This study examined the psychological well-being and retention of rural general practitioners (GPs) in South Australia. A survey of 187 rural GPs found that those seriously considering leaving rural practice reported higher work-related distress, lower work-related morale, and lower quality of work life than those not considering leaving. GPs considering leaving also reported having fewer colleagues with whom to discuss professional issues. The results indicate that psychological interventions targeting stress reduction and coping mechanisms, such as cognitive behavioral training and increased interaction with colleagues, may help increase retention of rural GPs by improving their psychological well-being.
Weāre always ready to take on board the views of the people who matter most: itās what helps us focus on providing products and services that people really need. This is the tenth year in which weāve conducted our Health of the Nation study, canvassing the opinions of GPs right across the UK. This year weāve extended our research to include the views of 1,000 patients to understand their experiences of healthcare in the UK.
A Review on Maternal Common Mental Disorders and Associated Factors: A Crossā...aponhasan
Ā
It's a simple review of mental health of mother and child nutrition related article publish on the journal named International Journal of Mental Health Systems.
Weāre always ready to take on board the views of the people who matter most: itās what helps us focus on providing products and services that people really need. This is the tenth year in which weāve conducted our Health of the Nation study, canvassing the opinions of GPs right across the UK. This year weāve extended our research to include the views of 1,000 patients to understand their experiences of healthcare in the UK.
A Review on Maternal Common Mental Disorders and Associated Factors: A Crossā...aponhasan
Ā
It's a simple review of mental health of mother and child nutrition related article publish on the journal named International Journal of Mental Health Systems.
Presentation by Dr Susanne Stanley PhD and Lucia Ferguson - The Wellness Clinic: A model of integrated care for people with complex mental illness.
Presented at the Western Australian Mental Health Conference 2019.
EVIDENCE-BASED PSYCHIATRIC NURSING PRACTICE, Components of EPBBASES FOR NURSING PRACTICE, DEVELOPING EVIDENCE-BASED CARE, HIERARCHY OF RESEARCH EVIDENCE, TAXONOMY FOR INFORMED DECISION-MAKING, CHARACTERISTICS OF GOOD BEHAVIORAL HEALTH PRACTICE GUIDELINES, CLINICAL ALGORITHMS
Anna Ratzliff, MD, PhD, Associate Director for Education, Division of Integrated Care & Public Health Department of Psychiatry & Behavioral Sciences, University of Washington
Latino Health Forum 2014
Penny Georgeā¢ Institute for Health and Healing: Meeting Patients Where They AreAllina Health
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By Courtney Baechler, MD. A discussion about the Penny George Institute and its goal to empower patients using the mind-body-spirit approach to health, encouraging a philosophy of wellness at any stage of care. The Penny George Institute has become a national leader in holistic health care and is an important component of Allina Health efforts to achieve health care transformation through the Triple Aim.
Outcomes of Online Mindfulness-Based Cognitive Therapy for Patients With Residual Depressive SymptomsA Randomized Clinical Trial
Zindel V. Segal, PhD1; Sona Dimidjian, PhD2; Arne Beck, PhD3; et alJennifer M. Boggs, PhD3; Rachel Vanderkruik, MA2; Christina A. Metcalf, MA2; Robert Gallop, PhD4; Jennifer N. Felder, PhD5; Joseph Levy, BA2
Author Affiliations
JAMA Psychiatry. Published online January 29, 2020. doi:10.1001/jamapsychiatry.2019.4693
Significance for fasd
Horticulture Therapy in Dementia Care Impact on Behavioral: Symptoms, Physical and Cognitive Activities
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For more information, Please see websites below:
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Increase Food Production with Companion Planting in your School Garden =
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Simple Square Foot Gardening for Schools - Teacher Guide =
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Whereās the evidence that screening for distress benefits cancer patients?James Coyne
Ā
āThe case against screening for distress.ā A presentation delivered as part of an invited debate with Alex Mitchell at the International Psycho Oncology Conference, Rotterdam, November 7, 2013
Author: Hazrath Maulana Mohammed Abdullah Qasmi Saheb, Supreme Sadar, Rabita Wafaq ul Madaris Arabia, Marathwada, Aurangabad, Maharashtra.
This booklet highlights the desire, determination, perseverance, enthusiasm and passion of Hazrath Dr Quadri Saheb (DB) towards knowledge of Deen. THIS BOOK IS SOURCE OF INSPIRATION FOR KNOWLEDGE SEEKERS.
Presentation by Dr Susanne Stanley PhD and Lucia Ferguson - The Wellness Clinic: A model of integrated care for people with complex mental illness.
Presented at the Western Australian Mental Health Conference 2019.
EVIDENCE-BASED PSYCHIATRIC NURSING PRACTICE, Components of EPBBASES FOR NURSING PRACTICE, DEVELOPING EVIDENCE-BASED CARE, HIERARCHY OF RESEARCH EVIDENCE, TAXONOMY FOR INFORMED DECISION-MAKING, CHARACTERISTICS OF GOOD BEHAVIORAL HEALTH PRACTICE GUIDELINES, CLINICAL ALGORITHMS
Anna Ratzliff, MD, PhD, Associate Director for Education, Division of Integrated Care & Public Health Department of Psychiatry & Behavioral Sciences, University of Washington
Latino Health Forum 2014
Penny Georgeā¢ Institute for Health and Healing: Meeting Patients Where They AreAllina Health
Ā
By Courtney Baechler, MD. A discussion about the Penny George Institute and its goal to empower patients using the mind-body-spirit approach to health, encouraging a philosophy of wellness at any stage of care. The Penny George Institute has become a national leader in holistic health care and is an important component of Allina Health efforts to achieve health care transformation through the Triple Aim.
