Job Satisfaction, Life

Satisfaction and
Burnout in French
Anaesthetists

Journal of Health Psychology

Copyright 2010 SAGE Publications
Los Angeles, London, New Delhi,
Singapore and Washington DC
www.sagepublications.com
Vol 15(6) 948958
DOI: 10.1177/1359105309360072

BRU N O C H I RO N
Hpital de Blois, University of Franois-Rabelais de Tours
(E.A. 2114), France

EST E L L E M I CH I N O V
University of Rennes 2, France

ELO D I E O L IV I E R - C H I R O N & M A R C L A F F ON
University Franois-RabelaisCHRU de Tours, France

EM M A N U E L R U S C H
Laboratoire de sant publique, University of Franois-Rabelais
de Tours & CHRU de Tours, France

Abstract
The present study aimed to examine
the prevalence of burnout, levels of
life satisfaction and job satisfaction in
anaesthetists in France. A crosssectional study was conducted among
193 anaesthetists from eight French
public hospitals. The results indicated
low levels of emotional exhaustion
and depersonalization scores, but high
levels of reduced accomplishment.
The results also revealed differences
between subgroups: physician
anaesthetists reported higher levels of
depersonalization and reduced
accomplishment than nurse
anaesthetists, female and junior
anaesthetists reported higher levels of
emotional exhaustion and job
dissatisfaction than male and senior
anaesthetists. The results and the
implications to reduce burnout
symptoms in anesthesia teams are
discussed.

Keywords
COMPETING INTERESTS:
ADDRESS.

None declared.

Correspondence should be directed to:

Universit de Rennes 2, Dpartement de psychologie,
Laboratoire CRPCC, Place du Recteur Henri le Moal CS 24307, 35043
Rennes Cedex, France. [Tel. +33(0)2 99 14 19 47; email:
estelle.michinov@univ-rennes2.fr]
ESTELLE MICHINOV,

anaesthesia teams
burnout
gender
job satisfaction
life satisfaction
stress

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CHIRON ET AL.: BURNOUT IN FRENCH ANAESTHETISTS

Introduction
burnout is a psychological syndrome
characterized by emotional exhaustion, depersonalization and reduced personal accomplishment
(Maslach, Jackson, & Leiter, 1996). It has been
described in many individuals under constant pressure and exposed to chronic interpersonal stressors on
the job (Maslach & Leiter, 2005). Physicians in particular are frequently overloaded with the demands of
caring for sick patients and the constraints of fewer
organizational resources, and the syndrome of professional burnout has been described among physicians
in several countries and in many branches of medical
practice including general medicine, surgery, intensive care, surgeons, oncologists and anaesthetists
(Adam, Gyorffy, & Susanszky, 2008; Grassi &
Magnani, 2000; Kluger, Townend, & Laidlaw, 2003;
Maslach & Leiter, 2005; McManus, Winder, &
Gordon, 2002; Ramirez, Graham, Richards, Cull, &
Gregory, 1996). Burnout has been associated with
impaired job performance and poor health including
headaches, sleep disturbances, fatigue, marital difficulties, anxiety, depression, hypertension and may
contribute to alcoholism and drug addiction (Maslach
et al., 1996). Burnout does not only adversely affect
the well-being of physicians and their families but
that of patients and health care organizations as well
(Shanafelt, Bradley, Wipf, & Back, 2002). Thus,
physician burnout is an important concern both for
medical as well as public health settings.
While burnout syndrome has been extensively
studied among various professional groups, only one
study (Estryn-Bhar et al., 2009) to our knowledge
has evaluated the prevalence of professional burnout
in physician anaesthetists in France. In this survey
conducted with doctors coming from various medical
disciplines (psychiatrists, geriatricians, emergency
physicians, liberal medicine), 558 physician anaesthetists (63.6 per cent male and 36.4 per cent female)
responded. The results revealed that 38.4 per cent of
physician anaesthetists expressed high levels of general burnout (Copenhagen Burnout Inventory, CBI)
and 17.3 per cent expressed high level of professional
burnout syndrome (Maslach Burnout Inventory,
MBI). In spite of the wide sample questioned in this
survey, it does not concern particularly the speciality
of French team anaesthetists and does not thus handle
specific conditions connected to this medical practice.
Now, a certain number of conditions bound to the speciality of anaesthetist teams in France leads to the
study of this population in a more specific way. For
PROFESSIONAL

