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Int. J. Indian Culture and Business Management, Vol. 4, No.

1, 2011

Stress level among the medical practitioners of public


and private sector: a comparative insight
Shilpi Goyal*
RIMT-IMCT,
Mandi Gobindgarh 147301, Punjab, India
Fax: +91 1765 250041
E-mail: Shilpi_0205@yahoo.co.in
*Corresponding author

O.P. Goyal and Anu Singh Lather


GGSIP University,
Delhi 110006, India
E-mail: opgoyal_sms@yahoo.co.in
E-mail: anusinghlather@yahoo.com
Abstract: The review of literature on occupational stress and its adverse
consequences emphasises the importance of its assessment and management.
The recognition of the harmful physical and psychological effects of stress,
both on individuals and organisations has been widely studied. However,
empirical research on the sources of stress among Indian doctors is scarce.
Most research studies reported in leading journals have been done on doctors
from countries other than India. Keeping in view the gaps in research, this
paper aims to get an insight into the various stressors in the occupational life of
the medical practitioners and to make a comparison of the stress levels in the
public and private sector in India. A self-designed pre-tested questionnaire has
been used for the purpose of the study. The study has been conducted on 200
medical practitioners from public as well as private sector hospitals in the state
of Punjab in northern India.
Keywords: medical practitioners; public sector hospitals; private sector
hospitals; stressors; stress.
Reference to this paper should be made as follows: Goyal, S., Goyal, O.P. and
Lather, A.S. (2011) Stress level among the medical practitioners of public and
private sector: a comparative insight, Int. J. Indian Culture and Business
Management, Vol. 4, No. 1, pp.112.
Biographical notes: Shilpi Goyal has received MBA in Human Resources
Management and is pursuing PhD in the area of Human Resources
Management at GGS Indraprastha University, Delhi, India. She is working as a
Faculty at RIMT-IMCT, Mandi Gobindgarh, Punjab (India) since last two
years. She has published her research papers in referred journals of repute and
has attended many national/international level conferences. Her areas of
interest are human resources, applied psychology, organisational behaviour and
organisational development.

Copyright 2011 Inderscience Enterprises Ltd.

S. Goyal, O.P. Goyal and A.S. Lather


O.P. Goyal is a Professor and a Director at GGSIP University, Delhi, India. He
has a wide experience of teaching and research of more than 40 years. He has
successfully supervised more than 20 PhD scholars. He has been on the board
of many corporate and educational institutes. He has worked at the university
level in various capacities such as Dean-Academics, Dean Research and
Director-Corporates, etc. He has published a large number of research papers in
national/international journals of repute.
Anu Singh Lather is a Professor of Management in the University School of
Management Studies at GGS Indraprastha University, Delhi, India. She is an
HRD professional and OD expert. She has to her credit teaching, research and
corporate training experience for 20 years. Her research papers have been
published in various international and national journals of repute. In addition,
she has been contributing papers/articles/presentations in various national and
international conferences, seminars and conclaves.

Introduction

Causes and effects of occupational stress have received research attention for several
decades although increasing focus has been paid to it during the 1990s as organisations
and individual workers attempt to adapt to accelerating rates of change. The impact of
stress on the economic health of the organisation and the mental and physical health of
the individual have been well documented (e.g. Cooper, 1994; Cooper and Marshall,
1976; Quick and Quick, 1984).
Occupational stress has become more common today, because of the ever increasing
job demands of organisations from the employees. The term stress has typically been
used to refer both to the adjustive demands placed on an organism and to the organisms
internal biological and psychological response to such demands. The adjustive demands
are referred to as stressors and the effects they create within an organism as stress.
According to Neufeld, stress is a by-product of poor or inadequate coping.
Stress is a medical term that describes how the human body reacts when it fears it is
under attack. Stress can be caused by mental or physical conditions, or, a combination of
both. When the human body fears it is under attack it automatically responds. The pulse
rate increases, blood flow to the brain and to major muscle groups increases, and
adrenaline and other stimulants are released into the blood stream. All these relate to the
human instinct for fight or flight when attacked. The extra blood flow and stimulants
get the body ready for physical activity.

Review of literature

All occupations have the capacity to be stressful, but some occupations and organisations
are potentially more stressful than others. Cranwell-Ward (1987) identified organisations
within the service industry, those with high technology and those undergoing structural
job changes as potentially more stressful than others. Thus the study of occupational
stress in the service sector is an important area of research, which can identify the causes
of stress and may suggest coping strategies so as to strike a balance among the
employees professional and family life.