Outcomes of Online Mindfulness-Based Cognitive Therapy for Patients With Residual Depressive SymptomsA Randomized Clinical Trial
Zindel V. Segal, PhD1; Sona Dimidjian, PhD2; Arne Beck, PhD3; et alJennifer M. Boggs, PhD3; Rachel Vanderkruik, MA2; Christina A. Metcalf, MA2; Robert Gallop, PhD4; Jennifer N. Felder, PhD5; Joseph Levy, BA2
Author Affiliations
JAMA Psychiatry. Published online January 29, 2020. doi:10.1001/jamapsychiatry.2019.4693
Significance for fasd
Horticulture Therapy in Dementia Care Impact on Behavioral: Symptoms, Physical and Cognitive Activities
`
For more information, Please see websites below:
`
Organic Edible Schoolyards & Gardening with Children =
http://scribd.com/doc/239851214 ~
`
Double Food Production from your School Garden with Organic Tech =
http://scribd.com/doc/239851079 ~
`
Free School Gardening Art Posters =
http://scribd.com/doc/239851159 ~
`
Increase Food Production with Companion Planting in your School Garden =
http://scribd.com/doc/239851159 ~
`
Healthy Foods Dramatically Improves Student Academic Success =
http://scribd.com/doc/239851348 ~
`
City Chickens for your Organic School Garden =
http://scribd.com/doc/239850440 ~
`
Simple Square Foot Gardening for Schools - Teacher Guide =
http://scribd.com/doc/239851110 ~
Whereās the evidence that screening for distress benefits cancer patients?James Coyne
Ā
āThe case against screening for distress.ā A presentation delivered as part of an invited debate with Alex Mitchell at the International Psycho Oncology Conference, Rotterdam, November 7, 2013
Author: Hazrath Maulana Mohammed Abdullah Qasmi Saheb, Supreme Sadar, Rabita Wafaq ul Madaris Arabia, Marathwada, Aurangabad, Maharashtra.
This booklet highlights the desire, determination, perseverance, enthusiasm and passion of Hazrath Dr Quadri Saheb (DB) towards knowledge of Deen. THIS BOOK IS SOURCE OF INSPIRATION FOR KNOWLEDGE SEEKERS.
BOOST by Design is a new project for Dundeeās social enterprises who are keen to develop their understanding of design, innovation and digital skills. If you are a social enterprise based locally interested in taking part in it early 2017, then it's FREE and open for application. Find out more: http://bit.ly/BoostbyDesign
HEALTH CARE MANAGEMENTUNIT I Part IV JOURNAL Instruct.docxpooleavelina
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HEALTH CARE MANAGEMENT
UNIT I Part IV JOURNAL Instruction:
You are the newly appointed compliance officer for a major medical center in Chicago. One key objective of your compliance plan is to create a secure and effective reporting process so that you can avoidĀ qui tamĀ lawsuits against your hospital. Your goal is to have zeroĀ qui tamĀ lawsuits during your tenure as compliance officer. What steps will you take to avoid such lawsuits against your facility?
Your journal entry must be at least 200 words. No references or citations are necessary. SIMPLE SHEET / NO HEAD RUNNING / NOTHING JUST 200 WORDS _____________________________________________________________________________ DO NOT MIXED Part I & PART II. There are two different assignments. Posted separated.
_____________________________________________________________________________
UNIT I Part IV Instructions
You have just been hired as a compliance officer for your healthcare organization, and you have discovered that the food services department of the organization is not in compliance with state food safety regulations for healthcare organizations. The board of directors has requested a report from you and your team that contains an outline of the issues that have been occurring within the food services department that have caused it to become noncompliant, a plan to bring the department into compliance, and a description of how you and your team plan to maintain the departmentās compliance in the future.
Your report should cover the following topics:
Ā· a description of the foodborne hazards that have occurred within the healthcare organization that have caused it to become noncompliant,
Ā· why it is important for patient recovery that the food service department maintain food safety and become complaint with state regulations,
Ā· the key elements of your compliance plan, and
Ā· the importance of internal audits and project management in the creation, implementation, and maintenance of the compliance plan.
Your report should consist of at least three pages, not including a title page and reference pages. Please be sure to use APA formatting for all sources, including your textbook. You must use at least three sources, one of which can be your textbook.
Course Textbook(s)
Safian, S. C. (2014).Ā Fundamentals of health care administration. Upper Saddle River, NJ: Pearson.
Randomized Clinical Trial of Cognitive Behavioral Social Skills Training
for Schizophrenia: Improvement in Functioning and Experiential
Negative Symptoms
Eric Granholm and Jason Holden
Veterans Affairs San Diego Healthcare System and University
of California, San Diego
Peter C. Link
Veterans Affairs San Diego Healthcare System
John R. McQuaid
Veterans Affairs San Francisco Medical Center and University of California, San Francisco
Objective: Identifying treatments to improve functioning and reduce negative symptoms in consumers
with schizophrenia is of high publ ...
Prevalence and predictors of mental health among farmworkers in Southeastern ...Agriculture Journal IJOEAR
Ā
Abstractā
Background: Mental health problems represent a major component of the global burden of disease. The primary objective of this study was to assess the prevalence and predictors of psychological wellbeing among farmworkers and to evaluate their mental health services need for in rural primary health care settings.