example, the prevalence of burnout among physicians and nurse anaesthetists was not examined, nor
the difference among male and female or junior and
senior specialists. Thus, the present study aimed to
measure the prevalence of burnout and the degree of
job satisfaction in physician and nurse anaesthetists
working in French public hospitals. The stakes are
high in France today because this speciality is
increasing and has doubled in 15 years and faces predictable demographic difficulties (Pontone, Brouard,
Scherpereel, Boulard, & Arduin, 2002, 2004;
Vanderschelden, 2009). Anaesthesia speciality was
indeed identified as a speciality at risk of professional burnout especially among physician anaesthetists because of high workload, organizational
issues, the threat of malpractice litigation, excessive
volume of work, chronic sleep deprivation and difficulties in combining family with work (see EstrynBhar, 2008; Mrat & Mrat, 2008; Mion &
Ricouard, 2007 for studies in French contexts). Time
management and organizational factors (such as conflict with another colleague, and/or with a nurse) are
often less well managed than clinical scenarios and
may contribute to a greater degree of stress in physician anaesthetists (Kluger & Bryant, 2008; Kluger et
al., 2003). Thus, physician anaesthetists display the
signs of stress to a greater degree than normative
groups: use of drugs or of alcohol, marital difficulties
and psychiatric disorders (Cooper, Clarke, &
Rowbottom, 1999; Lindfors et al., 2006; Luck &
Hedrick, 2004; Mrat & Mrat, 2008).
Moreover, we note in France, as in the other
countries (Adam et al., 2008; McMurray et al.,
2002), an increasing feminization of the medical
professions. According to Vanderschelden (2009),
the proportion of female medical students has risen
from 57.9 per cent in 2004 to 63.7 per cent in 2008,
and for the anaesthesia speciality from 42.4 per cent
in 2004 to 50.4 per cent in 2008. This speciality is
also among five specialities of choice for female
medical students in France (Vanderschelden, 2009).
According to the projections of the Ministry of
Statistics Department (Niel, 2002), the feminization
of the medical studies of anaesthesia should echo in
the profession of the doctor anaesthetists on the
horizon of 2020 and be translated by a parity
men/women. This feminization of the profession
brings with it concerns in terms of public health, as
a number of studies shows that female doctors are
more likely to report signs or symptoms of occupational burnout than male doctors, and more especially in the emotional exhaustion component
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JOURNAL OF HEALTH PSYCHOLOGY 15(6)

(Adam et al., 2008; Gautam, 2001; McMurray et al.,

2000). The sources of stress and professional dissatisfaction of the women are not only related in
particular to the conflict existing between professional life and family life (Adam et al., 2008;
Estryn-Bhar, 2008), but also to discrimination at
the workplace, lack of support and sometimes
some sexual harassment from colleagues or
patients (Robinson, 2003; Stewart, Ahmad,
Cheung, Bergman, & Dell, 2000). Despite the
increasing number of female physicians, French
society remains a culture where women tend to
have responsibility for management of domestic
responsibilities and have to reconcile their role of
mother (or spouse) and the role of physician with
career demands. Thus, the development of
workfamily conflict causes strain and may lead
to stress, such as burnout. Moreover, analysis of
demographic data for the anaesthesia speciality
in France shows the ageing of staff doctors and
the massive arrival of young practitioners in
future years (Vanderschelden, 2009). Nevertheless, some studies on occupational burnout
among medical practitioners have shown that
junior anaesthetists are generally more vulnerable
to emotional exhaustion than the seniors, or physicians exercising high responsibilities (Lindfors et
al., 2006; Morais, Maia, Azevedo, Amaral, &
Tavares, 2006; Nyssen, Hansez, Baele, Lamy, &
de Keyser, 2003; Seeley, 1996). Despite this evidence, no published research is available about
burnout in French anaesthetists (including both
juniors and seniors).
All these data led us to assess the prevalence of
burnout, the level of job satisfaction and life satisfaction among nurse and physician anaesthetists
working in French public hospitals, and to explore
the relative influence of some socio-demographic
variables related to status (physician vs nurse anaesthetists), gender (male vs female) and age (junior vs
senior anaesthetists).
Based on previous studies related to occupational
burnout among anaesthetists in other countries
(Adam et al., 2008; Cooper et al., 1999; Kluger &
Bryant, 2008; Lindfors et al., 2006; Morais et al.,
2006; Nyssen et al., 2003; Nyssen & Hansez, 2008),
we hypothesized that: (H1) Physician anaesthetists
working under constant pressure and with high
responsibilities would report higher degree of
burnout and job dissatisfaction than nurse anaesthetists; (H2) More female than male anaesthetists
would report a high degree of burnout and job