Stress level among the medical practitioners

Stress spares none, not even those who advise how to prevent it (Shah and Kanwar,
1999).
Stress refers to the causes and the effects of feelings of pressure. How we cope with
these pressures often is determined by our own levels of resistance and what else is going
on at the time. Thus, the interplay of constraints, demands and supports is endlessly
variable and, as such, it makes research into the area complex. Stress, therefore, may be
defined as a response to the perceived relationship between the demands on us and our
ability to cope. The factors which cause stress at work can be grouped into various
categories: factors intrinsic to the job; role in the organisation; relationships at work;
career development; organisational structure and climate; extra-organisational sources of
stress. Consideration of the various dimensions of these stress categories has been
considered in depth elsewhere (see e.g. Cooper and Cartwright, 1994; Cooper and
Marshall, 1976, 1978; Cooper et al., 1988; French and Caplan, 1972; Sworder, 1981), as
has the applicability of various potential work stressors in a retail management context
(Broadbridge, 1998a).
Research into the incidence of stress in a variety of occupational sectors has received
academic attention (e.g. Bogg and Cooper, 1995; Burke and Greenglass, 1995; Kahn and
Cooper, 1993; Worrall and Cooper, 1995). Within service sector, however, it is a
relatively under-developed area (see e.g. Broadbridge, 1998a,b; Lusch and Jaworski,
1991). Also, less attention has been paid to stress arising from the work-home interface
with a few notable exceptions (Frone et al., 1992; Ginn and Sandell, 1997; Lewis and
Cooper, 1983, 1988; Swanson et al., 1998).
Research by Pleck et al. (1980) revealed that a substantial proportion of employed
adults report conflict between their work and family roles. Glowinkowski and Cooper
(1985) propose three hypotheses to explain the workfamily relationship. The first is
spillover, where the events of one environment affect the other; the second is
compensation, where the individual attempts to compensate in one environment for what
is lacking in the other and the third is where both environments can be described as
independent.
In turn, stress (either derived from work or home) can create problems in the
workplace, and has a variety of outcomes. These may be quantifiable factors such as
absenteeism (Cooper, 1994; Cooper and Cartwright, 1994) and labour turnover (Terborg,
1985) both of which are high within retailing. However, they also incorporate the less
quantifiable outcomes of stress such as the people who physically turn up for work but
are unable to contribute fully because of their stress-related problems (Cooper, 1994).
Such forms of stress may result in irrational thinking and rigidity of views, faulty
decision making, communication breakdowns (Quick and Quick, 1984), interpersonal
conflict, general time wasting and avoidance of responsibilities or tasks (Adams, 1980)
and job dissatisfaction (Cooper, 1983). All such forms of stress manifestation are
important as they contribute to deficient work performance and loss of productivity, not
only from the individuals under stress, but also potentially from those who have to work
with them.
Job-related stress and its adverse consequences are taking a toll on Indian employees
in all sectors and the health sector is no exception.
Research has suggested that physicians jobs are more stressful than many other types
of work, but sources of job stress of physicians have rarely been measured systematically.
The job of the medical practitioners is such that they are so engrossed in their task of
treating their patients that their own health becomes a secondary consideration. Keeping

S. Goyal, O.P. Goyal and A.S. Lather

in view the gaps in research in the health sector, the following study is proposed to be
undertaken in the public and private sector hospitals in the state of Punjab in northern
India and to evaluate the level of stress among the medical practitioners working therein.

Research objectives and methodology

3.1 Objective of the study


The primary objectives of the study are:
x

to assess the level of stress among the medical practitioners in the selected public
and private sector hospitals in the state of Punjab in northern India

to gain an insight into the major stressors and making a comparison of the stress
levels between the two sectors.

3.2 Scope of the study


The scope of the study has been limited to the medical practitioners working in the public
and private sector hospitals in the state of Punjab in northern India.

3.3 Hypothesis of the study


For achieving the aforesaid objectives, the following null and alternate hypotheses were
framed.
Ho: There is no significant difference between the stress levels of medical practitioners in
the public and private sector hospitals.
HA: The medical practitioners of private sector hospitals experience a higher level of
stress as compared to those working in public sector hospitals.