Methods: The study sample comprised 1855 farmworkers (918 women, and 937 men) who were selected using probability cluster sampling method at 95% confidence interval (87.6 % response rate). The 12-item General Health Questionnaire (GHQ-12) and socio-demographic information form were used to data collection.
Results: The overall prevalence of mental health problems was 31.5%; the prevalence among women was 1.4 times that of men (35%, females; 28.2%, males). Logistic regression analyses revealed that poor general health, as well as presence of chronic diseases and exposure to traumatic life events predicted mental ill health among both sex. Poor economic situation, being seasonal migrant farmworker, and pesticide exposure history affected male mental health problems; while type of settlement, history of having disabled child at birth, and not having a family physician were significant predictors of female mental ill health (P < 0.05).
Conclusions: These findings highlight the need for systematic development of community-based mental health services in conjunction with rural primary health care center and an integrated approach to health care of farmworkers. These include screening, early identification and treatment of mental health problems, development of non-communicable disease (NCD) control program, maternal health services and urgent measures to improve farmworkersā work safety and pesticide applications.
BioMed CentralPage 1 of 9(page number not for citation pChantellPantoja184
Ā
BioMed Central
Page 1 of 9
(page number not for citation purposes)
BMC Health Services Research
Open AccessResearch article
Prevalence and associated factors in burnout and psychological
morbidity among substance misuse professionals
Adenekan Oyefeso*1, Carmel Clancy2 and Roger Farmer3
Address: 1Division of Mental Health, Medical School, St George's, University of London, London SW17 0RE, UK, 2School of Health and Social
Sciences, Middlesex University, F Block, Holborn Union Building, Archway Campus, Highgate Hill, London N19 3UA, UK and 3South West
London and St George's Mental Health NHS Trust, Richmond Royal Hospital, Kew Foot Road, Surrey TW9 2TE, UK
Email: Adenekan Oyefeso* - [emailĀ protected]; Carmel Clancy - [emailĀ protected]; Roger Farmer - [emailĀ protected]
* Corresponding author
Abstract
Background: Studies of psychological stress among substance misuse professionals rarely
describe the nature of burnout and psychological morbidity. The main aim of this study was to
determine the extent, pattern and predictors of psychological morbidity and burnout among
substance misuse professionals.
Methods: This study was a cross-sectional mail survey of 194 clinical staff of substance misuse
services in the former South Thames region of England, using the General Health Questionnaire
(GHQ-12) the Maslach Burnout Inventory (MBI) as measures of psychological morbidity and
burnout, respectively.
Results: Rates of psychological morbidity (82%: 95% CI = 76ā87) and burnout (high emotional
exhaustion ā 33% [27ā40]; high depersonalisation ā 17% [12ā23]; and diminished personal
accomplishment ā 36% [29ā43]) were relatively high in the study sample. High levels of alienation
and tension (job stressors) predicted emotional exhaustion and depersonalisation (burnout) but
not psychological morbidity. Diminished personal accomplishment was associated with higher
levels of psychological morbidity
Conclusion: In the sample of substance misuse professionals studied, rates of psychological
morbidity and burnout were high, suggesting a higher level of vulnerability than in other health
professionals. Furthermore, pathways to psychological morbidity and burnout are partially related.
Therefore, targeted response is required to manage stress, burnout and psychological morbidity
among substance misuse professionals. Such a response should be integral to workforce
development.
Background
Since the introduction of the United Kingdom Govern-
ment's Drug Strategy in 1998, substance misuse services
have expanded with increases in funding available from
central government as part of implementation of the drug
strategy [1]. The targets set in the strategy may have put
extra demands on substance misuse services with a likely
increase in job-related stress, burnout and associated psy-
chological morbidity.
Studies of stress and burnout in various occupational
groups and settings have been widely reported [2-4].
Published: 8 February 2008
BMC Health Servic ...
Anna Ratzliff, MD, PhD, Associate Director for Education, Division of Integrated Care & Public Health Department of Psychiatry & Behavioral Sciences, University of Washington
Family Therapy CourseUsing the brief case description below, pre.docxssuser454af01
Ā
Family Therapy Course
Using the brief case description below, prepare a script you could use to call the mock clientās pediatrician for a 10-minute conversation. To prepare, consider the following: What facts do you need to communicate to the doctor? What will the doctor likely want to know from you? What will you want to be sure to tell the doctor about your diagnosis of him having ADHD and treatment plan for family? You diagnose that he should be placed on medication and pediatricians nurse prescribe the diagnosis level ĀĀĀĀ
Case description: Your client is an 8-year-old male whose parents are concerned might have ADHD. He is the middle child of three boys. You have met the parents and the child in your initial sessions. At this point, you have had only three sessions with the family. Your client says he has lots of friends, he hates school because itās boring, and his parents yell at him too much!
Write a mock transcript of an imaginary phone call between you and the clientās physician. In your mock discussion, include information you would provide to the doctor about your assessment, treatment plan, and orientation to treating ADHD; include the doctorās questions or responses to the information you provide. Also, include questions you would ask the doctor, and the doctorās responses.
Transcript Length: 5 pages
A NATIONAL SURVEY OF FAMILY PHYSICIANS:
PERSPECTIVES ON COLLABORATION WITH
MARRIAGE AND FAMILY THERAPISTS
Rebecca E. Clark
Lifespan Family Healthcare, Newcastle, Maine
Deanna Linville
University of Oregon
Karen H. Rosen
Virginia Polytechnic Institute and State University
Recognizing the fit between family medicine and marriage and family therapy (MFT),
members of both fields have made significant advances in collaborative health research
and practice. To add to this work, we surveyed a nationwide random sample of 240 family
physicians (FPs) and asked about their perspectives and experiences of collaboration with
MFTs. We found that FPs frequently perceive a need for their patients to receive MFT-
related care, but their referral to and collaboration with MFTs were limited. Through
responses to an open-ended question, we gained valuable information as to how MFTs
could more effectively initiate collaboration with FPs.
