Job stress and burnout among urban and rural hospital physicians in Japan

Objective: To elucidate the differences in job stress and burnout status of Japanese hospital physicians between large cities, small cities, and towns and villages. Design: Cross-sectional study. Setting: Postal self-administered questionnaires were distributed to 2937 alumni of Asahikawa Medical University. Participants: Four hundred and twenty-two hospital physicians. Main outcome measures: The Brief Job Stress Questionnaire was used to evaluate job demand, job control and social support. The Japanese version of the Maslach Burnout Inventory-General Survey (MBI-GS) was used to evaluate burnout. An analysis of covariance was conducted on the mean scores on the Brief Job Stress Questionnaire and the MBI-GS scales after adjusting for sex, age and specialties. Results: In adjusted analyses, the job demand score was significantly different among physicians in the three areas. In Bonferroni post-hoc tests, scores in large cities was significantly higher than those in small cities and towns and villages. The job control score showed a significant difference and a marginally significant trend, with large cities associated with lower job control. There were significant differences in support from supervisors and that from family/friends, and scores in large cities was significantly higher than those in small cities in the post-hoc test. There was a significant effect on the exhaustion scale of the MBI-GS, with large cities associated with higher exhaustion, and scores in large cities was significantly higher than those in small cities. Conclusions: Urban hospital physicians had more job demand, less job control and exhaustion caused by burnout, and rural hospital physicians had less social support.