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

Kapur et al1 compared psychological morbidity and job satisfaction in
consultants and junior house officers, but there are problems with their
methods.

Firstly, far more consultants (445) than PRHOs (93) were questioned,
and the consultants were taken from 5 teaching hospitals whilst PRHOs only
from 2. More comparable data would have been obtained if consultants and
PRHOs from the same 5 hospitals had been sampled. The authors note the
limitations of only using teaching hospitals, but the conclusions could
have been strengthened by varying both the type and geographical location
of hospitals included.

Secondly, different follow up methods were used for the two groups of
doctors. This is reflected in the different response rates, introducing
additional bias.

Thirdly, there is wide variation in the working environments of
different specialties, and it seems inappropriate to consider consultants
as a homogeneous group. In a footnote to the table, the authors stated
that there was no difference in GHQ scores total job satisfaction score
across specialties. However, this may mask significant differences in
individual indicators of job satisfaction that may be relevant to specific
specialties.

Lastly, the authors draw attention to greater psychological morbidity
than PRHOs (25% vs. 19%). Risk factors for psychiatric disorders vary
according to age, sex and other factors2, and several factors may
contribute to the observed difference between consultants and PRHOs.

The authors' conclusions are consistent with their data, but had the
above methodological problems been addressed the results may have been
different. Furthermore, the authors' recommendations are somewhat
unrealistic; the house officer post is intended to be a suitable training
post and greater autonomy is neither feasible nor necessarily desirable.
Similarly the level of responsibility, current status of the NHS and
economic climate dictate the consultant workload and significant change in
these is unlikely.

Yours sincerely,
D.J. Burrow
J. Campbell
E.Z. Godrich

4th year Medical Students
University of Newcastle-upon-Tyne

References
1Kapur, Borrill and Stride, Psychological morbidity and job satisfaction
in hospital consultants and junior house officers: multicentre, cross
sectional survey. BMJ 1998; 317:511-2
2Edwards et al, Davidson's Principles and Practice of Medicine, p979; 1995