Profiles

Ann Fridner

Docent, universitetslektor

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Arbetar vid Psykologiska institutionen
Telefon 08-16 38 42
E-post ann.fridner@psychology.su.se
Besöksadress Frescati hagväg 14
Rum 14:243
Postadress Psykologiska institutionen 106 91 Stockholm

Om mig

International coordinator

I am the international coordinator of the project "Health and Organisation among University hospital Physicians in Europe" [the HOUPE] - study since it started 2003, www.houpe.no. It is a longitudinal intervention research project now consisting of eight countries: Sweden, Norway, Italy, Hungary, Austria, the Netherlands, Spain and Turkey.

The project generates data among 7 000 hospital physicians on determinants in the educational system, the organization and work environment that affect the recruitment in academic medicine and physicians career, work conditions, work satisfaction and health. Academic medicine is entrusted by society toward improving the health of the public, including clinical research and education.

My research is now also focusing on physicians in outpatient health care, i.e. general practitioner, psychiatrists and geriatric physicians.

Theoretically, we apply an intersectionality perspective on traditional work models including the balance between job demands and resources and potential outcomes such as engagement, burnout or intention to leave academic medicine.

Prizes

Price for the "Best teaching" in gender equity and gender equality 2014. The prize is assigned to teachers who in a meritorious way take up and highlights the equality aspects in the broad sense in psychology. Department of Psychology, Stockholm University.

The 1.6 Million Club's Science Prize 2005 for research focusing on equal opportunities and health among female and male physicians.

Publikationer

I urval från Stockholms universitets publikationsdatabas
  • 2016. Marie Gustafsson Sendén, Karin Schenck-Gustafsson, Ann Fridner. Annals of Occupational and Environmental Medicine 28

    Background: It is common that physicians go to work while sick and therefore it is important to understand the reasons behind. Previous research has shown that women and men differ in health and health related behavior. In this study, we examine gender differences among general practitioners who work while sick.

    Methods: General practitioners (GP’s) working in outpatient care in a Swedish city participated in the study (n = 283; women = 63 %; response rate = 41 %). Data were obtained from a large web-based questionnaire about health and organization within primary care. Two questions about sickness presenteeism (going to work while sick) were included; life-long and during the past 12 months, and five questions about reasons. We controlled for general health, work-family conflict and demographic variables.

    Results: Female physicians reported sickness presenteeism more often than male physicians. Work-family conflict mediated the association between gender and sickness presenteeism.

    Women reported reasons related with “concern for others” and “workload” more strongly than men. Men reported reasons related with “capacity” and “money” more strongly than women. These differences are likely effects of gender stereotyping and different family-responsibilities.

    Conclusions: Gender socialization and gender stereotypes may influence work and health-related behavior. Because sickness presenteeism is related with negative effects both on individuals and at organizational levels, it is important that managers of health organizations understand the reasons for this, and how gender roles may influence the prevalence of sickness presenteeism and the reasons that female and male GPs give for their behavior.

  • 2016. Ann Fridner (et al.). Book of Proceedings. 12th Conference of the European Academy of Occupational Health Psychology, 203-203

    Objective: Physicians tend to demonstrate inappropriate behavior when it comes to taking care of their own health. Self-prescribing or self-treatment seems to be practiced in many countries, and self-treated illnesses are found to be more common among general practitioners. For the physician such behavior is a threat to their own health, and as a consequence their patients might not be able to receive optimal health care. The purpose of this study is to examine the relationship between help seeking behavior, sickness presenteeism, exhaustion, and self- treatment among general practitioners.

    Method: This cross-sectional study was conducted in 2013 among GPs employed in one City Council in Sweden using a questionnaire on health and work factors. The criterion variable “To self-diagnose and self-treat” was measured with a single item from the Physician Career Path Questionnaire (PCPQ; Fridner, 2004). Exhaustion was measured with a scale from the Oldenburg Burnout Inventory, OLBI (α = .82; Demerouti et al., 2001, 2003). “Sickness presenteeism” and “Taking vacation due to stress” was measured with single items, also from the PCPQ (Fridner, 2004). For the analyses, we used hierarchical multiple regression.

