Doctors’ perceived working conditions, psychological health, and patient care: a meta-analysis of longitudinal studies

Background: Studies have demonstrated an association between doctors’ perceived working conditions, and their psychological wellbeing and patient care. However, few have examined inter-relationships among these three domains, and even fewer using longitudinal designs. Using meta-analytic structural equation modelling, we tested longitudinal relationships among doctors’ perceived working conditions, their psychological wellbeing, and patient care. We further tested if doctors’ psychological wellbeing mediates the relationship between perceived working conditions and patient care. Methods: We carried out a systematic review using Academic Search Premier; Business Source Premier; PsycInfo, PsycArticles, and Medline for the twenty-year period between January 2000 and the start of the pandemic (January 2020). We included studies with practicing doctors as participants, and that reported a quantifiable bivariate effect size between at least two of the three constructs of interest – perceived working conditions (i.e., job demands, job resource), psychological wellbeing (i.e., emotional exhaustion, work engagement), and patient care (i.e., clinical care, patient safety). We pooled relationship effect sizes using random-effects meta-analysis, before testing for indirect effects using two-stage structural equation modelling. Results: Twenty-three samples from 11 countries representing 7,275 doctors were meta-analysed. The results indicated that job resources predicted work engagement (ρ=.18; 95% CI .11, .24) and emotional exhaustion (ρ=-.21; 95% CI -.38, -.11), while job demands predicted emotional exhaustion (ρ=.27; 95% CI .17, .36). Better clinical care was also associated with higher levels of job resources (ρ=.16; 95% CI .04, .29), and lower levels of emotional exhaustion (ρ=-.23; 95% CI -.35, -.10) and job demands (ρ=-.27; 95% CI -.43, -.10). Both factors of the work environment were associated with clinical care through doctors’ emotional exhaustion, but there were insufficient studies to test the indirect effects for work engagement or patient safety. Conclusion: Our results demonstrate the need for a systems perspective to address working conditions to support both doctors’ psychological wellbeing and patient care. Interventions should target doctors’ job resources as they are more strongly associated with psychological wellbeing. However, given that job demands were strongly associated with emotional exhaustion, and in turn, clinical care, there is a need to better manage doctors’ workload, conflict, and pressure to support the current psychological wellbeing crises amongst this occupational group