dissatisfaction; (H3) More junior than senior anaesthetists would report a high degree of burnout and
job dissatisfaction.

Materials and methods

Participants
A cross-sectional study was conducted among 193
nurse anesthetists and physician anesthesiologists
distributed across eight French public hospitals.
The questionnaire was administered by a research
assistant during work time between April and June
2006. There were 77 nurse anaesthetists and 74
physician anaesthesiologists respondents out of 193
questionnaires administered in hospitals (N = 151;
response rate 78 per cent). The characteristics of the
sample are provided in Table 1. We are dealing with
a typical sample of anaesthesia teams in public
French hospitals consisting of predominantly male
physician anaesthesiologists (60.81 per cent for the
present study, 63.6 per cent for the Estryn-Bhar,
2008 study) and female nurse anaesthetists
(58.44%), working full-time and reflecting an ageing population of physician anaesthesiologists
(Pontone et al., 2002, 2004).
The average team size was 28.31 (range 545;
SD = 15.44, Median = 40). Anaesthetists had
worked in the team for an average 7.55 years (range
035 years; SD = 8.0), no statistical difference was
observed between nurse or physician anaesthetists.

Measures
Job satisfaction To assess anaesthetists satisfaction with their work, we used the standard 20item short form of the Minnesota Job Satisfaction
Questionnaire (MSQ, Roussel, 1996; Weiss, Dawis,
England, & Lofquist, 1967). The MSQ is a selfreport instrument which measures job satisfaction
across 20 different dimensions, with five questions
on each dimension. The short-form consists of 20
items from the long-form MSQ that best represent
each of the 20 dimensions. The responses were
given on a five-point Likert-scale ranging from 1
(very dissatisfied) to 5 (very satisfied). High scores
on this scale indicate higher job satisfaction. The
reliability coefficient (Cronbachs alpha) of this
instrument for our total sample was 0.88.
Occupational burnout Burnout was measured
using the Maslach Burnout Inventory (MBI; Maslach
& Jackson, 1981; Maslach et al., 1996), validated
and used in a different French sample in a medical

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CHIRON ET AL.: BURNOUT IN FRENCH ANAESTHETISTS

Table 1. Socio-demographic and work characteristics of nurse and physician
anaesthetists in France
Characteristics
Gender
Male
Female
Age
<35 yr
3645 yr
4655 yr
> 56 yr
Marital status
Single
Married
Children
Yes
No
Work time
Full-time
Part-time
Tenure in Team
< 1 yr
25 yr
610 yr
> 10 yr

Nurse anaesthetists

Physician anaesthetists

32 (41.56%)
45 (58.44%)

45 (60.81%)
29 (39.19%)

17 (22.1%)
31 (40.3%)
27 (35.1%)
2 (2.6%)

19 (25.7%)
21 (28.4%)
21 (28.4%)
13 (17.6%)

20 (26%)
57 (74%)

12 (16.22%)
62 (83.8%)

62 (80.5%)
15 (19.5%)

56 (75.7%)
18 (24.3%)

61 (79.22%)
16 (20.78%)

69 (93.24%)
5 (6.76%)

11 (14.29%)
33 (42.86%)
17 (22.07%)
16 (20.78%)