    Results: Altogether 193 (63,9%) female GPs and 109 (36,1%) male GPs answered the questionnaire, a 44% response-rate. Among them 46,2% stated they had diagnosed and treated themselves for a condition for which they would have referred a patient to a specialist. Our regression analysis model revealed that those physicians who self-treated themselves were also significantly more sickness present at work. Adding to this, exhaustion among the GPs was also included in the model.

    Conclusions: This study shows that self-treatment is not an isolated behavior, but occurs together with exhaustion and sickness presenteeism, indicating a quite severe situation for their health, which would need to be investigated by other doctors than themselves. This needs to be further investigated and taken into account by the National Board of Health and Welfare, County Councils and Medical Associations, and for future physicians our medical schools. 

  • 2015. Ann Fridner (et al.). BMC Medical Education 15

    Background: The proportion of women in medicine is approaching that of men, but female physicians are still in the minority as regards positions of power. Female physicians are struggling to reach the highest positions in academic medicine. One reason for the disparities between the genders in academic medicine is the fact that female physicians, in comparison to their male colleagues, have a lower rate of scientific publishing, which is an important factor affecting promotion in academic medicine. Clinical physicians work in a stressful environment, and the extent to which they can control their work conditions varies. The aim of this paper was to examine potential impeding and supportive work factors affecting the frequency with which clinical physicians publish scientific papers on academic medicine.

    Methods: Cross-sectional multivariate analysis was performed among 198 female and 305 male Swedish MD/PhD graduates. The main outcome variable was the number of published scientific articles.

    Results: Male physicians published significantly more articles than female physicians p <. 001. In respective multivariate models for female and male physicians, age and academic positions were significantly related to a higher number of published articles, as was collaborating with a former PhD advisor for both female physicians (OR = 2.97; 95% CI 1.22–7.20) and male physicians (OR = 2.10; 95% CI 1.08–4.10). Control at work was significantly associated with a higher number of published articles for male physicians only (OR = 1.50; 95% CI 1.08–2.09). Exhaustion had a significant negative impact on number of published articles among female physicians (OR = 0.29; 95% CI 0.12–0.70) whilst the publishing rate among male physicians was not affected by exhaustion.

    Conclusions: Women physicians represent an expanding sector of the physician work force; it is essential that they are represented in future fields of research, and in academic publications. This is necessary from a gender perspective, and to ensure that physicians are among the research staff in biomedical research in the future.

  • 2014. Mari Eneroth (et al.). BMC Public Health 14, 271

    Background: Physicians have an elevated risk of experiencing suicidal thoughts, which might be due to work-related factors. However, the hierarchical work positions as well as work-related health differ among resident and specialist physicians. As such, the correlates of suicide ideation may also vary between these two groups. Methods: In the present study, work- and health-related factors and their association with suicidal thoughts among residents (n=234) and specialists (n=813) working at a university hospital were examined using cross-sectional data. Results: Logistic regression analysis showed that having supportive meetings was associated with a lower level of suicide ideation among specialists (OR=0.68, 95% CI: 0.50-0.94), while an empowering leadership was related to a lower level of suicide ideation among residents (OR=0.55, 95% CI: 0.32-0.94). Having been harassed at work was associated with suicidal ideation among specialists (OR=2.26, 95% CI: 1.31-3.91). In addition, sickness presenteeism and work disengagement were associated with suicide ideation in both groups of physicians. Conclusions: These findings suggest that different workplace interventions are needed to prevent suicide ideation in residents and specialists.

