Occupational Medicine 2011;61:163–170
Advance Access publication on 7 March 2011 doi:10.1093/occmed/kqr004
Working hours, occupational stress and depression
among physicians
K. Tomioka, N. Morita, K. Saeki, N. Okamoto and N. Kurumatani
Department of Community Health and Epidemiology, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara
634-8521, Japan.
Correspondence to: K. Tomioka, Department of Community Health and Epidemiology, Nara Medical University School of
Medicine, 840 Shijo-cho, Kashihara-city, Nara 634-8521, Japan. Tel: 181 744 29 8841; fax: 181 744 29 0673;
e-mail: [email protected]
...................................................................................................................................................................................
Background Physicians report high prevalence of depression, work long hours and are exposed to many occupational stresses (OSs).
...................................................................................................................................................................................
Aims
To investigate the cross-sectional association between working hours, OS and depression among
physicians.
...................................................................................................................................................................................
Methods
A self-administered questionnaire was mailed to 1902 alumni of a medical school. The questionnaire
evaluated working hours in the previous week, OS assessed by the effort–reward imbalance model,
social support and depression evaluated by the Center for Epidemiologic Studies Depression scale.
The associations between these occupational factors and depression were analyzed using multiple
logistic regression.
...................................................................................................................................................................................
Results
The questionnaire was returned by 795 alumni (response rate, 42%), and 706 respondents (534 men
and 172 women) were suitable for analysis. The odds ratio (OR) of depression in the long working
hours group (>70 h/week) was 1.8 (95% CI: 1.1–2.8) compared with the short working hours group
(<54 h/week), adjusted for basic attributes. The adjusted ORs of depression in the upper effort–reward
ratio (ERR) tertile versus the lower ERR tertile were 0.6 (0.2–1.8) in the short working hours group,
8.5 (3.0–24.0) in the middle working hours group and 9.9 (3.8–25.7) in the long working hours group.
The adjusted ORs of depression stratified according to working hours and ERR tended to be higher in
the groups with a higher ERR, but no association between working hours and depression was found.
...................................................................................................................................................................................
Conclusions This study indicates that the management of OS is needed as a countermeasure against depression
among physicians.
...................................................................................................................................................................................
Key words
Depression; effort–reward imbalance model; occupational stress; physicians; working hours.
...................................................................................................................................................................................
Introduction
Depression among physicians is recognized as an important problem in occupational health because of its high
prevalence [1–3] and the potential risks it imposes on
medical practice [1,2,4].
Physicians’ work is characterized by long working
hours [4,5]. Some studies have reported that lengthy
working hours can be associated with depression in particular occupational settings [6,7], while others have disputed the existence of such an association [8,9]. In past
studies, mean working hours were often limited to 35–
50 h/week. Therefore, it is worthwhile examining whether
longer working hours, such as the average 50–70 h/week
that most physicians work [2,10–12], might be associated
with a higher prevalence of depression.
Physicians are exposed to many stressors, such as the
burden imposed by expectations of a high degree of professionalism, responsibility for patient well-being and
maintenance of relationships with patients and health
workers, as well as concerns about medical errors and
malpractice litigation [4,12]. It has been reported that
such occupational stresses (OSs) are associated with depression among physicians [10,13–16]. However, the
participants in previous studies have been limited to specific populations of physicians such as residents, those
with fewer years of experience [10,15], physicians in particular medical specialties [13] and general practitioners
[14,16]. Therefore, whether the results of these studies
can be extrapolated to a broader population of physicians
remains unclear. To date, several models for evaluating
The Author 2011. Published by Oxford University Press on behalf of the Society of Occupational Medicine.
All rights reserved. For Permissions, please email: [email protected]
164 OCCUPATIONAL MEDICINE
OS have been established. The effort–reward imbalance
(ERI) model [17] is characterized by the evaluation of reward and assessment of the intrinsic or personal characteristics of coping with various job demands and eliciting
rewards, a feature not found in other models [18,19].
Furthermore, the ERI model is considered more suitable
for assessing stress among professionals, particularly
those dealing with individual-based interactions [20].
The ERI model has been demonstrated to have greater
explanatory power than the demand-control model
for evaluating OS among physicians [11]. Thus, the
ERI model appears to be appropriate for evaluating OS
among physicians, but only a few studies to date have
examined depression among physicians using this model
[10,15].