Despite the success of medical family therapists in providing integrative, collaborative
healthcare, we know little about how commonly family physicians (FPs) and marriage and fam-
ily therapists (MFTs) collaborate in routine patient care. To our knowledge, there have been
no studies published from the perspective of the FP that describe the extent to which FPs seek
the collaboration of MFTs, the degree to which they are aware of MFT as a field, their per-
ceived need for their patients to receive MFT, or their attitude toward MFT as a potential
resource for patient treatment.
Leaders in family medicine and MFT recognize the common occurrence of mental health
concerns arising in a medical visit. In fact, it ...
A small study of individuals with Parkinsonās disease finds that adding palliative care to standard care may help raise their quality of life. Half the patients in a 210-person trial were assigned to visit physicians as usual, while the others also received palliative care ā a team of a social worker, nurse, palliative medicine specialist, and chaplain visited the patient at home or via telemedicine to discuss symptoms and difficult emotions and offer support to caregivers. Patients in the combination care group had more improvement in their quality of life score (as measured by a survey that assesses physical and mental health).
These patients also scored higher on quality of life measures when their caregivers were surveyed in their stead.
Freudenberger and subsequently developed by Maslach and colleagues, chronic stress associated with emotionally intense work demands for which resources are inadequate can result in burnout. Burnout is a work-related syndrome involving emotional exhaustion, depersonalization and a sense of reduced personal accomplishment.
MayJune 2021 Volume 39 Number 3 111Nursing Economic$AbramMartino96
Ā
May/June 2021 | Volume 39 Number 3 111
Nursing Economic$
Developing a well-prepared and geographically
distributed mental health
workforce is a crucial goal of
healthcare workforce planning
initiatives and contributes to
health systemsā ability to
improve population health
(Beck et al., 2020). Before the
SARS COV-2 global pandemic,
sharp increases in suicide,
substance abuse, opioid crises,
gun violence, and severe
depression among young
people were increasing
demands on mental and
behavioral health professionals,
including nurses (Substance
Abuse and Mental Health
Services Administration, 2020).
However, the growing demand
for behavioral health services,
let alone treating the 44 million
American adults who have a
diagnosable mental health
condition, is being met by a
potential shortage of
professionals, which the Health
Resources and Services
Administration (2016) projects
will worsen to as many as
250,000 workers by 2025.
Access to mental health care is
crucial given the societal
upheaval brought about by the
SARS COV-2 global pandemic.
To address the growing
demand for mental health
services, many communities and
healthcare systems are exploring
novel ways to integrate mental
health treatment into primary
care delivery, for example, using
the Collaborative Care Model
(Vanderlip et al., 2016). Nurses
often contact people living with
mental or behavioral health
conditions while being treated
for physical and medical
conditions in both community
and hospital settings. A recent
focus on mental health care,
particularly in outpatient
settings, has been an emphasis
in team-based models,
telehealth, and integration of
mental health and primary care
with contributions from
physicians, nurses, social
workers, peer support, and
community health workers ā all
of which can be beneficial
relative to more traditional and
often siloed models of mental
health treatment (Reiss-Brennan
et al., 2016).
Characteristics of Registered Nurses
and Nurse Practitioners Providing
Outpatient Mental Health Care
David I. Auerbach
Max C. Yates
Douglas O. Staiger
Peter I. Buerhaus
The growing demand for mental
health services, together with
current and increasing shortages
of mental health professionals
and increasing adoption of
integrated models of care
delivery, suggest nurses will
become increasingly needed to
provide mental health services.
Analysis of a national survey
finds registered nurses and
nurse practitioners working in
outpatient mental health settings
are older than those in other
settings. Most would benefit
from additional training. Provision
of team-based care was
associated with higher job
satisfaction.
May/June 2021 | Volume 39 Number 3112
The growing demand for
mental health services, together
with current and increasing
shortages of mental health
professionals and increasing
adoption of integrated models
of care delivery, suggest nurses
will b ...
MayJune 2021 Volume 39 Number 3 111Nursing Economic$
Ā
psych wellbeing rural gps 05
1. Aust. J. Rural Health (2005) 13, 149ā155
Blackwell Science, LtdOxford, UKAJRAustralian Journal of Rural Health1038-52822005 National Rural Health Alliance Inc.June
2005133149155Original ArticlePSYCHOLOGICAL WELL-BEING AND RETENTION OF GPSM. GARDINER
Et al.
Correspondence: Maria Gardiner, School of Psychology,
Flinders University of South Australia, Bedford Park,
South Australia, 5042, Australia. Email: maria.
gardiner@ļ¬inders.edu.au
Accepted for publication November 2004.
Original Article
The role of psychological well-being in retaining rural
general practitioners
Maria Gardiner,1
Roger Sexton,2
Mitchell Durbridge1
and Kiara Garrard2
1
School of Psychology, Flinders University of South Australia, Bedford Park and 2
Rural Doctors
Workforce Agency, Wayville, South Australia, Australia
Abstract
Objective: Retention of rural GPs is an increasing area
of concern and is receiving considerable attention from
the government, medical authorities and the media. This
study aimed to examine the potential for psychological
interventions to assist in the retention of rural GPs
through targeting their psychological well-being.