  • 2014. Lise Tevik Løvseth (et al.). British Journal of Medicine and Medical Research 4 (27), 4582-4590

    Background: For decades there has been a prominent gender gap in the number publications among physicians in academic medicine. Increased recruitment of women into medicine and a new generation work force that emphasize work-life balance can contribute to narrow this gap. Aims: The present study investigates whether younger hospital physicians may display less gender differences in authorship of scientific publications compared to those older of age. Methodology: Baseline cross-sectional survey data among senior consultants (N=1379) working at public university hospitals in three European countries, participating in the HOUPE study (Health and Organization among University hospital Physicians in Europe). Analysis: Chi-square tests and logistic regression analysis with probit link function. Results: There were differences in number of publications based on country where Italy and Sweden reported a significantly higher number of first- or last authorship compared to Norway (&#935;2=30.6, P<.001). Logistic regression analysis confirmed gender differences in number of publications and first-and last authorships (P<.001) across all age categories. The rate of increase in number of publications is higher for men than for women physicians. Conclusion: These findings confirm that scientific production is still more relevant to discuss in terms of gender than generation. It is important to look at factors that are essential to career choice and faculty retention in women in particular but also among women and men in the new generation of physicians.

  • 2014. Lise Tevik Løvseth (et al.). Work 49 (1), 113-121

    Background: Concerns about protecting patient's privacy can interfere with proper stress adaptation which isassociated with physician's health. It is important to investigate relevant organizational confounders to this phenomenon to enable interventions that can ameliorate the subjective burden of patient confidentiality. Objectives: This study investigatesfactors in the psychosocial work environment that can explain patient confidentiality's prominence in social support seeking among physicians, and if these factors covary differently with support seeking according to country. Participants: University hospital physicians in four European cities (N=2095) in Sweden, Norway, Iceland and Italy participated in a cross-sectional survey. Methods: Questionnaire comprised items on psychosocial work environment, basic socio-demographics, presence of formal and informal meetings at work, and measurement of confidentiality as a barrier for support. Resultats: High role conflict, availability of formal or informal meetings, lack of control over decisions, and lack of control over work pace were predictors of confidentiality as a barrier to support. There were differences between countries in how these factors covaried with confidentiality as a barrier to support. High role conflict was the strongest predictor of confidentiality as a barrier to support across all samples. Conclusions: Psychosocial work factors predicted confidentiality as a barrier to support seeking among physicians. It is important to create routines and an organizational framework that ensures both the patient's right to privacy and physician's ability to cope with emotional demanding situations from work.

  • 2014. Ann Fridner (et al.). Journal of Health Science 2 (7), 325-329

    Abstract: Reports from European university hospitals show an increase in work-related mental strain. Four European university hospitals started a comprehensive research program called Health and Organisation among University hospitals Physicians in Europe—the HOUPE Study in the year 2003. Based on the results from the HOUPE study, the authors conducted an intervention project together with HR-consultants at one of the participating hospitals. A collected cross-sectional survey in 2005 among permanently employed academic physicians (N = 1800, response rate 60%) at Karolinska University Hospital in Sweden. Results from the study were used in survey feedback seminars (N = 250). This method is a way of systematic collection of data to process and give feedback to the organisation’s members in order to initiate organisational change. By providing results based on the total sample, on each division, and unpublished data from each clinic the authors aimed to improve physicians’ health and work satisfaction and thereby enhance the health of the physicians. Feedback seminars can arouse many emotions and might make people defensive. The role of resistance in the process of change is a paradox in that resistance slows down change. However, without resistance there will be no change at all. The authors conducted 20 feedback seminars of three hours duration where results were discussed relating mainly to the psychosocial work environment, psychological distress, and career paths, i.e., job demands, control at work, social interactions, leadership, commitment to the organisation, harassment at work, burnout, depression and suicide ideation. Altogether, 250 physicians participated in these meetings. To achieve acceptance for organisational change, data about relevant conditions in the organisation have to be processed in a systematic way in collaboration with all those who will benefit from changes, in concrete work units as divisions and clinics.