Social support (SP) is known to act as a buffer factor in
stress reactions to occupational stressors [19], and a similar relationship has been proposed with regard to depression [15,21]. However, it has not been determined
whether SP also acts as a buffer factor in depression
for physicians who work longer hours.
In this study, we conducted a cross-sectional study of
the alumni of a medical school to evaluate the associations
between working hours, OS and depression among physicians.
Methods
The participants in our study were selected from among
the 1902 alumni of Nara Medical University, who had
graduated within 20 years before the study’s start date.
The 20-year limit was used because Japanese physicians
frequently change their workplace from a hospital setting
to their own private office at around the 20th year after
graduation. Alumni who had died or were studying
abroad were excluded from the study. Questionnaires
were sent to all the participants and returned by mail.
The study protocol was approved by the Ethics Committee of Nara Medical University.
The anonymous self-administered questionnaire consisted of demographic information, years of clinical experience, specialties and place of work and variables such as
working hours, depression, OS and SP, as described below. Participants were asked to record the time of their
arrival and the time of their departure from the office
for each day during the previous week; the sum of hours
spent at their office was then defined as the working hours
in the previous week.
To assess depression, we used the Center for Epidemiologic Studies Depression (CES-D) scale [22]. This scale
has been widely used to measure symptoms of depression
in the general population; in the present study, the scale
was used to screen for current depressive states during the
1-week period prior to taking the survey. The CES-D
yields an item score (range, 0–3) and a sum total for
the 20-item scores (range, 0–60) (Cronbach’s a 5
0.79) [23]. The depression level is considered to advance
in parallel with increasing scores. A score of 16 or higher
is widely used as a threshold for defining depression
[22].
To evaluate OS, we used the ERI questionnaire [17].
The questionnaire is composed of 23 items for effort (6
items), reward (11 items) and overcommitment (OC) (6
items). The items of the ‘effort’ scale measure the intensity of distress produced by time pressure, high levels of
responsibility, overtime and increasing demands, while
the items of the ‘reward’ scale consist of three factors such
as money, self-esteem and career opportunities including
job security. OC focuses on the personal component of
the model and reflects a specific individual pattern of coping with various job demands and eliciting rewards. The
OC scale consists of one-dimension and measures the respondent’s inability to withdraw from work obligations
and to develop a more distant attitude toward job requirements. The ERI model assumes that the imbalance between high effort and low reward at work increases
illness susceptibility as a result of continued strain reactions, and OC modifies the effect on health produced
by ERI at work. Cronbach’s alpha of effort, reward and
OC were 0.87, 0.91 and 0.66, respectively [24]. We calculated the effort–reward ratio (ERR) by dividing the effort score by the reward score, where the latter score was
multiplied by a correction factor of 6/11. The ERR is
a measure of the discord between these two components:
an ERR . 1.0 indicates that the effort devoted does not
correspond with the reward received. Regarding OC, the
six 4-point Likert scaled items are computed to a total
score varying from 6 to 24. The higher the score, the more
likely a subject is to experience OC at work. In this study,
each distribution of the ERRs and the OC score among
the study participants was divided into tertiles for logistic
regression analysis.
The SP score from family/friends, one of the subscales
of the National Institute for Occupational Safety and
Health Generic Job Stress Questionnaire, was implemented to evaluate the degree of SP [19]. A higher total
score indicates greater SP. The SP score was classified into low, medium and high according to the tertiles.
Differences in the mean values between men and
women were analysed by t-test, and Fisher’s exact test
was used to test the differences in the distribution between men and women. Associations between working
hours, OS and depression were evaluated using a multiple
logistic regression analysis. The CES-D score was categorized into two groups using a threshold of 16 points and
was used as a dependent variable. To evaluate the factors
associated with depression, we stratified the participants
into three working hours groups and three ERR groups
according to tertile. For analysis of the interaction between the ERR, OC and depression, the participants were
classified into four groups based on their ERR and OC
K. TOMIOKA ET AL.: WORKING HOURS, OS AND DEPRESSION AMONG PHYSICIANS 165
score. SPSS 12.0 J software for Windows was used to perform the statistical analyses, and the null hypothesis was
rejected when P , 0.05.
Results
Replies were obtained from 795 physicians after two
reminders (response rate, 42%). A total of 706
individuals (534 men and 172 women) were eligible for
further analysis after excluding responders who were
on pregnancy leave (n 5 18), were working as
researchers or administrators (n 5 55) or did not provide
complete information regarding the basic attributes (n 5
16).
