** p<.001

11. Summary Physicians reported high prevalence of somatic and psychological morbidity. Burnout and allergy are more prevalent among female physicians whereas hypertension and myocardial infarction are more widespread among male doctors. Female physicians scored significantly higher on the emotional exhaustion subscale compared to male physicians. Physicians reported high prevalence of somatic and psychological morbidity. Burnout and allergy are more prevalent among female physicians whereas hypertension and myocardial infarction are more widespread among male doctors. Female physicians scored significantly higher on the emotional exhaustion subscale compared to male physicians. For example, one unit increase in perceived work-family conflict would increase the probability of developing depression by almost 4.5 times. For example, one unit increase in perceived work-family conflict would increase the probability of developing depression by almost 4.5 times. Significantly lower prevalence of job satisfaction among female physicians compared with men. Significantly lower prevalence of job satisfaction among female physicians compared with men. Work-family conflict is a significant predictor of physicians ’ well- being, in particular Work-family conflict is a significant predictor of physicians ’ well- being, in particular somatic and psychological morbidity including burnout somatic and psychological morbidity including burnout job dissatisfaction among female physicians job dissatisfaction among female physicians

12. Negative discrimination against highly educated women: In low educational strata the number of actual children is the same as the number of wanted children In low educational strata the number of actual children is the same as the number of wanted children It would be the task of the society, of the civic organisations to help the highly educated women to have to possibility to give birth to their wanted, desired children It would be the task of the society, of the civic organisations to help the highly educated women to have to possibility to give birth to their wanted, desired children beside the possibility to work and be successful in their profession beside the possibility to work and be successful in their profession

13. The number of wanted and actual number of children among women younger than 45 years of age, according to education (Hungarostudy 2002)

14. The number of wanted and actual number of children among professional male and female health care workers (Hungarostudy 2002)

15. Important steps for improvement:

18. Stress management methods? Lifeskills programme? Organisational changes? Attitudes?

19. References: References: Kopp MS, Réthelyi J (2004) Where psychology meets physiology:chronic stress and premature mortality- the Central-Eastern-European health paradox, Brain Research Bulletin,62,351-367. Kopp MS, Réthelyi J (2004) Where psychology meets physiology:chronic stress and premature mortality- the Central-Eastern-European health paradox, Brain Research Bulletin,62,351-367. Skrabski,Á.Kopp MS, Rózsa S, Réthelyi J, Rahe RH (2005)Life meaning: an important correlate of health int he Hungarian population, International Journal of Behavioral Medicine, 12,2, 78-85. Skrabski,Á.Kopp MS, Rózsa S, Réthelyi J, Rahe RH (2005)Life meaning: an important correlate of health int he Hungarian population, International Journal of Behavioral Medicine, 12,2, 78-85. Kopp MS, Skrabski Á, Kawachi I, Adler NE (2005) Low socioeconomic staus of the opposite gender is a risk factor for middle aged mortality, J. Epidemiology and Community Health, 59,675-678. Kopp MS, Skrabski Á, Kawachi I, Adler NE (2005) Low socioeconomic staus of the opposite gender is a risk factor for middle aged mortality, J. Epidemiology and Community Health, 59,675-678. : 60,782-788. Kopp,M., Skrabski, Á., Szántó, Zs., Siegrist, J. : Psychosocial determinants of premature cardiovascular mortality differences within Hungary, J ournal of Epidemiology & Community Health 60,782-788. Kopp MS., Stauder A, Purebl Gy., Janszky I, Skrabski Á (2007) Work stress and mental health in a changing society, European Journal of Public Health, 18: 238-244. Kopp MS., Stauder A, Purebl Gy., Janszky I, Skrabski Á (2007) Work stress and mental health in a changing society, European Journal of Public Health, 18: 238-244. Kopp MS, Skrabski Á, Székely A, Stauder A, Williams R (2007) Chronic stress and social changes, socioeconomic determination of chronic stress, Annals of NewYork Academy of Sciences, 1113:325-338. Kopp MS, Skrabski Á, Székely A, Stauder A, Williams R (2007) Chronic stress and social changes, socioeconomic determination of chronic stress, Annals of NewYork Academy of Sciences, 1113:325-338. Balog P, Janszky I, Leineweber C, Blom M, Wamala SP, Orth-Gomer K (2003): Depressive symptoms in relation to marital and work stress in women with and without coronary heart disease. The Stockholm Female Conary Risk Study. Journal of Psychosomatic Research, 54, 113-119. Balog P, Janszky I, Leineweber C, Blom M, Wamala SP, Orth-Gomer K (2003): Depressive symptoms in relation to marital and work stress in women with and without coronary heart disease. The Stockholm Female Conary Risk Study. Journal of Psychosomatic Research, 54, 113-119. Blom M, Janszky I, Balog P, Orth-Gomer K, Wamala SP (2003): Social Rlations in women with coronary heart disease. The effects of work and Marital stress. Journal of Cardiovascular Risk; 10 (3):201-206. Blom M, Janszky I, Balog P, Orth-Gomer K, Wamala SP (2003): Social Rlations in women with coronary heart disease. The effects of work and Marital stress. Journal of Cardiovascular Risk; 10 (3):201-206.

20. Publications Szilvia Adam Ádám, S., Győrffy, Z., & Susánszky, É. (2008). Physician burnout in Hungary: a potential role for work-family conflict. Journal of Health Psychology, 13(7), 839-.848. Ádám, S., Győrffy, Z., & Susánszky, É. (2008). Physician burnout in Hungary: a potential role for work-family conflict. Journal of Health Psychology, 13(7), 839-.848. Ádám, S., Győrffy, Z., & Susánszky, É.: High prevalence of work-family conflict among female physicians: lack of social support as a potential antecedent. International Journal of Behavioral Medicine, submitted for publication. Ádám, S., Győrffy, Z., & Susánszky, É.: High prevalence of work-family conflict among female physicians: lack of social support as a potential antecedent. International Journal of Behavioral Medicine, submitted for publication. László, K.D., Győrffy, Z., Ádám, S., Csoboth, C., & Kopp, M. (2008). Work-related stress factors and menstrual pain: a nation-wide representative survey. Journal of Psychosomatic Obstetrics & Gynecology, 29(2), 133- 138. László, K.D., Győrffy, Z., Ádám, S., Csoboth, C., & Kopp, M. (2008). Work-related stress factors and menstrual pain: a nation-wide representative survey. Journal of Psychosomatic Obstetrics & Gynecology, 29(2), 133- 138.