20 (27.02%)
19 (25.67%)
18 (24.32%)
17 (22.97%)

context (Lidvan-Girault, 1996). This is a 22-item

scale which produces three scores: emotional
exhaustion (nine items), depersonalization (five
items) and personal accomplishment (eight items).
According to a psychometric study by LidvanGirault (1996), the validity and reliability of the
French version are comparable to the original MBI
values. Some examples of questions on the emotional exhaustion subscale are: I feel fatigued when
I have to get up in the morning to face another day on
the job and Working directly with people puts too
much stress on me. Some examples of questions on
the depersonalization subscale are: I feel some
clients blame me for some of their problems and I
have become more callous towards people since I

took this job. Some examples of questions on the

personal accomplishment subscale are: I feel I have
a positive influence on other peoples lives through
my work and I have accomplished many worthwhile things in this job. The questionnaire required
the participants to mark how often they experienced
each of the situations on a rating scale ranging from
0 (Never) to 6 (Always). Three separate scores were
calculated for each participant by summing their
responses on each subscale: an emotional exhaustion
score (range 054), a depersonalization score (range
030) and a personal accomplishment score (range
048). Normative scores are available for the calculation of the burnout level (see Table 2). High scores
on the emotional exhaustion and depersonalization

Table 2. Normative scores to calculate level of burnout with the Maslach

Burnout Inventory
Levels of burnout

Emotional
exhaustion

Depersonalization

Personal
accomplishment

Low burnout
Moderate burnout
High burnout

< 17
1829
> 30

<5
611
> 12

> 40
3439
< 33
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JOURNAL OF HEALTH PSYCHOLOGY 15(6)

dimensions and low scores on the personal accomplishment dimension reveal a high level of occupational burnout. The reliability coefficients of the
emotional exhaustion, depersonalization and personal accomplishment scales for our total sample
were 0.91, 0.73 and 0.72, respectively.
Satisfaction with Life Scale (SWLS) The
SWLS is a short five-item instrument designed to
measure global cognitive judgements of satisfaction
with ones life. This scale was initially developed in
English by Diener, Emmons, Larsen and Griffin
(1985), and subsequently adapted for French samples
by Blais, Vallerand, Pelletier and Brire (1989). The
responses were given on a five-point Likert-scale
ranging from 1 (very dissatisfied) to 5 (very satisfied).
Scores on the five items were averaged to form a
composite index of life satisfaction. Higher scores are
indicative of greater satisfaction. The reliability coefficient of this measure for our total sample was 0.85.
The questionnaire also sought biographical information relating to sex, age, status, marital status,
number of children and other controlled variables
related to tenure in the team and size of the team.
Participants were ensured of confidentiality.

Data analyses
All data analyses were carried out using the
Statistical Package for Social Sciences (SPSS 11.5
for PC). First, descriptive analyses (frequencies,
means and standard deviations) of each of the MBI
subscales scores for the total sample were calculated. Given the non-normal distribution of the data,
different non-parametric tests (Chi-square, U de
Mann-Whitney) were used to assess differences
between different subgroups in the mean scores on
each burnout dimension. Finally, a set of multiple
regression analyses was also used to identify the
relative influence of socio-demographic variables
on job satisfaction, life satisfaction and burnout
scores. In each case, the predictors were entered
into the equation in two stages. On the first step,

status (1 = physician, 1 = nurse), gender (1 = male,

1 = female), and age (continuous variable) were
entered. After accounting for the variance due to
socio-demographic variables, some controlled variables related to tenure in team (continuous variable)
and size of team (continuous variable) were entered
on a second step. Significance was assumed for a pvalue < .05. The exact level is given in all results.

Results
Burnout among anaesthesia teams
For the MBI instrument, we first calculated the
mean scores for each subscale in the total sample.
The results showed that the mean scores for the
whole sample were 15.50 (SD = 9.86) for the emotional exhaustion subscale, 5.19 (SD = 4.73) for the
depersonalization subscale and 29.83 (SD = 7.90)
for the personal accomplishment subscale. Given the
non-normal distribution of the data, we examined
the mean scores between subgroups with non-parametric tests (Chi-square and Mann-Whitney U Test).
For the emotional exhaustion subscale, the results
revealed that female anaesthetists were more
exposed than male (U = 1.94, p = .05), and junior
anaesthetists were more exposed than senior (< 35
years = 16; 3645 years = 17.50; 4655 years =
14.84; 5665 years = 9.33), (Chi-square = 10.62,
p = .01). For the depersonalization subscale, the
mean scores were higher for physician anaesthetists
(M = 6.45, SD = 5.46) than for nurse anaesthetists
(M = 3.97, SD = 3.55), (U = 3.13, p = .002). For the
personal accomplishment subscale, the mean scores
were higher for physician anaesthetists (M = 31.79,
SD = 7.86) than for nurse anaesthetists (M = 27.99,
SD = 7.54), (U = 2.91, p = .004).
Second, we examined the prevalence of different levels of burnout (high, low or moderate) in
the whole sample and among different subgroups
(see Table 3). For the total sample, the analysis
revealed that 68.9 per cent reported a low affect of