Table 1 shows the demographic data for all participants. In the previous week, the mean working hours
for all the participants was 62.8 6 19.8 h, and 16% of
them had spent .80 h at their office. The prevalence
of physicians with a CES-D score $ 16 and an ERR .
1 were 28 and 14%, respectively. The men were significantly older, had lower SP, worked longer hours and
had a higher ERR than the women. No differences in
the prevalence of hospital doctors or of participants
who had worked for .80 h were noted between men
and women. There was also no difference in the mean
OC score between men and women.
Table 2 shows the prevalence and the crude and adjusted odds ratios (ORs) for depression. The data were
adjusted for gender, years of clinical experience, specialty
and place of work. Regarding the basic attributes, only
psychiatrists showed a significantly lower adjusted OR
(0.3; 95% CI: 0.1–0.8), compared with internal medicine
specialists. None of the remaining basic attributes showed
a significant adjusted OR. The adjusted OR for participants who worked .70 h was 1.8 (95% CI: 1.1–2.8) compared with those who worked 54 or fewer hours. The
adjusted OR for depression in the upper ERR tertile
was 8.7 (5.3–14.3), while for those in the upper OC tertile
and in the low SP group; the adjusted ORs were 8.9 (5.5–
14.5) and 3.3 (2.1–5.2), respectively.
Table 3 shows the results of the study in which the adjusted OR of depression for OS and SP was calculated for
participants grouped into tertiles according to the number of working hours. In the short working hours group
(,54 h/week), no association between ERR and depression was noted. Regarding the middle working hours
group (54–70 h/week), the adjusted ORs of depression
in the upper ERR tertile and the low SP group were
Table 1. Basic attributes, working hours, depression, OS and SP among study participants according to gender
Basic attributes
Age in years, mean (SD)
Years of clinical experience, mean (SD)
Specialty
Internal medicine (%)
Surgery (%)
Psychiatry (%)
Paediatrics/obstetrics/gynaecology (%)
Ophthalmology/dermatology (%)
Radiology/anaesthesia/others (%)
Place of work: hospital (%)
Working hours in the previous week (h/week)
Mean (SD)
.80 (%)
Depression
CES-D score, mean (SD)
CES-D score $ 16 (%)
OS
Effort, mean (SD)
Reward, mean (SD)
ERRa, mean (SD)
ERR . 1 (%)
OC score, mean (SD)
SP
SP score, mean (SD)
Total (n 5 706)
Men (n 5 534)
Women (n 5 172)
37.4 (6.7)
11.0 (5.7)
38.0 (6.7)
11.5 (5.8)
35.6 (6.7)
9.2 (5.3)
29
32
7
11
9
12
86
27
40
7
8
7
12
85
37
9
6
19
14
15
90
62.8 (19.8)
16
65.1 (17.6)
16
55.5 (24.2)
17
***
NS
12.2 (8.3)
28
12.0 (8.1)
26
12.9 (8.9)
34
NS
NS
15.5 (5.5)
45.7 (8.1)
0.67 (0.36)
14
14.5 (3.6)
15.9 (5.3)
45.5 (7.7)
0.68 (0.37)
15
14.5 (3.7)
14.5 (5.8)
47.2 (6.7)
0.59 (0.31)
10
14.3 (3.4)
**
*
**
NS
NS
12.4 (3.1)
12.2 (3.2)
12.9 (2.8)
**
P
***
***
g
***
NS
Numerical values express mean 6 SD; t-test was used to evaluate differences between the mean values for men and women. The percentages express prevalence. Fisher’s
exact test was used to test the differences in the distribution between men and women.
a
ERR 5 E score/R score*(6/11).
*P , 0.05; **P , 0.01; ***P , 0.001.