3.4 Research methodology


The exploratory research design has been used to obtain the relevant results for the
problem at hand. Survey approach has been adopted to collect primary data. A selfdesigned, pre-tested questionnaire has been used as the tool for data collection. The tool
was tested for reliability and validity. The questionnaire has high-content validity as the
framing of questions was done by involving professional judgement of the academicians
and experts in the area of stress management. The value of Cronbach alpha was found to
be 0.82, which indicates a high degree of reliability.
The respondents were directed to indicate their responses on five-point Likert scale.
The total score for each respondent has been calculated by adding the scores of each
factor. Secondary data has been collected from various sources such as websites, books,
journals, magazines, etc. A sample of 200 respondents, (out of which 50% of the sample
is from the public and the other half is from the private sector hospitals) has been selected
on a random basis.
Data have been tabulated in the form of tables to get a better insight of the
relationship between various variables.

Stress level among the medical practitioners

The following model has been used to check the significance of the hypothesis.

x1  x2

x  x  x
2

 x2

n  n
1

 2 1/ n1  1 / n2

where x1 is the mean of the first sample; x2 is the mean of the second sample; n1 is the
number of observations in the first sample and n2 is the number of observations in the
second sample.
Degree of freedom is calculated as follows:

n1  n2  2

In the present study, t-test has been used to test the significance between the means of
two independent samples, i.e. public and private sector.

Analysis and discussion

The data thus collected with the help of questionnaires were subjected to some statistical
tools for reaching at suitable results and conclusions. The results have been tabulated in
Table 1.
The participants in the proposed study were medical practitioners working in the
public and private sector hospitals in the state of Punjab in northern India. Half of the
respondents in the sample were from the public sector and the other half were from
the private sector. The sample was composed of 64% males and 36% females. About
46% of the sample belonged to the age group of 3040 years, 26% to the age group of
4050 years and the remaining 28% to the age group of 5060 years.
As revealed by the data in Table 2, only 4% of the total number of respondents in the
public sector experienced low-stress levels whereas the number was nil in case of the
private sector. The percentage of respondents who experienced moderate level of stress
was significantly higher in the public sector as compared to that in the private sector. The
results were found to be equally contrasting in case of high level of stress. In this case,
the percentage of respondents experiencing high level of stress was approximately double
in the private sector as compared to the public sector. The results clearly indicate that the
medical practitioners of the private sector experience a much higher level of stress as
compared to those working in the public sector. The reasons for the stress may be
different in both the sectors but the results clearly point out to a higher level of stress in
the private sector as compared to that in the public sector.
Table 1
S. no.
1

Demographic profile of the respondents


Demographic variable
Gender
Male
Female
Age group (years)
3040
4050
5060

Number of respondents

Percentage of
respondents

128
72

64
36

92
52
56

46
26
28

6
Table 2

S. Goyal, O.P. Goyal and A.S. Lather


Comparison of stress levels among the medical practitioners in the public and private
sector hospitals
Level of stress
Low

Moderate

High

Sector

No. of
respondents

% of
respondents

No. of
respondents

% of
respondents

No. of
respondents

% of
respondents

Public

66

66

30

30

Private

44

44

56

56

Table 3

Stress level among male and female medical practitioners of public and private sectors
Level of stress
Low

Sector

Gender

Public

Male
Female

Private Male
Female

Moderate

High

No. of
% of
No. of
% of
No. of
% of
respondents respondents respondents respondents respondents respondents
4

6.25

38

59.3

22

34.3

28

77.7

22.2

28

43.7

36

56.2

16

44.4

20

55.5

Stress is found to be significantly higher among male practitioners working in private


sector hospitals in comparison to their colleagues working in public sector hospitals
(Table 3). The medical practitioners working in the private sector hospitals have to work
for long hours. They are even required to work at odd hours.
The figures in Table 3 indicate that it is the male practitioners of the private as well as
the public sector who are more stressed as compared to their female counterparts. One
probable reason for this finding could be that the female practitioners do not work for
long and at odd hours in the hospitals as they have to handle family tasks in a different
manner than their male counterparts. Thus, the level of occupational stress experienced
by the female practitioners is lesser as compared to their male colleagues who spend
relatively more time at work, especially in the private sector.
As indicated by the figures in Table 4, the medical practitioners who experienced
low-stress levels was almost negligible and only a meagre percentage (7.14%) of the
respondents in this category belonged to the age group of 5060 years. Maximum
percentage of the respondents (65.5%) experiencing moderate stress levels was found to
be in the age group of 3040 years. High-stress level was experienced almost equally by
respondents of all the age groups. Thus the respondents do not seem to differ much in
experiencing low- and high level of stress whereas the respondents in the age group of
3040 years report more stress, may it be moderate or high.
When analysed department wise, it was observed that the medical practitioners of
plastic surgery, psychiatry, neurology and gynaecology experienced maximum moderate
level of stress and practitioners working in the urology, eye and physiotherapy
departments reported highest level of stress. The various reasons for stress have been
found to be impatience on the part of the patients, fear of getting infected, odd working
hours and inability to help the patient sometimes in spite of the best efforts (Table 5).

