Effort–reward imbalance and self-rated health among physicians: evidence from hospital and outpatient settings in Upper Austria

Background Physicians are exposed to substantial psychosocial work stress, which may adversely affect their health and wellbeing. The effort–reward imbalance (ERI) model provides a theoretical framework for understanding how disproportionate work effort combined with insufficient reward can impair health. However, evidence among physicians, particularly across different medical practice settings, remains limited. This study examined the association between effort–reward imbalance, overcommitment, and self-rated health among physicians working in clinic and private practice settings in Upper Austria. Methods A cross-sectional survey was conducted between September and December 2023 among licensed physicians practicing in Upper Austria. Work-related stress was assessed using the validated German version of the Effort–Reward Imbalance questionnaire. Self-rated health was measured using a single-item 5-point Likert scale. Hierarchical multiple linear regression analyses were performed to examine associations between ERI indicators (ERI ratio and overcommitment) and self-rated health, adjusting sequentially for sociodemographic variables, work-related characteristics, lifestyle factors, and physical and mental health indicators. Results A total of 701 physicians (mean age 45.9 ± 10.9 years; 56.2% women and 43.8% men) were included in the analyses. The mean ERI ratio was 1.19 (SD = 0.36), indicating an overall imbalance between effort and reward. Higher ERI ratios and higher overcommitment scores showed consistent associations with poorer self-rated health across the sequential regression models. In the final model, the estimated associations remained evident for both the ERI ratio (B = 0.29, p = 0.012) and overcommitment (B = 0.03, p = 0.001), although the estimates were smaller than in the less extensively adjusted models. Age also showed a tendency toward an association with self-rated health. Physical and mental health problems in the previous 12 months, higher body mass index, and poorer sleep quality were also associated with poorer self-rated health. Weekly working hours and night or weekend shifts did not show a clear pattern of association with the outcome. Conclusions Effort–reward imbalance and overcommitment showed consistent associations with poorer self-rated health among physicians across sequential regression models. These findings suggest that psychosocial work stress may be an important correlate of physician health alongside workload and clinical health indicators. Organizational and system-level approaches addressing working conditions, recognition, and physician wellbeing warrant further investigation.