166 OCCUPATIONAL MEDICINE
Table 2. Prevalence and crude and adjusted ORs of depression (CES-D score $ 16) according to basic attributes, working hours, OS and SP,
as determined using a logistic regression analysis
Independent variable
Basic attributes
Gender
Male
Female
Years of clinical experience (years)
$15
8–14
1–7
Specialty
Internal medicine
Surgery
Psychiatry
Paediatrics/obstetrics/gynaecology
Ophthalmology/dermatology
Radiology/anaesthesia/others
Place of work
Clinic
Hospital
Working hours in the previous week (h/week)
,54
54–70
.70
OS
ERR
Lower tertile
Middle tertile
Upper tertile
OC
Lower tertile
Middle tertile
Upper tertile
SP
High
Middle
Low
CES-D $ 16 (%)
Crude OR (95% CI)
Adjusted ORa (95% CI)
534
172
26
34
1.0
1.4 (0.98–2.1)
1.0
1.2 (0.8–1.8)
223
269
214
24
26
35
1.0
1.1 (0.7–1.7)
1.7 (1.1–2.6)
1.0
1.0
1.5 (0.98–2.4)
205
228
47
77
61
88
29
25
13
34
31
34
1.0
0.8
0.4
1.2
1.1
1.2
1.0
0.9
0.3
1.3
1.2
1.2
98
608
20
29
1.0
1.6 (0.97–2.7)
1.0
1.5 (0.8–2.0)
235
235
236
23
26
36
1.0
1.2 (0.8–1.8)
1.9 (1.2–2.8)
1.0
1.3 (0.8–2.0)
1.8 (1.1–2.8)
236
235
232
13
20
52
1.0
1.7 (1.0–2.8)
7.6 (4.8–12.0)
1.0
1.8 (1.0–3.0)
8.7 (5.3–14.3)
266
235
203
11
27
51
1.0
3.0 (1.8–4.8)
8.2 (5.1–13.1)
1.0
3.0 (1.8–4.8)
8.9 (5.5–14.5)
191
274
231
18
26
39
1.0
1.6 (1.0–2.6)
3.0 (1.9–4.7)
1.0
1.7 (1.1–2.7)
3.3 (2.1–5.2)
n
(0.5–1.3)
(0.7–0.9)
(0.7–2.2)
(0.6–2.0)
(0.7–2.1)
(0.6–1.4)
(0.1–0.8)
(0.7–2.2)
(0.6–2.4)
(0.7–2.1)
Values in bold are statistically significant.
a
Adjusted for gender, years of clinical experience, specialty and place of work.
8.5 (3.0–24.0) and 3.7 (1.5–9.6), respectively. For the
long working hours group (.70 h/week), the adjusted
ORs of depression in the upper ERR and the middle
ERR tertiles were 9.9 (3.8–25.7) and 2.8 (1.1–6.8), respectively. In contrast, no association between SP and depression was noted. OC was significantly associated with
depression in all three of the working hours groups.
Figure 1 displays the adjusted ORs of depression stratified according to working hours and ERR. The data were
adjusted for gender, years of clinical experience, place of
work, specialty, OC and SP. Within each working hours
group, the same increasing trend in the prevalence of depression with increasing ERR was apparent. In contrast,
within each ERR category, no discernible trends according to increasing working hours were evident.
Table 4 shows the interaction between ERR and OC
and the prevalence of depression. When compared to
the prevalence of depression in participants with neither
a high ERR nor a high OC, the adjusted ORs of depression in participants with a high ERR only or a high OC
only showed statistically significant increases in adjusted
ORs; i.e. 4.3 (95% CI: 2.6–7.3) and 2.7 (1.4–5.2), respectively. However, the adjusted OR in participants with
both a high ERR and a high OC was 12.2 (7.4–20.2), indicating that the interactive effect between ERR and OC
on depression was multiplicative, rather than additive.
Discussion
In this study, the OR of depression after adjustment for
basic attributes in the long working hours tertile relative
to the short working hours tertile was 1.8 (95% CI: 1.1–
2.8), and the prevalence of depression was significantly
K. TOMIOKA ET AL.: WORKING HOURS, OS AND DEPRESSION AMONG PHYSICIANS 167
Table 3. Adjusted OR of depression (CES-D score $ 16) for OS and SP depending on working hours groups, as determined using a multiple
logistic regression model
Independent variable
Short working hours
group, ,54 h/week
(n 5 235)
Middle working hours
group, 54–70 h/week
(n 5 235)
Long working hours
group, .70 h/week
(n 5 236)
Adjusted ORa (95% CI)
ERR
Middle/lower tertile
Upper/lower tertile
OC
Middle/lower tertile
Upper/lower tertile
SP
Middle/high
Low/high
0.7 (0.3–2.0)
0.6 (0.2–1.8)
1.6 (0.5–4.9)
8.5 (3.0–24.0)
2.8 (1.1–6.8)
9.9 (3.8–25.7)
2.4 (0.9–6.9)
10.4 (3.3–32.5)
2.0 (0.7–5.8)
4.3 (1.6–11.8)
2.9 (1.3–6.5)
2.6 (1.1–6.3)
3.5 (1.2–10.0)
6.0 (2.1–17.5)
1.2 (0.5–3.2)
3.7 (1.5–9.6)
1.2 (0.5–2.6)
1.8 (0.9–3.7)
Values in bold are statistically significant.
a
Adjusted for gender, years of clinical experience, ERR, OC and SP.