Table 3. Prevalence of burnout (%) in French anaesthestists (physicians and nurses)

Level of
burnout

Low
Moderate
High

Emotional exhaustion

Depersonalization

Personal accomplishment

Total

Phys.

Nurse

Total

Phys.

Nurse

Total

Phys.

Nurse

68.9
19.2
11.9

62.2
21.6
16.2

75.3
16.9
7.8

65.6
22.5
11.9

58.5
23.9
17.6

72.7
22.1
5.2

9.9
25.2
64.9

13.5
32.4
54.1

6.5
18.2
75.3

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CHIRON ET AL.: BURNOUT IN FRENCH ANAESTHETISTS

emotional exhaustion, 65.6 per cent for depersonalization (mean of low burnout = 67 per cent compared to 61.6 per cent in the PRESS-Next study,
Estryn-Bhar, 2008), and 64.9 per cent expressed
a high level of personal accomplishment in their
job. Nevertheless, the results showed that burnout
does exist in French anaesthesia teams: 31.1 per
cent expressed moderate (19.2%) or high (11.9%)
levels of emotional exhaustion and 34.4 per cent
expressed moderate (22.5%) or high (11.9%) levels of depersonalization. Moreover, subsequent
univariate analyses revealed some differences of
prevalence of burnout in different subgroups.
Specifically, the results revealed an effect of status showing that physician anaesthetists were
more exposed to burnout than nurse anaesthetists
(Chi-square = 3.61, p = .05). Specifically, high
levels of emotional exhaustion were more frequent among physician anaesthetists than nurse
anaesthetists (16.2% and 7.8% respectively), and
high levels of depersonalization were more frequent among physicians than nurses anaesthetists
(17.6% and 5.2%, respectively). For personal
accomplishment, low levels were more frequent
among physician than nurse anaesthetists (13.5%
and 6.5% respectively).

Job satisfaction among

anaesthesia teams
For the job satisfaction measure, the results showed
that the global mean score for the whole sample
was 3.38 (SD = 0.53). The results revealed also an
effect of gender, F(1, 150) = 4.81, p = .03, showing
that female anaesthetists were less satisfied with
their job (3.29, SD = 0.60) than male (3.40, SD =
0.45). This job dissatisfaction among females
affected more specifically items concerning supervision, moral values, authority, creativity and compensation. The results also indicate a significant
effect of the age, F(1, 150) = 6.22, p = .014 and
tenure in team, F(1, 150) = 5.17; p = .024 showing
an increase of job satisfaction with age and tenure
in team. This job dissatisfaction in junior anaesthetists affects more specifically items concerning
compensation, creativity, recognition and accomplishment. Moreover, it appears as well as the satisfaction in the work is better in the small-sized teams
(M = 3.55, SD = 0.51) than in the large-sized teams
(M = 3.25, SD = 0.52), F(1, 150) = 12.57, p = .001.
Finally, the results did not reveal an effect of status, nurse (M = 3.31, SD = 0.50) and physician

anaesthetists (M = 3.46, SD = 0.56) expressed

globally the same level of job satisfaction, F(1,
150) = 2.75, p = .09.

Life satisfaction among

anaesthesia teams
For the life satisfaction measure, the mean score
was 3.68 (SD = 0.83) for the whole sample. Results
did not show any significant effects of socio-demographic variables.

