GROUP 2

Roll nos.: 2014075- 2014084

IMPACT OF ORGANIZATIONAL ROLE STRESS AMONG DOCTORS

ABSTRACT

Doctors work in one of the most stressful work environment. Occupational stress research
emphasizes the need to assess the management of work related stress among doctors. This study
is undertaken to investigate the difference between stress levels of male and female doctors and
the relationship between job engagement level and stress among doctors. The total sample of 128
respondents was divided into two on the basis of gender. Mean was calculated for each type of
role stress and for the total role stress for both the groups and t-test was used to determine the
significance of difference between the two groups. Results indicate that women experience more
stress than men on most of the stress parameters. Analysis of Variance (ANOVA) was used to
test the significance of difference in stress between low, medium and high job engagement. For
the total and eight types of role stress (IRD, REC, RO, RI, PI, SRD, RA, RIn), the doctors with
high job engagement experienced minimum stress and those with low job engagement
experienced maximum stress, pointing to the existence of a negative relationship between level
of job engagement and role stress

INTRODUCTION
Stress among doctors is of grave concern, as the decisions they make affect patients life and is
inevitable in the high-pressure medical work environment. "Stress can be defined as the disparity
between comprehensions of the requirements on one side and our ability to cope with this
demand on the other side." (Looker and Gregson in Ivanko and Stare 2007, 224). Stress is a part
of every employed individuals life and is common among healthcare professionals, including
doctors and this could result in multiple negative consequences like low morale, psychological
distress and lack of motivation. Detecting it early may have positive outcomes for doctors, their

families and the patients they treat. Moreover, the work-life conflicts affect the effectiveness of
the doctors as well as their peers.
In todays healthcare industry in India, there are immense opportunities for new and existing
players to achieve innovation and profits. India's competitive advantage over its peers can be
inferred by the fact that it has a large pool of well-trained medical professionals. In India, the
diagnostics sector has been witnessing tremendous progress in innovative competencies and
credibility. Advancement in technology and higher efficiency systems are taking the Indian
Healthcare market to new heights.
The healthcare sector in India is expected to grow at a CAGR of 15 per cent to touch US$ 158.2
billion in 2017 from US$ 78.6 billion in 2012, according to a report by Equentis Capital. Indias
per capita healthcare expenditure has increased at a CAGR of 10.3 per cent from US$ 43.1 in
2008 to US$ 57.9 in 2011, and moving forward it is expected to reach US$ 88.7 by 2015. (IBEF,
2014)
Doctors in India experience high intensity of work, conflict in time demands, huge professional
responsibility, job insecurity and work-family conflicts. This kind of stress among doctors may
affect the quality of service they provide to their patients and leave them physically and
emotionally drained. Therefore, it becomes imperative to understand the concept of organization
role stress in doctors life.

LITERATURE REVIEW
The modern healthcare setting is exceptionally stressful. It is a complex environment in which
health professionals continually have to learn new skills, work long hours, constantly care for ill
people and face death, and have high levels of responsibility and reliance. Stress in medical
professionals has potentially more serious consequences for individuals and the community as a
doctor's role in the community is central. Stress in doctors affects not only their private lives and
health but also the quality of medical care that they provide, patients satisfaction with the doctor,
and patients adherence to treatment.

A number of studies have been undertaken in other countries as well as in India investigating the
problem of role stress among doctors. It has been found that health workers are highly
susceptible to stress at work and experience more negative outcomes of stress than other
professions. For example, a survey conducted in Irish hospitals indicated that work stress caused
dissatisfaction in 79% of physicians, 56% evaluated their job as stressful or extremely stressful,
and as many as 68% considered leaving the profession, half of them very seriously. Based on the
1premise that females have primary responsibility for home life, and males perceive work as
primary because of their 'breadwinner' role, Pleck (Mirande, 1986) also suggested that work to
home conflict would be greater for males, whereas the demands of home life were more likely to
conflict with work demands for females.

For women doctors, the most important predictor is the interference of job with the family and
for men it is the joint stressors of practice administration and job demands. Most stress come
from night calls, emergencies during surgeries and interruption of family life. Stressors for
females are identified too. Female doctors experience more stress than their male counterparts
from visiting during adverse weather conditions, and fear of being assault on night visits among
others.