Figure 1. Adjusted ORs of depression (CES-D score $16) stratified
according to working hours and ERR (effort–reward ratio), as determined using a multiple logistic regression model. OR is adjusted for gender, years of clinical experience, place of work, specialty, OC and social
support. Values in bold italics are statistically significant.
associated with the number of hours physicians worked in
the previous week. However, the analysis in which the
participants were stratified according to working hours
and OS (ERR) to investigate the association with depression showed that the adjusted ORs of depression tended
to be higher in the groups with a higher ERR, whereas no
association was found between working hours and depression. To our knowledge, few studies have assessed
the association between working hours and depression,
particularly among physicians. In a previous study of
physicians working in an emergency department [13],
the Spearman correlation coefficient between working
hours and depression scores was nonsignificant; however,
the participants averaged eight fewer hours of work per
week than the physicians in our study. Another longitudinal study [2], where the mean weekly working hours
of residents were reduced from 75 to 67 h over the course
of a single year, reported no significant difference in the
prevalence of depression between the beginning and the
end of the study period. The present study and previous
studies indicate that the total number of working hours is
not a decisive factor influencing depression among physicians. Therefore, restricting the working hours of physicians is unlikely to be an effective countermeasure against
depression, though it might promote patient safety [1],
improve the well-being of physicians [25] and reduce
their fatigue [26] or psychosomatic symptoms [27].
Concerning the association between OS based on the
ERI model and depression, a longitudinal study of young
physicians [10] reported that depression scale scores at
the end of a 2-year follow-up period were significantly
higher among residents whose ERR had been consistently
high or had increased over the period, compared with
those of residents whose ERR had been consistently
low or had decreased. Additionally, a cross-sectional
study [15] showed that an ERR .1 was a significant explanatory factor for depression among residents, after
considering SP and frequency of overnight shifts. We
found that the adjusted ORs of depression in the upper
ERR tertile versus the lower ERR tertile were 0.6
(95% CI: 0.2–1.8) in the short working hours group
but 8.5 (3.0–24.0) in the middle working hours group
and 9.9 (3.8–25.7) in the long working hours group.
These findings are consistent with those of previous
studies in which an association between ERI and depression was noted. However, in our study, in which
the participants were stratified according to working
hours and OS to investigate the associations with depression, a dose–response relationship between OS and
depression was found in all the working hours groups.
In contrast, no association was observed between working hours and depression, and OS assessed using the
168 OCCUPATIONAL MEDICINE
Table 4. Interaction effect between ERR and OC on depression
Neither high ERR nor high OC
High ERR only
High OC only
Both high ERR and high OC
n
CES-D $ 16 (%)
Crude OR (95% CI)
Adjusted ORa (95% CI)
394
108
67
137
13
38
27
63
1.0
3.9 (2.4–6.4)
2.4 (1.3–4.4)
10.8 (6.9–17.0)
1.0
4.3 (2.6–7.3)
2.7 (1.4–5.2)
12.2 (7.4–20.2)
High ERR indicates the upper tertile of effort–reward ratio. High OC indicates the upper tertile of overcommitment score. Dependent variable: CES-D score $16 or not.
Values in bold are statistically significant.
a
Adjusted for gender, years of clinical experience, place of work, specialty, working hours and SP.
ERI model had a greater influence on depression than
did the number of working hours. Furthermore, the association between ERI and depression was not limited
to young physicians but was observed for a broader
population of physicians.
In this study, OC was significantly associated with depression regardless of the number of working hours. A
longitudinal study [10] showed a significant association
between OC and depression, but a cross-sectional study
[15] did not. Another longitudinal study [14] demonstrated that medical students who were more self-critical
at graduation were more likely to develop depression 10
years later and suggested that individual characteristics,
such as personality traits, may be a risk factor for developing depression. The OC is an index for evaluating the
attitude and behavioral patterns of individuals who show
high levels of commitment to their jobs [17,24]. Individuals with an elevated OC have a strong desire to be appreciated for their work and are more likely to
continue thinking about their job after leaving the workplace. This scenario creates a dichotomy in effort that
cannot be compensated by actual reward. While OC is
not a personality trait, the present study suggests that
the attitude and behavioral patterns of physicians, who
show high levels of commitment to their jobs, may be associated with depression, independently of the number of
working hours.