Stress level among the medical practitioners

The results of the calculated mean show that the most contributing factor towards
stress among the medical practitioners of public sector hospitals is the time factor
(Table 6). The doctors complained that they do not get enough time to do things for
which they have a great liking. They were not able to devote time to their families. The
calculated value of mean for the time factor is 3.94. The next most stress causing factors
are the high expectations of the patients, impatience on the part of the patients, and
working at odd hours. The mean value of these factors is 3.80. These are followed by the
factors such as the fear of getting infected with some diseases from the patients, lack of
proper medical equipments in the hospitals and inability to help the patients in spite of
their best efforts. The values of the mean of these factors are 3.70, 3.68 and 3.64,
respectively.
Table 4

Comparison of stress levels among the medical practitioners of different age groups in
public and private sector hospitals
Level of stress

Sector

Low

Moderate

High

Age
group
(years)

No. of
respondents

% of
respondents

No. of
respondents

% of
respondents

No. of
respondents

% of
respondents

3040

52

65.5

40

43.4

4050

30

57.6

22

42.3

5060

7.14

28

50

24

42.8

Table 5

Stress level among the medical practitioners of different departments


Level of stress
Low

Department

Moderate

High

No. of
% of
No. of
% of
No. of
% of
respondents respondents respondents respondents respondents respondents

Plastic surgery

12

Skin

100

ENT

12

50

12

50

Dental

16

57.1

12

42.8

Psychiatry

12

100

Physiotherapy

20

16

80

Gynaecology

16

80

20

Eye

12

100

33.33

0
8

0
66.66

Medicine

24

75

25

Urology

12

100

Surgery

50

50

Neurology

100

8
Table 6

S. Goyal, O.P. Goyal and A.S. Lather


Stress among medical practitioners of public and private sector hospitals (N = 200)
Public sector
(N = 100)

Private sector
(N = 100)

Stressor

Mean

SD

Mean

SD

Heavy workload
Working at odd hours
Lack of proper compensation
Lack of growth and development
Impatience of patients
Long working hours
Dealing with patients having incurable diseases
High expectations of the patients
Inability to do things of ones likings
Lack of trust on the patients part
Lack of proper equipments
Inability to make the patients understand
Lack of time to upgrade knowledge
Patients go to other doctors
Lack of cooperation from the peers
Fear of getting infected
Feeling helpless to help certain patients
Lack of time for family
Compromise with values and standards
Ignorance of patients

3.36
3.80
2.98
3.30
3.80
3.30
2.7
3.80
3.94
3.60
3.68
2.98
2.74
2.84
2.92
3.70
3.64
3.30
2.80
3.56

1.20
1.03
1.26
1.41
1.01
1.30
1.24
1.19
0.79
1.33
1.11
1.39
1.0
1.30
1.47
0.88
1.24
1.12
1.32
1.10

3.64
4.28
3.28
3.12
4.12
3.44
3.80
4.0
3.72
4.02
2.84
3.54
3.12
2.52
2.96
3.56
4.20
3.44
2.72
3.78

0.980
0.726
1.155
1.113
0.518
0.808
0.899
0.752
0.877
0.816
1.161
0.968
0.956
1.068
1.317
0.857
0.752
0.988
1.288
0.733

It was also found that in case of private sector hospitals, working at odd hours causes
the maximum stress among the doctors working therein. The calculated mean value of the
factor is 4.28, which is even higher than the highest mean value in the public sector. The
second most stress causing factor is the inability to help the patients in spite of their best
efforts. Other factors such as impatience on the part of the patients, lack of trust among
patients and their high expectations are also potential stressors in the private sector.
The respective mean values of these factors are 4.12, 4.02 and 4.0.
After the calculation of mean for the responses given by the doctors of both private
and public sector, it is also revealed that the private sector doctors are more stressed than
the doctors of public sector. The total mean value of all the stressors for the private sector
is 70.1 whereas this value for the public sector is 66.66.

4.1 Application of t-test


As reflected by Table 7, the CV > TV. Thus the results are significant and the null
hypothesis, there is no significant difference between the stress levels of medical
practitioners in the public and private sector hospitals, is rejected and the alternate
hypothesis, the medical practitioners of private sector hospitals experience a higher level
of stress as compared to those working in public sector hospitals, stands confirmed.