Design: GPs completed a questionnaire, including ques-
tions about their level of support in rural practice, psycho-
logical health (work-related morale and distress, distress
related speciļ¬cally to working in rural general practice,
quality of work life) and intentions to leave rural practice.
Setting: Rural general practices in South Australia.
Participants: One hundred and eighty-seven rural GPs.
Results: Results indicated that rural GPs who were seri-
ously considering leaving rural practice had higher
work-related distress, higher distress related speciļ¬cally
to working in a rural general practice and lower quality
of work life. GPs who considered leaving rural practice
also reported having fewer colleagues with whom to
discuss professional issues.
Conclusion: Results indicated that psychological inter-
ventions (such as cognitive behavioural training), assis-
tance with stress reduction and coping mechanisms
(such as more interaction with colleagues) may be of
beneļ¬t to GPs who are considering leaving rural prac-
tice. Such training may increase the number of GPs who
ultimately stay in rural practice.
KEY WORDS: psychological well-being, quality of life,
rural general practice, rural GPs, stress.
Introduction
The maintenance of a viable rural general practice
workforce has attracted considerable attention from
government, media, medical organisations and Divi-
sions of General Practice.1
In particular, the focus has
been on retaining the relatively low number of rural
doctors and recruiting new doctors to work in rural
areas.2
Some of the more commonly reported reasons for
work dissatisfaction and/or rural GPs leaving rural gen-
eral practice include increased workload and profes-
sional isolation, family conļ¬icts and increasing demand
from a changing rural health care system (e.g. hospital
closures and reduction in staff numbers).3ā6
Other fac-
tors inļ¬uencing the decision to leave rural general prac-
tice include inadequate leave from work, a lack of
suitable and affordable child care, a lack of anonymity
in rural communities, reduced employment opportuni-
ties for spouses and reduced educational opportunities
for children.1,7ā9
To date, the majority of strategies and initiatives to
improve retention rates have focused on improving the
environment in which doctors work. Some of the strat-
egies suggested include increasing the number of loc-
ums available (both long- and short-term), providing
speciļ¬c skills training (e.g. trauma management train-
ing) and instigating multidoctor communities. How-
ever, given their limited success and their inability to
address such issues as choice of schooling and family
problems, some rural doctor organisations are apprais-
ing the role of psychological support in the retention of
rural GPs (recent research shows that GP well-being is
amenable to improvement through evidence-based
approaches).10
An example of one such program that directly targets
psychological well-being of GPs is the Physicians Health
Program (PHP) conducted by The Foundation of the
Pennsylvania Medical Society.11
This program includes
counselling and training and asserts that āphysicians
have to change the way they live and learn to balance
their personal needs with those of their patientsā.
In South Australia, the Dr DOC program, a rural GP
health and well-being program instigated in 2000 by
the Rural Doctors Workforce Agency (RDWA, formerly
SARRMSA), has implemented a statewide approach
2. 150 M. GARDINER ET AL.
aimed at improving rural doctorsā health and well-
being. The program aims to support rural and remote
GPs and their families in maintaining their well-being
through both physical and psychological health strate-
gies, as well as providing timely support to those in
crisis.
There is, however, a distinct lack of data on rural GP
psychological well-being as well as empirical evidence
to guide or support these types of initiatives.12
In an
effort to add to the empirical literature, the current
study aimed to provide a snapshot of South Australian
rural GP psychological well-being, and to begin to look
for possible interventions that could improve well-being
and ultimately increase retention rates, thereby provid-
ing a baseline measure with which to compare the efļ¬-
cacy of the Dr DOC Program as an interventional
strategy.
Method
Participants and survey distribution
Participants in the survey were 187 GPs working in
rural practice in South Australia, as identiļ¬ed by the
RDWA. The questionnaire was mailed out twice to 336
valid participants, resulting in a 56% response rate. All
information was coded for anonymity. Ethics approval
was obtained from the Social and Behavioural Research
Ethics Committee at Flinders University of South
Australia.
Survey instrument
The questionnaire comprised the following ļ¬ve sections:
1. Demographic data were collected by asking ques-
tions regarding age, gender, marital status, number
of children, years in general practice and practice
information.
2. Support in rural general practice was assessed by
asking questions about the following areas: use of
crisis support services, continuing medical educa-
tion (CME) activities and social support.
3. Four psychological health measures were used to
assess the psychological well-being of rural GPs.
They are: work-related distress, work-related
morale, quality of work life and rural doctor dis-
tress. Work-related distress and work-related
morale are orthogonal measures each consisting of
seven items and quality of work life consists of six
items.13
GPs were asked to rate the frequency of
their feelings whilst at work over the previous
month, and also their perceptions of their work life
on a 7-point scale (higher scores indicating higher
morale, distress or quality of work life). Internal
reliability was high for distress (Cronbachās
alpha = 0.89), morale and quality of work life (both
Cronbachās alpha = 0.91). In line with Gardiner
et al. to determine clinical signiļ¬cance a cut-off
score representing the bottom one-third of respon-
dents was used, with a score of 26 and above indi-
cating a high level of distress, 29 and below
indicating poor morale and 22 and below indicating
poor quality of work life.10
Rural doctor distress is
a customised 10-item scale, designed to measure
distress that respondents attributed speciļ¬cally to
being a rural GP. Respondents were asked to indi-
cate on a 7-point scale how much they agreed with
each of the statements (1 = not at all and 7 = very
much so). Internal reliability was high for this scale
(Cronbachās alpha = 0.88). However, the results
have been reported for each question separately, as
well as for the scale. The measure agreed well with
the other psychological health measures, correlating
0.629 with work-related distress, -0.439 with
work-related morale and -0.439 with quality of
work life (all P > 0.0001).