An interaction between ERI and OC was confirmed in
our study: the effect of this interaction on depression was
multiplicative rather than additive. A large-scale crosssectional study [28] reported that the risk of ERI was increased for highly overcommitted employees, whereas
a longitudinal study in young physicians [10] found no
effect of the interaction between ERI and OC on depression. Though the interaction between ERI and OC observed in the present study is not consistent with the
results of previous studies, it should again be emphasized
that ERI interacts multiplicatively, not additively, with
OC in relation to the prevalence of depression.
SP is a buffer factor in stress reactions to occupational
stressors [19], and an association between low SP and depression has also been reported in previous studies
[15,21]. In the present study, SP from family/friends
had a buffering effect on depression in the shorter working hours groups, but the influence of SP became weaker
in the longer working hours groups, and an association
between SP and depression was not observed in the long
working hours group. This result suggests that a buffering
effect of SP from family/friends on depression cannot be
expected in workers with long working hours. SP from
supervisors and colleagues in the workplace, which was
not investigated in the present study, might also act as
a buffer factor in stress reactions to occupational stressors
[19,29]. Further investigation is needed to determine
whether such support plays a role in mitigating stress
among physicians.
The present study had some limitations. First, since
this is a cross-sectional study, we cannot confirm causal
relationships. Individuals demonstrating psychiatric
symptoms have shown a tendency to complain negatively
about their work environments [30]. Thus, physicians
with depression were likely to express ERI, and the association between depression and ERI could have been
overestimated. Second, the response rate to the questionnaire was unexpectedly low (42%) even after two reminders. No differences in the gender ratio or the
mean number of years since graduation were observed between the responders and non-responders (data not
shown). However, we do not have any information regarding depression and working hours among the nonresponders. The non-responders might have suffered
from depression or worked longer hours, which could
have hindered the ability to participate in this study.
Third, because psychiatrists are familiar with depression
instruments, they could avoid answers corresponding to
depression, which might lead to underestimation of the
prevalence of depression among psychiatrists.
Despite these limitations, the results of the present
study, which indicated that OS was more strongly associated with depression than the number of working hours,
suggested that occupational stressors peculiar to physicians [4,12], cannot be simply measured using the number of working hours alone, while the psychological
burden of physicians can be evaluated by considering
the density of working hours and the work contents.
The management of OS causing an ERI, rather than
K. TOMIOKA ET AL.: WORKING HOURS, OS AND DEPRESSION AMONG PHYSICIANS 169
limiting the working hours (which is an effective patient
safety measure) [1], might be an important countermeasure against depression among physicians.
11.
12.
Key points
• Occupational stress induced by effort–reward imbalance independently related to depression among
physicians.
• Occupational stress due to effort–reward imbalance
was a greater explanatory factor than the number of
working hours for depression among physicians.
• This study indicates that the management of occupational stress is needed as a countermeasure
against depression among physicians
13.
14.
15.
16.
Acknowledgements
17.
We wish to express our gratitude to all of the members of the
alumni association of Nara Medical University School of Medicine for their cooperation in this study.
18.
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SOM ASM 2011 - Psyche, Science & Medicine
June 13th - 16th 2011 - Belfast Waterfront
The SOM Northern Ireland group, in partnership with the Irish Faculty of Occupaonal
Medicine are hosng the 2011 Annual Scienfic Meeng of the Society of Occupaonal
Medicine at the Waterfront in Belfast.
Speakers include:
Dr Kazutaka Kogi (President of ICOH)
Professor Tar-Ching Aw (United Arab Emirates University)
Professor Harri Vainio (Director General FIOH, Helsinki)
Professor Ian Hindmarch (University of Surrey)
Professor Sir Mansel Aylward (University of Cardiff)
Professor Sir Anthony Newman Taylor (Imperial College)
Professor John Ayres (University of Birmingham)
Surgeon Commander Neil Greenberg (King‘s College London)
Key Topics are:
Internaonal Occupaonal Medicine
Academic Occupaonal Medicine
The Science of Occupaonal Medicine
The Psyche in Occupaonal Medicine
More informaon is available here:
hp://www.som-asm.org.uk/index.asp