  • 2014. Marie Gustafsson Sendén (et al.). International Conference on Physician Health: Milestones and transitions  - Maintaining the balance, 64-65

    Background: In the health care sector sickness presence is common, and especially among physicians. Sickness presence is less studied than sickness absence but might have adverse effects for individual physicians, and for health care of patients (Wallace, et al, 2009). Previous research has shown that female physicians more often go to work while sick (Gustafsson et al., 2013). In this study, it is examined whether men and women also show different reasons for going to work while ill. Method and participants: The study was conducted within outpatient care in a large Swedish city (N = 283, women 64 %). The question studied were sickness presence in a long term perspective, during the last 12 months and reasons for going to work while sick (concern for colleagues; patients; workload; economy; and perceptions of own capability). Results: In a long-term perspective, women indicated that they went to work while sick more often than men, F (1,282) = 6.06, p = .014. Among the women, 37 % indicated that they often or very often go to work while ill. For men, this figure was 23.4 %. For the last 12 month, 50% of the women and 40% of the men had gone to work while sick more than two times (mean difference = ns.). Although men and women indicated similar reasons for going to work while sick, there were also interesting differences. Women indicated higher concerns for patients, and the workload as reasons for going to work while sick. On the other hand, men indicated economic concerns to a higher degree than women and that they were capable of going to work while sick.  There were no gender differences in concerns for colleagues. Conclusions: Sickness presence might have severe consequences, both for physicians themselves and for patients and medical care. Knowing the reasons for why physicians go to work is important in order to counter these behaviors. It is also important to notice that sex roles are of relevance in this type of behavior. HR departments and managers within medical care need to address these questions thoroughly and to implement strategies to decrease sickness presence among physicians.

  • 2014. Mari Eneroth (et al.). International Conference on Physician Health: Milestones and transitions  - Maintaining the balance, 2-2

    Background: General practitioners play a crucial part in healthcare as they provide the continuity of care that can prevent illness, and they most often represent the patients first contact with health-care. A current problem is however that there is a lack of general practitioners in several countries. Recruitment of general practitioners from abroad is essential to ensure the publics physician access, but there are indications that this group has even greater quitting intentions than native-born physicians. The antecedents of turnover intentions may moreover differ in importance for native-born and foreign-born physicians respectively. Methods and participants: The authors examined five fundamental physician work factors in relation to intention to quit among native-born general practitioners (n=208), and foreign-born general practitioners (n=73) working in a primary care setting in a central area in Sweden. Linear regression analysis was performed with control for age and gender. The sample consisted of 64 % females. Results: Foreign-born general practitioners more often stated that they would quit today if they could than native-born practitioners (t278= 3,73, p = .001). Regression analysis revealed that pressure from patients was related to an increased intention to quit in both groups. In addition, vacancies and pressure from financial goals were related to a higher risk of wanting to quit among native-born general practitioners. HR-Primacy was associated with a decreased risk of turnover intentions among the native-born general practitioners, while control of work pace was highly related to a decreased risk of turnover intentions among foreign-born general practitioners. Conclusions: General practitioners primarily experience pressure from patients and financial goals of the care-unit, which may provoke intentions to quit. Study suggestions are that care-unit financial goals are set in consent with physicians, and that control of work pace is encouraged.

  • 2014. S. Thun (et al.). Scandinavian Psychologist 1, e5

    Sickness present with signs of burnout: The relationship between burnout and sickness presenteeism among university hospital physicians in four European countries.

    Research has indicated that physicians often report symptoms of burnout and have a high prevalence of sickness presenteeism, yet there are few studies of the relationship between burnout and sickness presenteeism among physicians. The present survey study investigates the association between sickness presenteeism and the two dimensions of burnout, exhaustion and disengagement, when controlling for job resources. A survey was administered both on the web and in paper format among university hospital physicians in four European countries: Norway, Sweden, Iceland and Italy (N = 2078). Sickness presenteeism was positively associated with both exhaustion and disengagement, but explained more of the variance in exhaustion than in disengagement. The results of this study indicate that decreasing the high prevalence of sickness presenteeism may offer a promising avenue for future interventions aimed at reducing burnout among physicians. Although the study confirmed a relationship between burnout and sickness presenteeism, it is argued that the specific link between these two variables needs more attention.