Stress level among the medical practitioners


Table 7

Significance of the mean of two groups

Mean value of the 1st group, i.e. private sector

70.10

Mean value of the 2nd group, i.e. private sector

66.66

SD

7.8444

Value of the t-test (CV)

3.10

Degrees of freedom

198

Table value (TV) of t at 5% LOS

1.645

Major findings of the study

After a detailed analysis of the data, the important findings of the study can be enlisted as
follows:
x

The most stress causing factor among the doctors of government hospitals is the
time factor. They complain that they do not get enough time to do things for which
they have great liking. On the other hand, the most stress causing factor among the
doctors of private hospitals is that they have to work at odd hours also. Doctors of
public sector have more complaints regarding the time factor. Most of the doctors
complain that they do not get enough time for their families.

The least stress causing factor among the doctors of government sector is when they
have to deal with patients having incurable diseases whereas the least stress causing
factor among the doctors of private hospitals is the fact that more patients go to other
doctors.

The private sector doctors are living more stressful life than the doctors of public
sector. Doctors working in private hospitals experience more stress in their
profession than the doctors who work in government hospitals.

The female doctors have more of moderate level of stress but on the other hand, male
doctors have more of high level of stress.

Both male and female doctors of private sector experience high-stress level whereas
the doctors of public sector suffer from more of moderate level of stress.

The doctors of age group 5060 have comparatively low-stress level than the doctors
of other age groups such as 3040 and 4050.

The maximum number of doctors agrees to this fact that their workload is too heavy
and they have to work at odd hours also which acts as a major source of stress among
them.

Almost every doctor gets irritated because of the impatience shown by the patients
and maximum number of doctors gets upset when they have to deal with patients
having incurable diseases.

Almost half of the doctors agree to this fact that expectations of the patients from
them act as a source of stress for them.

10

S. Goyal, O.P. Goyal and A.S. Lather

About 70% of the doctors get disturbed when they see lack of trust in their patients
towards them.

Lack of proper medical equipments act as a hindrance in working effectively and


efficiently for doctors but this factor is a cause of stress only in case of government
hospitals whereas doctors working in private hospitals do not face such problems.

Almost half of the doctors get irritated when they are not able to make their patients
understand what they want to say. About 70% of the doctors strongly agree to the
fact that they get upset when they are not able to help their patients even after their
best efforts.

Most of the doctors tended to disagree to the fact that they get upset when their
patients go to other doctors.

Maximum number of doctors has a fear in their mind that they might get infected
with some disease from their patients, which cause stress for them.

About 38% of the doctors agree that sometimes they have to compromise with their
values and standards to fulfil the needs of their profession.

More than half of the doctors agree that the ignorance on the part of the patients
irritates them sometimes.

Recommendations

Although stress is an inbuilt characteristic of the job of the medical practitioners, the
organisations could prove to be of some help in reducing the amount of stress
experienced if they implement the following recommended strategies:
x

The medical practitioners should be encouraged to participate in several


conferences/seminars related to their field. This would not only help them to upgrade
their knowledge but also would bring about a change in their busy schedules.

The medical practitioners should be sensitised to stress by providing them certain


training programmes. Some sessions such as occupational stress workshops can be
arranged. These workshops would help to identify some of the most important
organisational and personal concerns causing stress.

Feedback should be obtained on these sessions which would further be helpful in


demonstrating the need for additional programmes or activities.

The organisations should ensure that the medical practitioners do not work
continuously for more than two shifts. They should be given proper rest pauses
within their shifts as well.

Contribution of the study

The study would help the academicians to develop some quantitative aspects related to
the measurement of stress. It would help the medical practitioners to gain an insight into

Stress level among the medical practitioners

11

the various factors that cause stress and to identify the most important stress element for
themselves. This would prove to be helpful in sensitising the practitioners to the
occupational stress. This study would also help the policy makers to design some policies
for the alleviation of occupational stress, which is inherent in the job of the medical
practitioners.

Limitations of the study and directions for future research

A major limitation of the current study is its limited scope. The scope for the study can be
extended to include medical practitioners from other states and regions. The study can
also be undertaken in different countries so that a comparative analysis can be carried out
and measures that have proved effective in combating stress in one country may be used
in other countries as well. There is a need to explore possibilities for multiplicative
interactions among the various stressors and the levels of stress. Eventually, weighting
factors might be developed to reflect the relative contribution of the various factors to the
total stress.

Acknowledgements
The authors wish to acknowledge the anonymous reviewers for their valuable feedback
and suggestions for improving the quality of this paper. We would like to express our
deep sense of gratitude to all those who have contributed towards the development of this
paper.

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