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Background: Medical practice is among the most demanding professions. Physicians are responsible for their patients and face various challenges within the healthcare system. Burnout and mental health issues are disproportionately prevalent among physicians, especially in emergency medicine. While there has been considerable focus on resilience, there is still a lack of research on the specific factors that burden and relieve physicians in daily work and how they cope with these challenges [1].

Question: What factors have a burdening or relieving effect on the (working) life of physicians? How do physicians cope with daily burdens? Are there specific patterns of coping strategies?

Methods: Semi-standardized interviews (approx. 65’ each) were conducted with 16 physicians at TUM University Hospital (13 anesthesiologists, 2 gynecologists and 1 cardiologist), balanced by gender. Data were analyzed using qualitative content analysis [2] followed by an ideal type analysis [3].

Results: We found that factors can act as both burdening and relieving (e.g., family, colleagues). We identified three ideal-typical physician constellations that perceive and cope with stress differently:

• Persevering Careerists prioritize career advancement, often at the expense of self-care. They view institutional hierarchy as supportive. Their key burdening factor is self-criticism in case of mistakes and difficulty accepting their personal limitations. They cope by keeping an emotional distance from their patients to maintain efficiency.
• Strategically-Adaptables balance ambition with pragmatism. They are system-adapted yet open to career transitions. They enjoy their work despite dissatisfaction with institutional structures and remain flexible if circumstances do not develop as desired – provided the collegial environment is right, as collegial relationships represent this type's key relief factor.
• The Critical-Reflective Balance Seekers identify strongly with medicine but actively question institutional structures. Key burdens include lack of appreciation, rigid hierarchies, absent role models, and limited peer support. They seek self-determined working conditions aligned with family, leisure, and mental health, viewing university positions as temporary.

Discussion: This result challenges the rigid concept of work-life-balance, where work is seen as burdening and life as relieving. Physicians' experience of causing and relieving stress vary not only by external factors but also by individual values, biography, priorities, and institutional contexts. Medical education should promote self-reflection to help students understand their individual stress management needs.

Take-home message: Many factors in physicians’ everyday life have a dual nature. Stress experiences are an interplay of individual values, priorities, biographies and external conditions. Self-reflexive approaches and support systems are essential for personalized stress management in medical education.

Literatur

[1] Harvey SB, Epstein RM, Glozier N, Petrie K, Strudwick J, Gayed A, Dean K, Henderson M. Mental illness and suicide among physicians. Lancet. 2021;398(10303):920-930. DOI: 10.1016/S0140-6736(21)01596-8
[2] Brüsemeister T. Qualitative Forschung: Ein Überblick. Wiesbaden: VS Verlag für Sozialwissenschaften; 2008. p.53-228. DOI: 10.1007/978-3-531-91182-3
[3] Stapley E, O’Keeffe S, Midgley N. Essentials of ideal-type analysis: A qualitative approach to constructing typologies. Washington, D.C.: American Psychological Association; 2021. DOI: 10.1037/0000235-000