Associations of psychosocial working conditions with health outcomes, quality of care and intentions to leave the profession: results from a cross-sectional study among physician assistants in Germany

  • Patricia Vu-Eickmann
  • Jian Li
  • Andreas Müller
  • Peter Angerer
  • Adrian Loerbroks
Original Article



Numerous epidemiological studies among health care staff have documented associations of adverse psychosocial working conditions with poorer health-related outcomes, a reduced quality of patient care and intentions to leave the profession. The evidence for physician assistants in Germany remains limited though.


We surveyed a total of 994 physician assistants between September 2016 and April 2017. Psychosocial working conditions were measured by the established effort–reward imbalance (ERI) questionnaire and by a questionnaire specifically developed to capture psychosocial working conditions among physicians. Health outcomes (i.e., self-rated health, depression, anxiety), self-rated quality of care and the intention to leave the profession were assessed by established measures. We ran multivariable logistic regression analyses.


The prevalence of work stress in terms of ERI equalled 73.77%. Work stress according to the ERI model was associated with significantly poorer self-rated health [odds ratio (OR) 3.62], elevated symptoms of depression (OR 8.83) and anxiety (OR 4.95), poorer quality of care (OR for medical errors 4.04; OR for interference of work with patient care 3.88) and an increased intention to leave one’s current profession (OR 3.74). The PA-specific questionnaire showed similar, albeit weaker, associations (all ORs > 1.22).


Our results are in line with previous findings among health care staff and provide specific and novel evidence for physician assistants. Interventions aiming at the improvement of working conditions seem needed given their potential adverse consequences in terms of employee health, quality of care, and personnel policy.


Psychosocial working conditions Health care staff Health Quality of care Intention to leave 



This study was funded by the Research Commission of the Medical Faculty of the University of Düsseldorf. We are grateful to the PAs for their participation in our study. We would also like to thank in particular the Association of Medical Professionals (VMF e.V.) for supporting our recruitment efforts as main cooperation partner. In addition, we are indebted to Dr. Mergenthal from the Institute for General Practice in Frankfurt for her recruitment support (via “AG WiForMFA” at the 2016 DEGAM Congress). We would also like to thank the following persons and institutions: (a) for forwarding study information to PAs in registered physician practices: association of statutory health insurance physicians Saarland and Mrs. Insa Seeger from the Department of Healthcare Research at the Carl von Ossietzky University of Oldenburg, (b) for forwarding study information to vocational training PA schools: association of statutory health insurance physicians Hamburg, (c) for distribution via internal distribution list and/or publication on their homepage: association of statutory health insurance physicians Brandenburg; section press and media of the association of statutory health insurance physicians Nordrhein; association of statutory health insurance physicians Sachsen; medical association Hamburg; Mr. Paul Hauschild, Managing Director of the local medical association of Trier; and Dr. Müller-Sacks of BAD GmbH.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Institute of Occupational, Social and Environmental Medicine, Centre for Health and SocietyMedical Faculty of the Heinrich-Heine-University DüsseldorfDüsseldorfGermany
  2. 2.Institute of Psychology, Work and Organizational PsychologyUniversity of Duisburg-EssenEssenGermany

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