What is already known on this
subject: Increasing the number and retention of
doctors in rural general practice is both a
government and community priority. To date
mostly only structural interventions (such as
increasing the number of locums) have been
tried. There are a number of ļ¬edgling GP well-
being programs in operation that aim to
improve GP well-being and ultimately GP
retention rates. However, none of these
programs have been evaluated.
What this study adds: This present study aims
to provide a snapshot of rural GP psychological
well-being as well as baseline measurement for
a South Australian well-being program (the Dr
DOC program). This survey study found that
GPs who seriously considered leaving rural
general practice have higher stress and lower
morale and quality of work life than those not
considering leaving. In addition, GPs, when
asked, requested more personal management
skills than medical skills to assist them in their
work life. These results indicate that providing
self-management skills such as stress and time
management may well increase rural GP
retention rates.
3. PSYCHOLOGICAL WELL-BEING AND RETENTION OF GPS 151
4. GPs were asked whether in the last two years they
had seriously considered leaving rural general
practice.
5. GPs were asked to make any general comments that
they felt were relevant and important to them and
that related to their personal and professional life
as a rural GP.
Results
Demographic data
Demographic data revealed that the majority of GPs in
the survey were male, with two-thirds aged between 30
and 50 years. Over 80% of the GPs had been in rural
general practice for more than ļ¬ve years. Only 5.9%
had been in rural general practice for less than a year.
Most GPs (87.2%) also reported having a partner living
at home. The majority of GPs (78.5%) reported working
more than seven sessions per week and nearly two-thirds
(63.2%) worked in a practice with four or more GPs.
Support in rural general practice
Use of crisis support services
Responses indicated that although 19% of GPs needed
a crisis support service in the past year, just over two-
thirds of these GPs did not actually use one. The reasons
for not using services seemed unrelated to a lack of
knowledge about their availability, but more to a reluc-
tance or unwillingness to access the services, with
respondents stating that they preferred to resolve the
issue themselves (34.8%), lacked conļ¬dence in the abil-
ity of crisis support services to help (26.1%), felt a
general reluctance to be helped (21.7%), or cited prac-
tical reasons such as lack of time (8.7%).
Continuing medical education
Tables 1 and 2 show that there was a wide variety of
CME activities judged to be most useful in general prac-
tice, with little consensus over which activities were
most useful. However, of most note is that although the
most frequently attended activities relate to patient care,
the skills GPs would most like to acquire relate to per-
sonal issues such as stress management and time man-
agement.
Social support
Table 3 shows that the majority of respondents
reported having at least some contact with other GPs.
However, the opportunity to discuss personal issues
with other GPs was less evident, as was the opportu-
nity to discuss these issues with people other than GPs
or partners.
Psychological health of rural GPs
Rural GP distress (rural general practice-speciļ¬c
inļ¬uences on psychological well-being)
The results in Table 4 show that approximately 10% of
respondents reported feeling elements of rural GP dis-
tress āquite a lotā. One-third (34.7%) of participants felt
quite strongly that they should take better care of their
health, while 16% felt a strong degree of personal iso-
lation. More generally it is estimated that at least one-
third to one-half of GPs indicated that they had either
āsome degreeā or āquite a lotā of distress directly related
to rural general practice.
Quality of work life, work-related morale and
work-related distress
Overall, participants reported a moderate (scale
median) quality of work life, with approximately one-
third (31.4%) reporting high quality. Very few respon-
TABLE 1: Continuing medical education (CME) activities
attended in the last 12 months that were most frequently
reported as being most useful in respondentsā general practice
(n = 142)
Activity
Number of
respondents Percentage
Cardiology 11 7.7
Anaesthetic refresher 11 7.7
Practice management seminar 8 5.6
Obstetrics 8 5.6
TABLE 2: Most frequently mentioned skills identiļ¬ed by
respondents that would make rural general practice better
(n = 148)
Skill Number of respondents Percentage
Personal skillsā 31 20.9
Time management 28 18.9
Practice management 18 12.2
Surgery skills 16 10.8
Computer skills 15 10.1
Counselling skills 14 9.5
Mental health skills 14 9.5
Respondents were asked to nominate two skills.
ā Personal skills include relaxation, balancing career/family,
stress management, communication skills, spare time.
4. 152 M. GARDINER ET AL.
dents (5.4%) reported a low quality of work life. This
same pattern also held for work-related morale, with
most (75.7%) reporting moderate levels, and very few
(2.7%) reporting low levels. Similarly, for work-related
distress most respondents (65.9%) reported moderate
levels of work-related distress, with few reporting high
levels (3.8%).
Intentions to leave rural general practice
Approximately half of the respondents (52.7%, n = 96)
reported that in the last two years they had seriously
considered leaving rural general practice.
Further analyses
GPs who seriously considered leaving rural
general practice in the last two years
GPs who seriously considered leaving rural general
practice in the last two years were approximately twice
as likely to have poor levels of work-related distress,
morale and quality of work life (Table 5). There was
also a small effect of social support, with GPs who
seriously considered leaving rural general practice also
having fewer other GPs with whom to discuss profes-
sional issues (a measure of support).
The relationship between social support and
psychological health
There were small but signiļ¬cant positive relationships
between the levels of reported psychological health
(work-related morale, rural GP distress and quality of
work life) and having other GPs available with whom
to discuss issues. Those GPs reporting higher levels of
support also reported lower rural GP distress (r = 0.21;
95% CI, 0.06ā0.34) and higher work-related morale
(r = -0.32; 95% CI, 0.18ā0.44) and quality of work life
(r = 0.25; 95% CI, Ā·
0.11ā0.38; all P < 0.01).