  • 2014. Maja Wall (et al.). BMC Psychology 2, 53

    Background: Suicidal ideation is more prevalent among physicians, compared to the population in general, but little is known about the factors behind surgeons’ suicidal ideation. A surgeon’s work environment can be competitive and characterised by degrading experiences, which could contribute to burnout, depression and even thoughts of suicide. Being a surgeon has been reported to be predictor for not seeking help when psychological distressed. The aim of the present study was to investigate to what extent surgeons in Italy and Sweden are affected by suicidal ideation, and how suicidal ideation can be associated with psychosocial work conditions. Methods: A cross-sectional study of surgeons was performed in Italy (N=149) and Sweden (N=272), where having suicidal ideation was the outcome variable. Work-related factors, such as harassment, depression and social support, were also measured. Results: Suicidal ideation within the previous twelve months was affirmatively reported by 18% of the Italian surgeons, and by 12% of the Swedish surgeons in the present study. The strongest association with having recent suicidal ideation for both countries was being subjected to degrading experiences/harassment at work by a senior physician. Sickness presenteeism, exhaustion and disengagement were related to recent suicidal ideation among Italian surgeons, while role conflicts and sickness presenteeism were associated with recent suicidal ideation in the Swedish group. For both countries, regular meetings to discuss situations at work were found to be protective. Conclusions: A high percentage of surgeons at two university hospitals in Italy and Sweden reported suicidal ideation during the year before the investigation. This reflects a tough workload, including sickness presenteeism, harassment at work, exhaustion/disengagement and role conflicts. Regular meetings to discuss work situations might be protective.

  • 2014. Marie Gustafsson Sendén, Ann Fridner. Book of Proceedings, 11th European Academy of Occupational Health Psychology Conference, 296-297

    Objective: General practitioners are responsible for the basic health care of the patients and if necessary, ensure the guidance of the patients within the medical system towards specialist care fulfilling the role of the “gatekeeper” of the medical system. However the shortage of doctors resulting in unfilled vacancies in the outpatient departments of hospitals has become a problem for the quality of care and a well-functioning health care delivery Doctors who are psychologically stressed are more likely to make medical mistakes, show a lower level of empathy, are more dissatisfied with their work and think more often of quitting their jobs or going on pension. The purpose of the study is to examine the relationship between doctors´ health, the organisation in which they work and the desire to stay on or quit working as a specialist general practioner.

    Method: Cross sectional survey in 2013 among General Practioners (GPs) employed in one City Council in Sweden. The criterion variable “intention to quit” was measured on a scale with three items (&#945; = .86; QPS-Nordic; Lindström et al, 2000). Exhaustion was measured by Oldenburg Burnout Inventory, OLBI, (&#945; = .82; Demerouti et al., 2001, 2003), “support from the organization” was measured also by scales from the QPS-Nordic (&#945; = .87). Scales about “vacancies” (&#945; = .90) and “economic goals” (&#945; = .86), were created within the project. For the analyses we used hierarchical multiple regression.

    Results: Altogether 193 (63,9%) female GPs and 109 (36,1%) male GPs answered the questionnaire, 44% response-rate. The results showed that analysed factors contributed to (50.6%) of unique variance in the physicians’ intention to quit. Physician exhaustion was included in the first model and accounted for 33% of the variance. All the subsequently introduced models added significantly to the “intention to quit”, specifically: “vacancies” (9.6%) , goal (2.1%) and “support from the organization” (5.2%).

    Conclusion: The results show that there are strong associations between physician’s level of exhaustion and their intention to quit their work as physicians. The results are important since they show that the organization needs to pay attention to resource planning, how economic goals are introduced in the organizations. A positive aspect is that support from the organizations seems to be a protective factor. This is something that the organizations need to implement.

  • 2014. Lise Tevik Løvseth, Ann Fridner, Marie Gustafsson Sendén. Book of Proceedings, 11th European Academy of Occupational Health Psychology Conference, 303-304

    Background: Medical academics are trained as medical practitioners’ and scientists. Their high workload combined with concern for patients and colleagues, and responsibilities associated to family- and social life can compromise sufficient self-care, restitution and rest. Exposure to high, and often, conflicting demands can compromise physicians work satisfaction, health and wellbeing. Growing evidence points to major negative consequences of physician’s ill-health to healthcare systems by affecting recruitment  and retention of physicians, workplace productivity and efficiency, and quality of patient care and patient safety in terms of medical errors, recovery and treatment adherence. No sufficiently powered, comprehensive international study that include different levels of organizational data, have by now documented.

