12. tbl. 107. árg. 2021

Professional moral character of physicians and clinical working environment

Faglegir mannkostir lækna og vinnuumhverfi

Svanur Sigurbjörnsson¹

Vilhjálmur Árnason²

¹Faculty of Medicine, ²Faculty of History and Philosophy, University of Iceland.

Correspondence: Svanur Sigurbjörnsson, svan@hi.is

Key words: professional moral character, clinical working environment,
stress, good medical practice, autonomy, virtue ethics

Introduction. A survey of the experience of Icelandic medical candidates, general physicians, and specialty physicians of clinical work, aimed to show how the working environment affects doctors' moral character and experience of support, well-being and expectations. For comparison, results of a British survey with the same questions for specialty physicians were used.

Material and methods. A total of 89 physicians answered 15 questions. Statistical comparison was made between results from topical clusters of questions.

Results. The results show a significant problem in work conditions of Icelandic doctors. Their experience is rated low in the second quarter (2,1 – 3,0) on a numerical scale of how the environment thwarts professional character and of lack of support. In comparison with British specialists, their experience is similar but slighly better regarding supportiveness. Icelandic candidates and general physicians experience significantly more stress, less support and autonomy in their work than specialists. Compared to the British, the experience of Icelandic specialists was more positive about professional autonomy and emotional attachment to the work. Our survey shows for the first time the effect of the working environment on professional virtues of Icelandic doctors.

Discussion. These findings resonate with the literature that the moral character of doctors contributes to satisfaction, flourishing and experience of meaningfulness. They substantiate views raised by Icelandic physicians about tremendous work stress and scarcity of staff. The survey demonstrates the doctors‘ experience of work-related challenges and provides reasons for society to improve their working conditions to enable them to live up to their ideals.

Table I. Cohort size of each group of physicians that participated. Candidates and general physicians (C-Gen) with two years or less of clinical work. Experienced specialists (ESpe) with 5 years or more of clinical working experience.

	C-Gen	ESpe	All
Number of participants	36	53	89
Estimated group size	220^a	1528^b	1748
Estimated ratio of cohort to group size.	~ 17%	~ 3,5%

^a,bEstimated total number of group population of C-Gen and ESpe from registered numbers in Doctors‘ Registry at the Directorate of Health on 4.2.2019 (downloaded from landlaeknir.is). All specialists registered prior to March 1, 2014, were included (a total of 1817 specialists and thereof 289 with < 5 years of work experience).

Table II. Sex ratio and age distribution of participants overall and among C-Gen and ESpe.

	C-Gen	ESpe	All
Numbers ♀ / ♂ (sum)	25 / 11 (36)	27 / 26 (53)	52 / 37 (89)
Percentages ♀ / ♂	69% / 31%	51% / 49%	58% / 42%
Average age (range) and standard deviation	29,2 (26–34) ± 2,8	59,8 (39–81) ± 10,7

C-Gen: Candidates/general physicians. ESpe: Experienced specialists. There is a statistically significant difference in mean age of C-Gen and ESpe (p = 0,003).

Table III. Doctors’ perception of challenge to living out their character

(All / C-Gen | ESpe)

Always (5)

Mostly (4)

Sometimes (3)

Rarely (2)

Never (1)

My work involves tasks that are in conflict with my personal values

0 | 0

14.6%

16.7 | 13.2

44.9%

61.1*| 34.0

40.4%

22.2 |52.8*

My work requires that I hide my feelings

5.6%

2.8 | 7.5

21.3%

27.8 | 17.0

38.2%

38.9 | 37.7

32.6%

27.8| 35.8

2.2%

2.8 | 1.9

I experience stress

11.2%

5.6 | 15.1

44.9%

63.9*|32.1

39.3%

30.6 | 45.3

4.5%

0 | 7.5

0 | 0

At work it is hard to do the right thing

0 | 0

2.4%

0 | 4.0

17.9%

23.5 | 14.0

65.5%

67.6 | 64

14.3%

8.8 | 18

I do not have time to do my work to a standard I feel is right

6.7%

8.3 | 5.7

28.1%

47.2*|15.1

38.2%

33.3 | 41.5

22.5%

11.1 | 30.2*

4.5%

0.0 | 7.5*

Mean

4.7%

3.3 | 5.7

19.3%

27.8 |13.6

29.6%

28.6 | 30.3

34.0%

33.5 | 34.3

12.3%

6.8 |16.0

C-Gen and ESpe in Iceland and ESpe in Britain by numerical scale

C-Gen, Iceland: 2.92 *

ESpe, Iceland: 2.63 *

ESpe, Britain: 2.75

Frequencies (grouped)

4.1 to 5.0

3.1 to 4.0

2.1 to 3.0

1 to 2

C-Gen, Icland

2.8%

44.4%

52.8%

0.0%

ESpe, Iceland

1.9%

32.1%

52.8%

13.2%

ESpe, Britain

1.1%

21.0%

70.3%

7.6%

* p ≤ 0.05: statistically significant difference between candidates/general physicians (C-Gen) and experienced specialists (ESpe). The numerical scale is formed from the mean of answers (1, 2, 3, 4 or 5) of each participant from the cluster where “Never” is 1, “Seldom” is 2, et cetera. Full data is not available to calculate significance in difference between the Icelandic ESpe and the British.