Comments made by GPs
Overall, GPsā comments tended to be polarised, with
many stressing the negative aspects and difļ¬culties of
being a rural GP, and nearly as many reporting the
positive and enjoyable experiences associated with rural
practice.
The main stresses and pressures that emerged in the
general comments related to:
TABLE 3: Level of social support reported by respondents
Contact 1 (none) 2 3 (some) 4 5 (a lot)
How much contact do you have with other GPs? 5.9% 9.2% 24.9% 21% 38.9%
Do you have other GPs with whom you can discuss professional issues? 2.7% 6.5% 24.3% 27% 39.5%
Do you have other GPs with whom you can discuss personal issues? 24.2% 29.6% 31.7% 9.7% 4.8%
Do you have other people (other than your spouse/partner) with whom
you can discuss professional or personal issues?
16.2% 28.6% 30.8% 15.2% 9.2%
TABLE 4: Responses to rural GP distress questions
Rural GP distress questions (scored on a 7-point Likert scale)
Not at all
(1ā2)
Somewhat
(3ā5)
Quite a lot
(6ā7)
In the last month I have felt:
Professionally isolated 57.8% 34.7% 7.5%
Personally isolated or alone 48.7% 35.3% 16%
Like I have no one to go to for support when work or life gets hard 48.4% 40.9% 10.7%
In crisis with no help available 69.5% 26.8% 3.8%
In crisis but donāt want to ask for help 69.5% 23% 7.4%
My physical health is suffering as a result of being a rural GP 40.9% 45.1% 14%
My mental health is suffering as a result of being a rural GP 36.9% 49.2% 13.9%
I should take better care of my health 19.4% 45.9% 34.7%
I donāt have all the skills that are expected of a rural GP 49.7% 40.2% 10.1%
Like life in rural general practice is just too hard 49.5% 40.4% 10.1%
5. PSYCHOLOGICAL WELL-BEING AND RETENTION OF GPS 153
ā¢ Lack of support services (including treating doctors)
available for rural GPs
ā¢ Workload
ā¢ Finding time to balance work and family life
ā¢ Need for more doctors
ā¢ Childrenās education
ā¢ Practice management (skills training)
ā¢ Issues related to being an overseas trained doctor.
Qualitative analyses of GPsā comments indicated
while many mentioned system-related factors as con-
tributing to their intentions to leave rural practice, more
indicated that it was the difļ¬culty in coping personally
with these stressors that inļ¬uenced intentions to leave.
In summary, it is clear from their comments that most
rural GPs get much satisfaction from their work and the
survey results reļ¬ect the reasonably good level of morale
and quality of work life. However, it is equally clear that
the difļ¬culties are multiple and sustained, and even the
most resilient rural GP has to ļ¬nd ways to cope with
the demands of the job. This is perhaps best summed
up by the GP who wrote:
I enjoy the content of my work (and) the company and
respect of my colleagues. (The) only problem is too
much work, too many patients (and) not enough free
time so that my family suffers.
Discussion
The ļ¬ndings in this study clearly reļ¬ect the nature of
current rural general practice with its mix of satisfying
clinical work juxtaposed with workload pressures, iso-
lation and work/family balance issues.
With regard to support in rural general practice, the
responses indicate that a signiļ¬cant proportion of GPs
(19%) have considered themselves in personal crisis
over the last year yet two-thirds of these have not used
a crisis support service, which may suggest these types
of support are unsuitable to them and different
approaches to supporting GPs are needed. In relation to
CME, it is noteworthy that when rural GPs were asked
which skills they would most like to acquire to assist
them as a rural GP, nearly 40% of the responses related
to the need for personal coping skills rather than clinical
skills. Divisions in particular might play a crucial role
in addressing this need.
In relation to psychological well-being, the majority
of rural GPs reported moderately good levels of quality
of work life and work-related morale and moderately
low levels of work-related distress. From the customised
measure of rural GP distress it is clear rural general
practice is impacting adversely upon the psychological
well-being of some GPs with approximately 10% (and
it could be as high as 15%) appearing to be suffering a
high degree of distress related speciļ¬cally to rural gen-
eral practice. However, many more than this acknowl-
edge that rural general practice contributes to a
signiļ¬cant level of distress.
These ļ¬ndings suggest that this group of GPs (conser-
vatively estimated at 30% of all GPs) is at risk of
increased psychological distress. However, the more
contact GPs have with each other (i.e. the more support
they receive), the better their work-related morale and
quality of work life, and the lower the level of their
distress. Although weak, this relationship holds across
all three measures indicating a deļ¬nite advantage (in
TABLE 5: Psychological well-being for GPs who considered leaving rural general practice compared to those who did not
consider leaving
Variable
Did consider leaving
Mean value, n = 96
(95% conļ¬dence intervals)
Did not consider leaving
Mean value, n = 86
(95% conļ¬dence intervals) t-value Signiļ¬cance level
Rural doctor distress 3.4
(3.12ā3.61)
2.6
(2.36ā2.82)
4.548 0.000
Work-related distress 3.5
(3.28ā3.75)
49.5% āpoorā
3.0
(2.81ā3.24)
30.6% āpoorā
3.06 0.003
Work-related morale 4.5
(4.25ā4.61)
40.0% āpoorā
4.9
(4.72ā5.02)
23.5% āpoorā
āĀ·
3.193 0.002
Quality of work life 4.1
(3.98ā4.33)
42.7% āpoorā
4.7
(4.43ā4.92)
20.9% āpoorā
āĀ·
3.507 0.001
Other GPs with whom to
discuss professional issues
3.8
(3.62ā4.07)
4.1
(3.93ā4.37)
āĀ·
1.955 0.052
6. 154 M. GARDINER ET AL.
terms of psychological health) for increased contact
between GPs, such as that which occurs through Rural
Divisions and networks of colleagues. Furthermore, it
seems that stress such as isolation, family/business issues
and lack of personal coping skills are more important
in determining well-being than are issues related directly
to practising medicine.
