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The effect of work-family conflict on employee well-being among physicians: the mediating role of job satisfaction and work engagement

BMC Psychology volume 12, Article number: 530 (2024) Cite this article

Abstract

Background

Work-family conflict among physicians has many adverse consequences, like reduced work engagement and impaired well-being. However, relatively little research has been conducted on the impact of work-family conflict on specific pathways of physician well-being. The aim of this study was to determine the relationship between work-family conflict and employee well-being among physicians and to explore the mediating role of job satisfaction and work engagement in this relationship.

Methods

Using data from a cross-sectional survey of 2,480 physicians in Jilin Province, China, partial least squares structural equation modeling (PLS-SEM) was applied in this study to examine the direct and indirect effects of work-family conflict on employee well-being and to assess the mediating roles of job satisfaction and work engagement therein.

Results

The employee well-being score of physicians in Jilin Province was 5.16 ± 1.20. The univariate analysis results indicated significant disparities in employee well-being scores across different age groups, marital statuses, and professional titles. Work-family conflict was significantly negatively associated with employee well-being, while job satisfaction and work engagement were significantly positively associated with employee well-being. In addition, job satisfaction and work engagement were found to mediate the association between work-family conflict and employee well-being, and work engagement was considered to mediate the association between job satisfaction and employee well-being.

Conclusions

Our study confirms that work-family conflict negatively affects physicians’ employee well-being. Moreover, our investigation revealed that the association between work-family conflict and employee well-being is influenced by both job satisfaction and work engagement and that work engagement plays a mediating role in the link between job satisfaction and employee well-being. Therefore, we propose that hospital administrators should rationally allocate organizational resources and develop manageable schedules to enhance physicians’ employee well-being.

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Background

As the “cornerstone” of the healthcare system, physicians bear the primary responsibility of providing health services to people. In their daily practice, physicians often experience significant burnout and stress due to excessive workloads, long working hours, and challenges in maintaining a work-life balance [1]. The incidence of burnout and stress is notably greater among health care professionals than among the general population [2]. In China, more than 4.5 million physicians are reportedly facing mounting pressure to manage increasing patient visits and meet expanding administrative demands [3]. Findings from a survey of 2,274 healthcare workers in the US revealed that more than a quarter reported feeling exhausted and nearly half experienced work-related stress [4]. Increasing work pressures, social responsibilities, and tension in doctor‒patient relationships have led to a gradual decline in physicians’ well-being [5]. In recent years, people have increasingly recognized the important role of employee well-being in the survival and development of organizations. From the perspective of happiness management, management models that pursue organizational happiness not only stimulate employees’ positive emotions, but also their organizational commitment [6]. In healthcare, a decline in physician well-being not only impacts the health of physicians but also influences the quality of care, patient satisfaction, and physician turnover, ultimately negatively affecting the healthcare system [7, 8]. A review revealed that out of 27 studies measuring well-being, 16 identified a significant correlation between lower well-being levels and poorer patient safety [9]. In addition, a decrease in physician well-being is expected to increase turnover rates and increase costs associated with physician recruitment and retention [7, 10]. Enhancing physicians’ well-being is therefore crucial for ensuring patient safety and the effective functioning of the healthcare system.

Although there is a lack of universally accepted definitions of employee well-being, much of the related research stems from the broader concept of general well-being. Danna and Griffin argued that well-being should consider the “whole person”, encompassing an individual’s mental, physical, and overall health, along with their experience of satisfaction at work and outside of work [11]. In this context, we agree with Zheng et al. that employee well-being should include life well-being, workplace well-being, and psychological well-being [12]. Over the years, extensive research on the antecedents of well-being has built a strong evidence base for policies and practices that promote employee well-being, including factors such as job satisfaction, work engagement, and job burnout [13, 14]. Previous studies on the well-being of the Chinese population have focused predominantly on university students, urban residents, and middle-aged and elderly individuals, with limited attention given to physicians. Research has indicated that Chinese doctors experience high rates of burnout, ranging from 66.5–76.9% [15]. A Korean national database study revealed that healthcare workers were more susceptible to mood and anxiety disorders, as well as psychiatric disorders, than employees in other industries [16]. Physicians encounter challenges related to burnout and mental health, which significantly impact their sense of well-being.

The job demands-resources model posits that well-being is reflected in low exhaustion and stress and high levels of work engagement, representing a balance between job demands and available resources for completing tasks [17]. According to the model, job resources typically have a positive effect on well-being, as increased resources lead to greater motivation and higher levels of employee engagement [18, 19]. A survey in the U.S. demonstrated that doctors with high levels of work engagement experienced greater well-being [20]. Conversely, job demands can lead to increased fatigue and stress, affecting doctors’ job satisfaction [21]. Prolonged exposure to high job demands often correlates with decreased levels of well-being [22]. Studies from various countries have shown that job satisfaction and employee well-being are positively correlated [23, 24].