The case in India is no better. Four incidents of suicides by doctors in the recent past have sent
out the signals of alarm among the fraternity and common public. In January, 2003-2004 one
doctor from the National Institute of Health and Family Welfare (NIHFW) doing diploma in
public health committed suicide by hanging herself. On January 24, 2002, one doctor at the
Safdarjung Hospital allegedly committed suicide. Another doctor doing some super-specialty
course from the AIIMS committed suicide on July 13, 2004. In February 2005, a senior resident
doctor attempted suicide inside his room at the AIIMS. Though these cases have been alarming
they are definitely not surprising. Newspapers frequently report such incidents. (Dhar, 2008)

In yet another study it was found that there was no difference between the stress levels among
male and female doctors except in case of the factors- Inter-role distance and Role inadequacy
and in these factors, the stress level among female doctors was much more than male doctors.
(Al, 2009)

Stress and suicide among doctors have been even more a matter of grave concern at the global
level. Suicide mortality in doctors is reported to be significantly higher in relation to other
professionals and general population in many industrialized countries including the US.
American doctors kill themselves at a rate of 41% higher comparatively to other places.

According to Schaufeli, Salanova, Gonzlez-Rom and Bakker (2002), engagement can be

defined as a positive, fulfilling and work-related state of mind that is characterised by vigour,
dedication (efficacy) and absorption.

Vigour is characterized by high levels of energy and mental resilience while working, the
willingness to invest effort in ones work, and persistence in the face of difficulties. This energy
can also relate to the level of mental effort or mental strength that individuals can put into doing
something. Dedication is characterised by a sense of significance, efficacy, enthusiasm,
inspiration, pride and challenge. It refers to the emotional side of work engagement and the
willingness of people to expend considerable time and effort in doing something meaningful.

Absorption refers to the cognitive aspect where individuals are fully focused on something and
experience a high level of concentration while performing a task. This includes being happily
engrossed in ones work, so that time seems to pass quickly and one has difficulties in detaching
oneself from work (Coetzer & Rothmann 2007). In view of the foregoing, work engagement
relates to the harnessing of organisation members selves to their work roles in which they
employ and express themselves physically, cognitively and emotionally during role
performances.

Engaged employees become physically involved in their tasks, cognitively alert and emotionally
connected to others when performing their job. In contrast, disengaged employees become
disconnected from their jobs and hide their true identity, thoughts and feelings during role
performances (Olivier & Rothmann 2007). Organisational benefits gained from employee
engagement have been known to include greater achievement of individual work goals or
productivity (Schaufeli & Bakker 2004), customer satisfaction and profitability.

Engaged employees are typically characterised by the willingness to take initiative and selfdirect their lives; they generate their own positive feedback and so encourage themselves; they
are also engaged outside of their employment; their values and norms are in agreement with
those of the organisation for which they work; they do become fatigued, but it is intrinsically
linked to an overall sense of satisfaction; they may also become burnt out, but are able to
extricate themselves from the situation; they are not enslaved to their job, and they tend to also
pursue outside interests (Vanden Berg, Manias & Burger 2008). (Villiers)

The concept of job involvement refers to the degree to which employees relate to their jobs as
comprising their lives in total, so that an employee who exhibits high job involvement identifies
strongly with his or her job and thinks about the job even when outside of work (Kanungo,
1982). Job involvement is influenced by organization characteristics, supervisory behaviors, and
individual differences (Brown & Leigh, 1996) and is reasoned to predict job performance
because individuals who identify the most strongly with their jobs focus their thoughts on work
and interpret more situations as opportunities to perform work role activities (Hillman,
Nicholson, & Shropshire, 2008; Kreiner, Hollensbe, & Sheep, 2006).
There is a rich history of research on the concept of job satisfaction, which refers to a
pleasurable or positive emotional state resulting from the appraisal of ones job or job
experience (Locke,1976: 1300). Job satisfaction is promoted through favorable perceptions of
job characteristics, supervisors, and coworkers (Russell, Spitzmuller, Lin, Stanton, Smith, &
Ironson, 2004) and is also influenced by differences in individual personality (Judge, Heller, &
Mount, 2002). The positive feelings associated with high job satisfaction that result from
favorable evaluations of what their organization explanations that emphasize affect or cognition
or the motives for physical persistence in tasks. Yet these explanations do not account for the
possibility that individuals can choose to invest their affective, cognitive, and physical energies
simultaneously into role performances and that this more holistic investment of the self into
ones role represents something that is distinct and fundamental (Kahn,1990, 1992). (RICH,
2010)

EMPIRICAL STUDY VARIABLES

According to Pareek (Srivastav, 2010), Role denotes the set of functions one performs in
response to the expectations of the significant others, and ones own expectations from that
position or office. The organization and individual come together through role. Pareek (1980)
pioneered work on role by identifying as many as 10 different types of organizational role
stresses. Briefly these are:

Inter Role Distance (IRD): Inter role distance is experienced when there is a conflict between
organizational and non-organizational roles. E.g., Conflict to make a decision between attending
family functions or a surgery.

