Intended for healthcare professionals


Psychological morbidity and job satisfaction in hospital consultants and junior house officers: multicentre, cross sectional survey

BMJ 1998; 317 doi: (Published 22 August 1998) Cite this as: BMJ 1998;317:511
  1. Navneet Kapur, lecturer in psychiatry,a,
  2. Carol Borrill, project managerb,
  3. Chris Stride, statisticianb
  1. aDepartment of Psychiatry and Behavioural Sciences, Rawnsley Building, Manchester Royal Infirmary, Manchester M13 9WL
  2. bInstitute of Work Psychology, University of Sheffield, Sheffield S10 2TN
  1. Correspondence to: Dr Kapur
  • Accepted 22 August 1998

Junior house officers have traditionally been the most distressed doctors in the health service.1 Recently, however, there have been reports of significant psychological morbidity in senior doctors such as hospital consultants.2Previous studies found that levels of distress decrease with increasing medical seniority.3 Much of the organisational burden of recent hospital reform has fallen on consultants, while junior doctors continue to have their hours of work reduced. We investigated whether these changes had affected the relation between medical seniority, psychological morbidity, and job satisfaction.

Comparison of job satisfaction, work demands, job autonomy, and general health questionnaire scores for consultants and house officers. Scores on 16 items of job satisfaction are also listed. In all cases higher scores indicate more favourable outcomes except for 12 item version of general health questionnaire (GHQ) and work demands scale where higher scores indicate greater psychological morbidity and increased work demands respectively. Values are mean (SD) unless stated otherwise

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Subjects, methods, and results

We carried out two postal surveys. Questionnaires were sent to all hospital consultants in five UK teaching hospitals as part of the NHS workforce survey.4Questionnaires were also sent to all preregistration medical house officers working in two teaching hospitals in 1995 and 1996. Follow up questionnaires were sent to non-responders, and the house officers also received telephone reminders. We used the 12 item version of the general health questionnaire as a measure of psychological distress.5 This can be scored 0-12, a score of 4 or more identifying a probable case of minor psychiatric disorder such as anxiety or depression.2 Each item can also be rated on a three point Likert scale giving a potential score of 0-36, with higher scores representing greater distress. The questionnaire also included validated Likert measures of job satisfaction, work demands, and job autonomy.4

The response rate was 60% (267/445) for consultants and 96% (89/93) for house officers. There was no difference in response rates by specialty or hospital. The consultants were older than the house officers (mean age (SD) 45 (7.8) versus 25.6 (3) years) and a greater proportion were men (77% (206/267) versus 57% (51/89) women). The table shows the consultants and house officers' scores for various measures; 25% (66/267) of consultants and 19% (17/89) of house officers scored as cases of psychiatric disorder. For consultants, general health questionnaire scores were most strongly correlated with scores on the work demands scale (Pearsons +0.42, P<0.001). For house officers, the scores were most strongly correlated with scores on the job autonomy scale (Pearsons −0.48, P<0.001).


In our study consultants had higher levels of psychological distress and suffered greater demands at work than the house officers. The house officers had lower overall job satisfaction and less job autonomy but were more satisfied with their hours of work.

Non-response among the consultants was a potential source of bias. However, previous studies with higher response rates have reported similar levels of distress.2 A study carried out as part of the NHS workforce survey found no difference in the levels of distress between responders and non-responders,4suggesting that non-response was not systematically related to psychological health. Our results may not be generalisable to non-teaching hospitals and might be confounded by the fact that consultants and house officers were selected from different trusts. In fact, one hospital was a source of both consultants and house officers for this study, and the occupational group differences at this hospital remained significant.

Some of these data are three years old. The continued upheaval in the health service and further reductions in junior house doctors' working hours mean that the differences in psychological distress between senior hospital doctors and their most junior colleagues may now be more pronounced. One approach to addressing this problem could be to tackle specific sources of occupational stress in different groups. For example, our results suggest consultants might benefit from a reduction in their workload, while house officers might benefit if they had greater autonomy.


We would like to thank the consultants and house officers.

Contributors: NK coordinated and collected data for the house officer study, helped analyse the data, and wrote the initial draft of the paper. CB coordinated the consultant study and commented on drafts of the paper. CS helped to extract and analyse the data, and commented on drafts of the paperNK and CB will act as guarantors for the paper.


  • Funding The NHS workforce survey was funded under the mental health programme of the NHS executive (Northern and Yorkshire).

  • Conflict of interest None.


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