    Aim: A sufficiently powered international longitudinal study with different type of organizational data on determinants in the organization, work environment, management and organizational culture to investigate the prevalence, interaction, manifestation or the effect of strain among physicians in academic medicine as a basis for both scientific knowledge and organizational interventions.

    Method: Longitudinal data by 1) Document analysis of national framework and policy, 2) Hospital statistics of their work force, 3) in-depth interviews and prospective survey data from 4) N = 3 500 physicians from HOUPE phase I and 5) N = 6 500 physicians of HOUPE phase II  in all partner countries. The survey data was collected in 2005 with repeated measure of survey data in 2012.

    Participants: All physicians permanently employed at each University Hospital at the time of data collection.  Phase I: The participants were university hospital physicians in Sweden (N= 2 300), Norway (N= 800) Iceland (N= 400) and Italy (N= 900). Phase II included all four countries of phase I in addition to university hospital physicians from Hungary (N= 800), the Netherlands (N= 800) and Austria (N= 500).

    The questionnaire comprised 110 items altogether with the following measurements: 1) Physician Career Path Questionnaire (PCPQ), 2) The General Nordic Questionnaire for Psychological and Social Factors at Work (QPSNordic) , 3)Patient confidentiality and personal support (CBS) , 4) Mini Oldenburg Burnout Inventory (MOLBI) 5)General Health Questionnaire (GHQ-12) , 6) Work-Family conflict and 7) Gender and Ethnicity analyses.

    Results: Results have contributed to empirical knowledge into the processes and mechanisms that affects physicians’ career, work conditions, satisfaction and health. Information about the character of work conditions and career choices of physicians have provided basis for organizational interventions to make each university hospitals more resource efficient and innovative by professional and organizational culture, conditions of employment and work, and health services provided.

  • 2014. Maja Wall (et al.). International Conference on Physician Health: Milestones and transitions  - Maintaining the balance, 48-49

    Background: Harassment and degrading experiences are frequently reported in the nursing workplace and is believed to be more common in highly demanding contexts (Fornés et al., 2011). Perceived discrimination based on race or sex could contribute to less engagement to work and more burnout (Volpone & Avery, 2013). Studies concluded among Canadian physician students showed that significantly more foreign-born students experienced harassment or discrimination on the basis of ethnicity or culture (Crutcher et al., 2011). In Sweden, 15 percent of the population is born abroad and integration is important to promote in the working life. There is uncovered ground among active physicians who experience harassment and unequal treatment in primary health care, why additional studies are needed. Method and participants: Participants in this cross-sectional study were primary health care physicians in central Sweden. The outcome variables were perceived harassment and unequal treatment at work, among general practitioners (N = 302). In the sample there were 64% females and 26% foreign-born. Results: Among male physicians, almost 14% of the foreign-born, compared to 3% of the native-born, reported being subject to harassment or mobbing during the last 6 months (21 = 3.983, p = .04). There was no such difference between female foreign-born and female native-born physicians. Nearly 27% of the foreign-born thought the basis for unequal treatment to be ethnicity compared to barely 9 % of the physicians born in Sweden, which is significantly less (21 = 10.008, p = .002). Among foreign-born, significantly more female than male physicians reported gender as reason for unequal treatment (21= 6.944, p < .01). There were no differences found among Swedish female and male physicians. Conclusions: There is evidence that foreign-born physicians working in primary health care in Sweden experience harassment and unequal treatment. Harassment and unequal treatment could affect physician health, and attention must be paid. The gender differences could also be a sign of gender inequality, which need to be examined more thoroughly.

Visa alla publikationer av Ann Fridner vid Stockholms universitet

Senast uppdaterad: 23 maj 2017

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