Role Stagnation (RS): Role stagnation is the feeling of being stuck in the same role. Such a type
of stress results in perception that there is no opportunity for the furthering or progress of ones
career. E.g. Executives doing Data entry job tend to suffer more from this stress.

Role Expectation Conflict (REC): Conflicting demands made on the role by role senders. This
type of stress is generated by different expectations by different significant persons, i.e.
superiors, subordinates and peers, about the same roles and the role occupants ambivalence as to
whom to please. E.g., producing excellent work but finishing under severe time restraints.
Role Erosion (RE): Role erosion is the function of the role occupants feeling that some
functions which should properly belong to his/her role are transferred to/or performed by some
other role. This can also happen when the functions are performed by the role occupant but the
credit for them goes to someone else. Another manifestation is in the form of underutilization in
the role.

Role Overload (RO): When the role occupant feels that there are too many expectations from
the significant roles in his/her role set, he/she experiences role overload. There are two aspects of

this stress: quantitative and qualitative. The former refers to having too much to do, while the
latter refers to things being too difficult and the accountability in the role.

Role Isolation (RI): This type of role stress refers to the psychological distance between the
occupants role and other roles in the same role set. It is characterized by the feelings that others
do not reach out easily, indicative of the absence of strong linkages of ones role with other roles.

Personal Inadequacy (PI): Personal In adequacy arises when the role occupant feels that he/she
does not have the necessary skills and training for effectively performing the functions expected
from his/her role. This is bound to happen when the organizations do not impart periodic training
to enable the employees to cope with the fast changes both within and outside the organization.
Self- Role Distance (SRD): Self-role distance is conflict of ones values and self-concepts with
the requirements of the organizational role. This is essentially a conflict arising out of a
mismatch between the person and his/her job.

Role Ambiguity (RA): Role ambiguity is lack of clarity about expectations of others from the
role, or lack of feedback on how performance is regarded by others.

Resource Inadequacy (RIn): Resource Inadequacy is evident when the role occupant feels that
he/she is not provided with adequate resources for performing the functions expected from
his/her role.

HYPOTHESIS

Based on the theory in the literature review, we hypothesize the following:

H1: Female doctors experience higher role stress compared to male doctors.

H2: Increase in job engagement reduces role stress.

RESEARCH METHODOLOGY
The respondents of the study were doctors in the different fields and specializations with
qualifications of MBBS, MDs, Dentists and interns at different clinics and hospitals across the
country like Goa Medical College, doctors in West Bengal, Gujarat and doctors from U.K. Out
of a total of 137 questionnaires which were distributed, 128 responded positively and have been
used for the study. The quantitative method consisted of a questionnaire having 50 questions.
The following quantitative data was collected through online questionnaire and Google docs and
was segregated under stress of different segments. Anova and t-test have been used to determine
the significance of role stress differences between the groups using SPSS.

RESULTS

Data Analysis
The data were analyzed to study the level of stress experienced by doctors based on their gender
and job engagement. The below table represents the sample data:

Variables

Categories

No. of doctors

Gender

Male

65

50.8

Female

Job

63

49.2

Total

128

100

Low

41

32

Middle

56

43.75

High

31

24.25

Total

128

Engagement

100

Table 1:Role Stress Among Male and Female Doctors(N=120)

Male (N=65)

Female (N=63)

Role stress

Mean

SD

Mean

SD

t-ratio

IRD

17.46

7.37

22.97

4.85

-4.976**

RS

15.75

6.61

16.30

6.05

-.489

REC

10.45

3.92

12.59

3.45

-3.283*

RE

12.95

6.60

13.67

5.52

-.663

RO

13.26

6.03

17.25

5.08

-4.058*

RI

3.75

2.12

4.87

1.80

-3.221*

PI

8.60

4.78

11.27

3.96

-3.446*

SRD

1.98

1.10

2.68

0.84

-4.034*

RA

8.49

2.28

8.83

2.29

-.825

Rin

7.97

3.35

9.1

2.98

-2.007

TRS

100.68

37.15

118.75

28.09

-3.096*

*p<0.05 **p<0.01

Table 1 shows the mean, standard deviation and t-ratio between male and female doctors. There
is a significant difference between mean of male (100.68) and female (118.75) doctors for the
total role stress (TRS). The mean value for six types of role stress(IRD,REC,RO,RI,PI,SRD)
out of the total ten role stress variables are higher in female doctors than in male doctors.