Table IV. Doctors’ view of supportiveness of their work environment. (All / C-Gen | ESpe)

Always (5)

Mostly (4)

Sometimes (3)

Rarely (2)

Never (1)

My colleagues help and support me

22.5%

19.4 | 24.5

61.8%

72.2*| 54.7

12.4%

8.3 | 15.1

2.2%

0 | 3.8

1.1%

0 | 1.9

I am treated fairly

10.1%

5.6 | 13.2

50.6%

44.4 | 54.7

27.0%

38.9*| 18.9

10.1%

11.1 | 9.4

2.2%

0 | 3.8

I am able to apply my own ideas in my work

14.6%

5.6 | 20.8*

42.7%

25 | 54.7*

33.7%

52.8*| 20.8

7.9%

13.9* | 3.8

1.1%

2.8 | 0

I am able to influence decisions that are important to my work

8.0%

0 | 13.5*

46.6%

41.7 | 50

33.0%

38.9 | 28.8

11.4%

16.7 | 7.7

1.1%

2.8 | 0

I feel ‚at home‘ in my workplace

5.6%

2.8 | 7.5

43.8%

25|56.6*

30.3%

38.9 | 24.5

14.6%

22.2* | 9.4

5.6%

11.1* | 1.9

Mean

12.2%

6.7 | 15.9

49.1%

41.7 | 54.1

27.3%

35.6 | 21.6

9.2%

12.8 | 6.8

2.2%

3.3 | 1.5

C-Gen and ESpe in Iceland and ESpe in Britain by numerical scale

C-Gen, Iceland: 3.18 *

ESpe, Iceland: 3.51 *

ESpe, Britain: 3.76

Frequencies (grouped)

4.1 to 5.0

3.1 to 4.0

2.1 to 3.0

1 to 2

C-Gen, Iceland

5.6%

80.6%

11.1%

2.8%

ESpe, Iceland

18,9%

71.7%

9.4%

0.0%

ESpe, Britain

24.6%

65.9%

8.7%

0.7%

The scores for statement four are reversed to keep positive aspects on the same (left) side of the table. * p ≤ 0.05: statistically significant difference between candidates/general physicians (C-Gen) and experienced specialists (ESpe). The numerical scale is formed from the mean of answers (1, 2, 3, 4 or 5) of each participant from the cluster where “Never” is 1, “Seldom” is 2, et cetera. Full data is not available to calculate significance in difference between the Icelandic ESpe and the British.

Table V. Doctors’ view of the degree of autonomy they are accorded. (All / C-Gen | ESpe)

Always (5)

Mostly (4)

Sometimes (3)

Rarely (2)

Never (1)

I am able to act in the best interests of my patients

14.8%

2.8|23.1*

69.3%

69.4 |69.2

13.6%

22.2*| 7.7

2.3%

5.6* | 0

0 | 0

I have the resources to do my work to a standard I believe is right

4.5%

0 | 7.5*

62.9%

52.8|69.8*

24.7%

33.3 | 18.9

7.9%

13.9* | 3.8

0 | 0

Mean

9.7%

1.4 | 15.3

66.1%

61.1 | 69.5

19.2%

27.8 | 13.3

5.1%

9.8 | 1.9

0.0%

0 | 0

C-Gen and ESpe in Iceland and ESpe in Britain by numerical scale

C-Gen, Iceland: 3.54 *

ESpe, Iceland: 4.00 *

ESpe, Britain: 3,76

Frequencies (grouped)

4.1 to 5,0

3.1 to 4.0

2.1 to 3.0

1 to 2

C-Gen, Iceland

44.4%

41.7%

13.9%

0.0%

ESpe, Iceland

73.6%

26.4%

0.0%

ESpe, Britain

20.3%

68.5%

10.1%

1.1%

Table VI. Doctors‘ emotional involvement with their work. (All / C-Gen | ESpe)

Always (5)

Mostly (4)

Sometimes (3)

Rarely (2)

Never (1)

I am emotionally involved in my work

43.8%

36.1 | 49.1

51.7%

55.6 | 49.1

3.4%

5.6 | 1.9

1.1%

2.8 | 0

0 | 0

I have the feeling of doing useful work

33.7%

19.4| 43.4*

57.3%

61.1 | 54.7

6.7%

13.9* | 1.9

2.2%

5.6* | 0

0 | 0

I am motivated to work to the best of my ability

56.2%

41.7|66.0*

41.6%

55.6*|32.1

2.2%

2.8|1.9

0 | 0

Mean

44.6%

32.4 | 52.8

50.2%

57.4 | 45.3

4.1%

7.4 | 1.9

1.1%

2.8 | 0

0.0%

0 | 0

C-Gen and ESpe in Iceland and ESpe in Britain by numerical scale

C-Gen, Iceland: 4.19 *

ESpe, Iceland: 4.51 *

ESpe, Britain: 4.10

Frequencies (grouped)

4.1 to 5,0

3.1 to 4.0

2.1 to 3.0

1 to 2

C-Gen, Iceland

80.6%

16.7%

2.8%

0.0%

ESpe, Iceland

98.1%

1.9%

0.0%

ESpe, Britain

45.3%

52.9%

1.8%

0.0%