The impact of the psychological well-being of rural
GPs should not be understated, with GPs who seri-
ously considered leaving rural general practice in the
last two years having higher levels of rural GP dis-
tress and work-related distress and lower levels of
work-related morale and quality of work life. They
also had fewer other GPs with whom to discuss pro-
fessional issues. It remains to be seen whether greater
availability of personal and professional support for
these GPs would inļ¬uence their decisions to leave
rural practice.
Psychological well-being is most likely to be improved
by providing better support structures and evidence-
based coping and personal skills. A signiļ¬cant number
(40%) of rural GPs themselves are asking for these
skills. Speciļ¬cally, these skills should target new behav-
iours and attitudes such as recognising limits, saying
ānoā and perfectionism, areas known to prove difļ¬cult
for doctors as a profession. While teaching doctors to
recognise and set personal limits (thereby possibly
reducing the number of hours they work) may reduce
services and hours worked in rural communities, it may
allow doctors to continue to practise effectively rather
than cease work altogether.
In summary, the results of this study indicate that:
1. Given that approximately 10% of GPs are highly
stressed and that some in need are not using
available services, it is essential that existing crisis
support services are promoted and maintained and
new acceptable choices are established.
2. There are beneļ¬ts for rural GPs in having contact
with each other. As such, gains in well-being might
be achieved by increasing opportunities for GPs to
network with each other, particularly isolated GPs
such as solo practitioners.
3. There are many GPs who need support, but who
are not in crisis. Preventative support services
targeted at the majority of GPs who fall into this
category are highly likely to reduce the number
of those who progress to the crisis category.
Considering that GPs who have seriously
considered leaving rural general practice in the last
two years have higher stress levels, preventative
support services are also likely to increase the
retention rate of rural GPs.
4. Preventative measures through CME or other
activities should be targeted at personal coping
skills for rural GPs. Improved evidence-based
coping skills for GPs should help to improve well-
being, prevent burnout and increase retention rates.
In conclusion, although continuing to provide practi-
cal resources is important (e.g. locums or patient-related
CME skills training), the ļ¬ndings from this study sug-
gest that other types of support that may improve the
psychological well-being of rural GPs and possibly
improve retention rates, need to be developed. This
study was designed as a baseline evaluation for the
RDWAās Dr DOC Program, which aims to provide such
support in a number of ways. Further empirical evalu-
ation will be needed to determine the efļ¬cacy of the
range of initiatives offered by such a program.
Acknowledgements
This research was funded by the Rural Doctors Work-
force Agency. Maria Gardiner, a Flinders University
researcher, retained independent control of all aspects
of the study and its submission for publication. Ethics
approval was granted by the Flinders Social and Behav-
ioural Research Ethics Committee. The authors wish to
thank Ms Susan Arthure for extensive editorial advice
and support.
References
1 Commonwealth Department of Health and Aged Care.
GP Wellbeing Project Final Report. Melbourne: CDHAC,
2001.
2 Australian Medical Workforce Advisory Committee. The
General Practice Workforce in Australia. Sydney:
AMWAC, 2000.
3 Matsumoto M, Masanobu O, Kajii E. Rural doctorsā
satisfaction in Japan: a nationwide survey. Australian
Journal of Rural Health 2004; 12: 40ā48.
4 Wainer J. Work of female rural doctors. Australian Jour-
nal of Rural Health 2004; 12: 49ā53.
5 Kamien M. Staying in or leaving rural practice: 1996
outcomes of rural doctorsā 1986 intentions. Medical Jour-
nal of Australia 1998; 169: 318ā321.
6 Dua J. Development of a scale to assess occupational
stress in rural general practitioners. International Journal
of Stress Management 1996; 3: 117ā128.
7 Hays R. Why doctors leave rural practice. Australian
Journal of Rural Health 1997; 5: 198ā203.
8 Horobin G, McIntosh J. Time, risk and routine in general
practice. Sociology of Health and Illness 1983; 5: 312ā
333.
9 Tolhurst HM, Talbot JM, Baker LL. Women in rural
general practice: conļ¬ict and compromise. Medical Jour-
nal of Australia 2000; 173: 119ā120.
10 Gardiner ML, Lovel G, Williamson P. Physician you can
heal yourself! Cognitive behavioural training reduces
stress in general practitioners. Family Practice 2004; 21:
545ā551.
11 Hoepfer M. Dealing with stress in medical practice.
Pennsylvania Medicine 1999; 102: 18ā19.
7. PSYCHOLOGICAL WELL-BEING AND RETENTION OF GPS 155
12 Humphreys J, Hegney H, Lipscombe J, Gregory G, Chater
B. Whither rural health? Reviewing a decade of progress
in rural health. Australian Journal of Rural Health 2002;
10: 2ā14.
13 Hart PM, Grifļ¬n MA, Wearing AJ, Cooper CL. Queen-
sland Public Agency Staff Survey: QPASS. Melbourne:
University of Melbourne, 1996.