In case of RS, RE, RA and RIn the hypothesis is not found significant to gender differences. RS
arises due lack of growth, RE arises when one does not receive the credit for his own work, RA
arises due to lack of clarity and RIn due to lack of resources. All these types of role stress arise
due to different circumstances faced in the work place. These situations are similar for both
male and female doctors. Hence to overcome these, both men and women have to take support
from their seniors in order to change the circumstances.

Among all types of role stress, IRD is coming out as the most significant area where female
doctors experience more stress than the male doctors. IRD arises due to conflict between ones
organizational and non-organizational role. As a female doctor has more obligations in her
family life than a male doctor, the stress level in this area is much higher in female doctors as
compared to male doctors.
Hence our first hypothesis Female doctors experience higher role stress compared to male
doctors is proved partially. One of the reasons is that men as compared to women handles
tense situation more patiently. Men have greater control over his emotions where as women
seeks emotional and social support, has less concentration and tends to lose control while facing
a tense situation (Thoits, 1995). Moreover responsibilities in the family front also lead to higher
level of stress in women professionals (Kaushal, 1998). Hence role stress is more in the female
doctors than the male doctors.

Table 2: Role Stress Across Groups Based on Job Engagement

Role

Mean Values

Stress

Low

Job Medium Job High

Job

FValue

Significance

Variable Engagement Engagement

Engagement

IRD

23.30

17.80

17.24

12.869

0.000**

RS

17.58

17.80

14.06

3.376

0.037*

REC

13.07

10.56

9.24

10.830

0.000**

RE

13.46

13.06

13.59

2.080

RO

16.89

13.93

13.76

4.316

RI

4.09

4.65

3.82

1.590

PI

17.65

12.52

5.35

280.051

SRD

2.56

2.15

2.12

2.682

RA

9.82

5.46

2.12

130.210 0.018*

RIn

10.67

8.61

7.82

8.874

0.031*

TORS

129.65

103.17

89.12

20.208

0.0126*

0.923
0.015*
0.208
0.000**
0.072*

Table 2 furnishes the mean values for 11 role stress variables (10 types of role stress and the total
role stress) for each job engagement group. It also furnishes the results of ANOVA(F-value and
significance) for each role stress variable.
All the findings are significant except for RE and RI. Seven types of role stress (IRD, REC, RO,
PI, SRD, RA, RIn) and the total role stress is minimum in the high job engagement group,
medium in the medium job engagement group and maximum in the low job engagement group.
So, the role stress decreases with increase of job engagement. One type of role stress (RS) is
stronger in medium job engagement group as compared to low job engagement group. The
finding does not support the second hypothesis and needs to be investigated further.

Hence our second hypothesis Increase in job engagement reduces role stress is proved for
eight out of eleven stress variables. Thus job engagement helps in creating a positive attitude in

the doctors. It also helps individuals deal effectively with the demands of stressful work (Britt,
Adler & Bartone 2001) and has been shown to be positively related to organisational
commitment (Demerouti, Bakker, De Jonge Janssen, & Schaufeli 2001) and employee
performance (Aktouf 1992). Higher job engagement leads to more involvement in the tasks.
Doctors with higher job engagement are cognitively alert and emotionally connected to others
when performing their job. All these factors help in role stress reduction.

CONCLUSION
Hospital doctors engage in sustained interpersonal interaction with patients which can lead to
them experiencing high levels of stress and exhaustion (V Swanson,1998). According to the
analysis done on the data collected, female hospital doctors are at greater risk of stress (Mean
TRS-118.75) or exhaustion than the male doctors (Mean TRS-100.68). In this context this
research paper examined the issue of gender differences on role stress and on doing so sought to
advance our understanding of potential gender disparities in the workrelated wellbeing of
hospital doctors, namely their experience of work burnout and intentions to quit. The research
showed that female doctors were significantly more likely to experience burnout from their work
than male doctors (Irfana Baba,2012).The findings showed that role stress is significantly and
negatively related to job engagement among doctors since senior doctors are more experienced
compared to the intern doctors. This is in accordance with the role stress study paper by
Srivastava(1993) on Organisation Role Stress (ORS).

The finding that female doctors experienced higher levels of burnout than male doctors is
therefore important in this context, and particularly so, given that hospital medicine has become
significantly more feminized. This was confirmed by the results of the T-test and Anova test
which was conducted for the data available with regards to first hypothesis which states that
women doctors experience more stress than male doctors. Also based on the analysis carried out
during the study and the results obtained the second hypothesis is also proved i.e. higher job
engagement reduces role stress. Despite this, there is substantial evidence that medical careers
are highly stressful for both male and female doctors.(Cooper et Al,1989:Sutherland &
Cooper,1993:Swanson et Al,1996). (R.NIRMALA, 2013)

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