Health, stress and impairment of physicians have attracted increased attention in health care systems during the past years. Burnout rates in physicians in European and Anglo-American countries are estimated to be between 20 and 45% [1
]. In a survey among U.S. internal medicine residents, the prevalence was as high as 76% [3
]. Physicians as compared to the general population or other academic professions are also at elevated risk for other psychosocial health problems such as alcohol and substance abuse, marital disturbances or suicide [4
]. There is increasing evidence that the development of psychosocial symptoms and impairment result from a complex interplay of several factors. Early longitudinal studies showed that personality traits in medical students evaluated before starting their course of study were important predictors for later impairment and burnout [7
]. A highly demanding educational process and professional life frequently fostered by a competitive environment and a hierarchic culture of medicine are regarded additional relevant factors [4
]. However, people respond differently to such challenges and strains. In a recent longitudinal study, Buddeberg-Fischer et al. [12
] reported that while almost three quarters of evaluated Swiss physicians during residency showed no or decreasing stress levels, about 25% reported increasing or persistently high levels of stress as the extrinsic and 17% overcommitment as the intrinsic part of the effort-reward imbalance model. Individual perceptions of strain and coping styles are therefore important parameters for predicting whether health can be maintained or impairment will occur [13
]. Research in health psychology revealed various attitudes, traits and behaviour patterns which either aggravate stress or have protecting effects as coping resources, e. g., perfectionism, compulsiveness, social support, optimism, hardiness, self-efficacy, and sense of coherence [17
Tyssen et al. point out, that types
of personality are more reliable in identifying those at risk than are dimensions
of personality alone [20
]. It has also been reported that male and female students and physicians differ in their experience and response to stress and psychosocial symptoms [21
Germany has no longstanding tradition in addressing physicians' health and impairments. Resch and Hagge [24
], two German psychologists, note that care for physicians' health in Germany is still at the level of the USA in the '60's. The aim of this study was therefore to investigate work-related experiences and behaviour patterns in medical students and physicians in Germany at different points in their medical education and professional life. Based on previous work by Schaarschmidt & Fischer, we aimed to identify risk factors or health resources for subsequent psychosocial impairments. We used the personality typology described by these authors derived from the cluster analysis of eleven health relevant dimensions from the domains of professional ambition, resistance to stress and emotional well-being, which comprises four health relevant patterns (the healthy pattern G, the unambitious pattern S, the overcommitted risk pattern A und the resigned risk pattern B) [25
Our hypotheses were:
(1) A majority in first year students presents a healthy pattern.
(2) Physicians are less likely to present healthy patterns and more likely to present risk patterns and less favourable scores in the health relevant dimensions compared to first and fifth year students.
(3) Differences between male and female students and physicians were expected, in particular in the domains of professional ambition, resistance to stress and social support.