Factors associated with burnout,

job satisfaction and life satisfaction:
multivariate analyses
A series of stepwise linear regression analyses (see
Table 4) for each measure of occupational burnout,
job satisfaction, and life satisfaction were finally
made to examine the relative contribution of sociodemographic variables (age, status, and gender) and
controlled variables (size of team and tenure in
team).
As we can see in Table 4, for emotional exhaustion, the main predictor variables were gender ( =
.20, t = 2.53), status ( = .20, t = 2.45) and tenure
in team ( = .19, t = 1.93), (F(5, 150) = 4.34, p =
.001, R2 adj. = .10) indicating that female physicians
and junior practitioners expressed high level of emotional exhaustion compared to male physicians,
senior practitioners and nurse anaesthetists. For
depersonalization, the main predictor was status ( =
.28, t = 3.32), (F(5, 150) = 3.07, p = .01, R2 adj. =
.06) suggesting that physician anaesthetists
expressed a higher level of depersonalization scores
than nurse anaesthetists. And for personal accomplishment, the main predictor was also only status,
( = .26, t = 3.04), (F(5, 150) = 2.33, p = .04, R2
adj. = .04) suggesting that physicians expressed a
lower level of personal accomplishment than nurse
anaesthetists.
Similarly, we assessed the effects of socio-demographic variables and controlled variables on job
satisfaction measure. Again, the regression analyses
revealed that the main predictors of job satisfaction
were status ( = .15, t = 1.89), and size of team (
= .27, t = 3.40), (F(5, 150) = 5.03, p = .001, R2
adj. = .12) suggesting that the level of job satisfaction was lower among physicians than among nurse
anaesthetists and in large-sized teams.
Finally, as we can see from Table 4, the variables
entered in the equation were not predictors of the
life satisfaction measure.
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JOURNAL OF HEALTH PSYCHOLOGY 15(6)

Table 4. Variables associated with burnout (emotional exhaustion, depersonalization and reduced personal
accomplishment), job satisfaction and life satisfaction: stepwise linear regression analyses
Dependent variables

Independent variables

Standardized

Emotional exhaustion

Sex
Age
Status
Size
Tenure
Sex
Age
Status
Size
Tenure
Sex
Age
Status
Size
Tenure
Sex
Age
Status
Size
Tenure
Sex
Age
Status
Size
Tenure

.20**
.05
.20**
.04
.19*
.09
.09
.28**
.06
.01
.02
.06
.26**
.09
.10
.11
.10
.15*
.27***
.06
.13
.05
.06
.07
.17

Depersonalization

Personal accomplishment

Job satisfaction

Life satisfaction

t
2.53
0.53
2.45
0.51
1.93
1.09
0.95
3.32
0.82
0.07
.24
.61
3.04
1.09
1.01
1.38
1.04
1.89
3.40
0.62
1.82
0.47
0.66
0.91
1.64

Adjusted R2
.10

.06

.04

.12

.03

*p < .05; **p < .01; ***p < .001

Discussion
The present study aimed to examine the prevalence
of occupational burnout, levels of life satisfaction
and job satisfaction of anaesthetists in France, and
to explore the relative influence of socio-demographic variables (age, gender, status).
Although anaesthesia has been described as
being stressful and being a risk factor for burnout,
the present findings did not reveal high levels of
emotional exhaustion and depersonalization (the
predictors of burnout syndrome) in French anaesthetists compared to other professional groups. A
large empirical body of evidence about the prevalence of burnout among medical professionals
(Grassi & Magnani, 2000; Kluger et al., 2003;
Maslach et al., 2001; McManus et al., 2002;
Ramirez et al., 1996) and in anaesthetists in other
countries (Adam et al., 2008; Cooper et al., 1999;
Lindfors et al., 2006; Morais et al., 2006; Nyssen et al.,

2003, 2008) exists and enables us to make comparisons. First, the levels of depersonalization and
emotional exhaustion among French physician
anaesthetists are quite similar to those observed in
other countries (see Table 5). However, the analysis
of different forms of burnout also revealed low levels of personal accomplishment in French anaesthesia teams compared to Australian, North American
or Hungarian anaesthetists. Such differences can
explain the low levels of global burnout observed in
the present study. The low levels of personal
accomplishment may actually be protective against
stress and burnout. A high prevalence of low personal accomplishment for physician anaesthetists
was already observed in some previous studies in
medical specialities (Adam et al., 2008; McManus
et al., 2002; Schaufeli & Janczur, 1994 with nurses).
For example, McManus et al. (2002) showed that
high degrees of personal accomplishment increase
stress and burnout levels of physicians. Thus, it

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CHIRON ET AL.: BURNOUT IN FRENCH ANAESTHETISTS

Table 5. The mean scores of burnout (and sample deviation) from physician anaesthetists in France
compared to other countries values
Burnout

