Estresse ocupacional e estratégias de enfrentamento entre médicos da atenção primária à saúde

Abstract

The process of team recomposition and the reorganization of the working process proposed by the new National Primary Health Care Policy make this even more difficult to achieve the required qualification of Primary Health Care workers; the implementation of more democratic and participatory working processes and the regularization of contractual bonds. This scenario can affect the workers' satisfaction with the environment and the working process, resulting in psychological suffering and fostering professional turnover, especially, among physicians. Objective: To evaluate occupational stress levels and coping strategies among physician in Primary Health Care Units. Method: Quantitative, descriptive, cross-sectional study, carried out in 2017, with a non-probabilistic, convenience sample, which comprised 32 physicians from Primary Health Care Units in São José do Rio Preto city, São Paulo state. For data collection, an instrument developed by the researchers was used with sociodemographic and professional variables; Workplace Stress Scale (WSS) and the Problem Coping Scale (PCS). Sociodemographic and professional variables were used to characterize study population. The scale data were analyzed according to calculation of scores for analysis of instruments and underwent appropriate statistical treatment, considering a significance level of 95%. Results: Thirty-two physicians participated, aged between 27 and 75 years (average of 45.2 years). There was predominance of females (59.4%), married (62.5%), with graduate specialization (46.9%), permanently assigned (53.1%), working 40 hours a week (59.4%), monthly family income above 10 minimum wages (68.8%). Working time of professionals in PHC ranged from six months to 30 years, with a median of seven years. The average score for occupational stress was 2.1 and eight professionals (25.0%) had scores compatible with important stress (> 2.5). The greatest stressors pointed out by physician were: lack of prospects for career growth (2.9; SD = 1.3); distribution of tasks (2.7; SD = 1.0); deficiency in professional training (2.7; SD = 1.2); no time enough to carry out the work (2.6; SD = 1.2); control type (2.5; SD = 1.0); lack of autonomy in carrying out work (2.5; SD = 1.2). The mode of coping with highest score was that focused on the problem (3.75), followed by search for social supporting (3.17). There was a significant difference in the mean scores for “problem-focused” coping strategies (p <0.001) and the search for social supporting (p = 0.013), with a higher score in these strategies among non-stressed professionals. Conclusion: The conditions and pressures of the working environment in PHC are propitious to the development of stress by physicians. Emotional imbalance guides the professionals' coping strategies in the work environment, reinforcing the need to create a welcoming work environment, with cohesive, integrated and well-managed teams that feel comfortable sharing emotions and are engaged in promoting social supporting. The results of this study have impacted the management of the municipal health system, especially, in relation to the health of PHC physicians and can indirectly contribute to the