Meta-analysis of effort-reward imbalance prevalence among physicians

Objective Estimate the effort-reward imbalance prevalence (ERI) among physicians. Methods A systematic review was conducted from 2005 to 2019 using PRISMA guidelines on the PubMed and EBSCOhost search engines. Data were classified according to the ERI definition used by the authors. A meta-analysis was performed on effort and reward scores and on ERI prevalence rates. Results Out of 3787 results, we selected 41 studies. The physicians' ERI prevalence rate ranged from 3.50 to 96.9%. The standardized pooled effort mean score was 58.5 for effort and 48.9 for a reward out of 100, respectively. The overall combined ERI rate (when the ratio between effort and reward scores was above 1) was 40.2% among 21,939 practitioners (31.7% in the working European population). ERI rate was 70.2% using a four-point Likert scale and 21.1% using a five-point Likert scale. The highest rate (96.9%) was observed among German rural general practitioners and the lowest rate (3.50%) among Swiss hospital practitioners. The low percentage of variability (I-2 = 27%) attributed to effort scores heterogeneity between studies suggested that this dimension is not discriminant in the physician ERI assessment. The high heterogeneity in reward scores (I-2 = 83%) indicated that this dimension is sensible in ERI assessment among physicians. The number of items used did not appear as a significant source of heterogeneity. Conclusion Physician job ERI appeared to be higher than in the working population. Studying each dimension and item indicators could help improve psychosocial risk prevention.