French
anaesthetists
(n = 74)*

Australian
anaesthetists
(n = 422)

American
anaesthetists
(n = 1104)

Hungarian
anaesthetists
(n = 420)

Emotional
exhaustion
Depersonalization
Personal
accomplishment

17.1 (11.1)

17.9 (9.53)

22.2 (9.5)

18.7 (11.0)

6.4 (5.5)
31.8 (7.9)

6.1 (4.8)
36.0 (7.7)

7.1 (5.2)
36.5 (7.3)

5.15 (5.0)
35.5 (7.9)

We report here only the sample of physician anaesthetists

would be plausible to assign a more central role for

the personal accomplishment subscale dimension of
the MBI in defining burnout among physician
anaesthetists (McManus et al., 2002). Other authors
have also suggested that burnout and stress can be
mitigated by having high job challenge, authority
and job satisfaction (Kluger et al., 2003; Nyssen et
al., 2003; Ramirez et al., 1996). For example,
Ramirez et al. (1996) showed that, although surgeons had high levels of stress, they also expressed
a high level of job satisfaction, thus possibly protecting them from burnout. In the present study, the
satisfactory level of job satisfaction may have contributed to protecting anaesthetists from high levels
of burnout.
Furthermore, the present study provides some
interesting findings about differences in the prevalence of burnout and job satisfaction in different
subgroups. First, it is worthy to note some differences among nurse and physician anaesthetists on
each dimension of the MBI scale. Results of
descriptive prevalence of burnout and multivariate
regression analyses revealed that the status of
anaesthetists (physician or nurse) is a major predictor of the level of burnout. Physician anaesthetists
exposed to high responsibilities and time pressure
in French hospitals expressed more emotional
exhaustion and depersonalization scores compared
to nurse anaesthetists. Job dissatisfaction was also
higher among physician anaesthetists who are
highly pressured to perform better, to have a higher
professional standards and higher efficacy. The
degree of depersonalization and emotional exhaustion observed in physician anaesthetists may contribute to protect them for future stress and high
levels of burnout. The cynical attitude may be a useful strategy to manage the workload and the daily

pressure. Finally, the low levels of burnout found

globally within French anaesthesia teams may also
be explained by the lower scores of burnout found
in French nurse anaesthetists. In some studies with
Australian anaesthetists (Kluger et al., 2003; Kluger
& Bryant, 2008), it has been demonstrated that one
factor of decrease of stress is the presence of qualified help. The degree of emotional exhaustion and
depersonalization of the nurses here is lower
thereby enabling the global scores of the team to be
improved.
Second, the present study showed the gender differences in the prevalence of burnout in French
anaesthetists, and more especially a high level of
emotional exhaustion among female physicians
compared to male physicians. Significantly more
female than male practitioners scored high on the
emotional subscale of the MBI. These findings are
the first to show high psychological morbidity
among French female physicians and younger specialists in terms of burnout. The gender differences
found here were similar to ones observed in some
countries (Hungary, the United States, the UK), but
not in other countries (Germany, the Netherlands).
The observation of organizational contexts and
work hours of females in these different countries
revealed that in countries where female practitioners could work part-time (such as in the Netherlands
and Germany), the research did not find such gender differences in the prevalence of burnout and job
satisfaction. These results suggested that the lack of
part-time employment and the high number of
working hours may have contributed to the high
levels of emotional burnout among French female
anaesthetists. Besides which, female anaesthetists
show themselves to be less satisfied with work than
male anaesthetists, in several instances. These data
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JOURNAL OF HEALTH PSYCHOLOGY 15(6)

confirm those already in evidence in other countries

(see Hawton, Clements, Sarakovitch, Simkin, &
Deeks, 2001). The explanation most frequently
advanced concerns the conflict between family-life
and professional-life. The important involvement in
professional life by women doctors generates a
level of stress which is significantly higher than that
of their male counterparts. It is about a conflict of
the work/family sphere, which defines itself as a
conflict of roles which appears when the requirements of work and those of the family are mutually
incompatible (Higgins & Duxbury, 1992). The
lower job satisfaction of the women observed in our
study could then constitute an answer to the
demands of the family sphere. The study of Hawton
and al. (2001) found a rate of suicides of women
doctors higher than of their male counterparts,
affecting first of all women specialized in anaesthesia. Besides which, women are also less satisfied than
men with their salary, considering the importance of
the supplied work; an imbalance of the efforts/
rewards balance matches emotional exhaustion
among women, and this supports the hypothesis of
an increased risk of burnout among women anaesthetists, especially since they are young physicians.
Furthermore, the results demonstrated that junior
French anaesthetists were more affected by emotional exhaustion and expressed low levels of personal accomplishment compared to senior
anaesthetists. These findings are consistent with
previous studies that have shown a high prevalence
of burnout syndrome among junior physicians
(Lindfors et al., 2006; Morais et al., 2006; Nyssen
et al., 2003; Seeley, 1996). Finally, the job satisfaction
was significantly better among the older physicians
and can be explained by related payment to age and
by the achievement of initial objectives, more so in
the professional life than in the personal life.
Experience over time should enable different facets
of the job to develop and increase overall job satisfaction. Furthermore, the literature describes the fact
of being married and of having children as protective factors from occupational burnout (Maslach &
Jackson, 1984). Now, in the present study, 78.8 per
cent of the anaesthetists are in couple (or married)
and 78.1 per cent have one or more children.
Finally, the present results indicated that in largesized teams the prevalence of burnout and low personal accomplishment was higher than in
small-sized teams. We can expect that the frequency
and quality of communication between team mem-

bers (i.e. openness of communication) within largesized teams are poorer than in small-sized teams
and thus, could affect the development of co-ordinated
practices and team satisfaction (Reader, Flin, Mearns,
& Cuthbertson, 2007). Some recent studies have
demonstrated that implicit systems of communication
and co-ordination within the team, known under the
name of Transactive Memory Systems (TMS,
Wegner, 1987), are more developed in the small-sized
teams and contribute to physicians work attitudes
such as job satisfaction and team identification (Faraj
& Xiao, 2006; Michinov, Olivier-Chiron, Rusch, &
Chiron, 2008). The recent studies of Estryn-Bhar
(2008) in France also point in this direction by showing importance of teamwork and the collaboration
reducing the symptoms of stress in the workplace and
the intention to quit the profession. Some future studies within anaesthesia teams should be made to examine precisely the relative contribution of organizational
and inter-individual variables to reduce stress.
The present study has some limitations. First, the
sample size is small and is focused on French
anaesthetists working in public hospitals. Further
studies with large samples and in various organizational contexts would be needed. Indeed, the significance of different practice settings (e.g. working in
public establishments with educational and research
tasks or working in private establishments) could
influence the prevalence of depersonalization or the
sense of personal accomplishment (Adam et al.,
2008). Moreover, the type of stressors in two clinical settings (private or public) could be different.
This point related to work settings and organizational climate merits further research. The second
major limitation is its cross-sectional nature. The
survey questionnaire may be biased because it comprised only self-reporting measures that could reflect
socially desirable responses and it does not infer a
causal relationship between variables. Despite these
limitations, this is the first study to explore the
prevalence of burnout among physician and nurse
anaesthetists in France. This study also contributes
to current efforts on establishing French national
norms for the MBI in medical burnout research.

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Author biographies
BRUNO CHIRON is an Anaesthesiologist working in
a general hospital in France. His recent research is
focused on risk, day surgery, team co-operation in
the anaesthesia team and simulator assessment.
ESTELLE MICHINOV is Associate Professor of Social
and Organizational Psychology in the department
of Psychology at the University of Rennes 2,
France. Her recent research focused on group
processes and team performance in varied contexts
(academic, medical, industrial and humanitarian).

is Co-ordinator in cancer
research of University Hospital in Tours, France.
Within the framework of her training, she became

ELODIE OLIVIER-CHIRON

interested in the quality of life of the medical

teams.
MARC LAFFON is

Professor in anaesthesia and

intensive care of University Hospital in Tours,
France. His research topics are obstetric
anaesthesia and airway risk management.

is Professor in public health

at the University of Tours, public health
physician at the University Hospital of Tours.
His research topics are in the fields of health
education or health promotion and
epidemiology (clinical pathway and behaviour
of patients).
EMMANUEL RUSCH

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