However, there is a dearth of research examining the effects of physicians’ work-family conflict on employee well-being. Work-family conflict is typically defined as a type of role conflict where pressures from their roles are contradictory in certain aspects [25]. A study conducted in Germany revealed that physicians encounter greater levels of work-family conflict than does the general population, which imposes significant stress on them [26, 27]. Previous research has found that work-family conflict has a strong negative impact on employee well-being [28].

Based on the aforementioned discussion, the aim of this study was to investigate the relationships among work-family conflict, job satisfaction, work engagement, and employee well-being among physicians using partial least squares structural equation modeling (PLS-SEM). PLS-SEM can be used to reliably evaluate complicated models and work efficiently when estimating relationships involving multiple structural paths, compared to covariance-based SEM (CB-SEM) [29].

The main contributions of this study lie in the following areas. Firstly, there are relatively few previous studies on the impact of work-family conflict on specific pathways of physicians’ well-being. This study explores in depth the relationship between physicians’ work-family conflict and well-being, thereby enriching the research on this topic. Secondly, studying the specific occupational group of physicians provides a more precise and scientific basis for hospital human resource management practices. In addition, the results of this study provide valuable information for improving physicians’ well-being, expanding the research field of well-being management, and contributing to the further development and improvement of the field.

The remainder of this paper is structured as follows: The second section reviews the relevant literature and presents the research hypotheses. The third section describes the research methodology, including data collection and analysis methods. The fourth section presents the research results. The fifth section discusses the research findings, including their theoretical, social, and practical implications, as well as the study’s limitations and future research directions. Finally, the paper concludes with a summary of the findings.

Literature review

Well-being

Well-being is a multidimensional construct, but there is still a lack of a unified definition. In previous studies, there were two different philosophical perspectives on well-being, which gave rise to different concepts of well-being. One of them is hedonism, which views well-being as a subjective experience of happiness. The philosophical root of subjective well-being (SWB) is believed to be hedonism. Another perspective is eudaimonism, which involves views on utilizing an individual’s abilities and potential [30]. Ryff’s psychological well-being (PWB) model is a manifestation of eudaimonism. Although the two perspectives are different, some studies have found a certain correlation between the concepts of SWB and PWB [31]. Lent and Brown’s socio-cognitive model of well-being combines the two perspectives to explore happiness [32]. Zheng et al.‘s research deems that well-being should be considered as a whole. Employees are not only members of the organization but also members of the family, and need to consider work-related psychological, physical, and social well-being, as well as family-related well-being [12]. We agree with this viewpoint. The purpose of human resource management is not only to enhance organizational benefits but also to consider the benefits of stakeholders, including employee well-being. Implementing a culture of happiness management in an organization can achieve employee happiness while also improving organizational performance [33]. In the field of health, focusing on the well-being experience of physicians can improve the quality of medical services and enhance the patient’s medical experience.

Work-family conflict and employee well-being

Greenhaus and Beutell suggested that work-family conflict arises from incompatible role pressures between work and family [25]. It consists of two directional dimensions, namely, work interference with family and family interference with work [34]. Netemeyer et al. noted that when behaviors, stress, emotions, etc., at work interfere with the performance of family-related responsibilities, work-family spillover effects will occur and conversely, family-work spillover effects will occur [35]. Two effects essentially characterize the conflict between work and family roles [36]. The job demands-resources theory proposes that although there are differences in the work environments of different occupations, these environmental characteristics can be divided into two categories: job demands and job resources [37]. Mauno et al. suggested that the basic assumption of this theoretical model supports the relationship between job demands/resources and employee well-being, that is, job demands (such as work-family conflict) lead to different stress reactions and affect employee well-being [38]. Wang et al. suggested that conflict between work and family serves as a potential source of stress, exerting a negative impact on well-being [39].

Prior studies have found that work-family conflict, as an antecedent variable, is negatively related to employee well-being. A study of Chinese nurse employees showed that work-family conflict was negatively correlated with employee well-being [40]. A study involving 233 Chinese teachers showed that work-family conflict negatively predicted employee well-being [41]. A study of employees in different organizations in Malaysia also revealed that work-family conflict was an important predictor of employee well-being [28].

Therefore, we propose the following hypothesis:

H1: Physicians’ work-family conflict will be negatively related to employee well-being.

Job satisfaction mediates the relationship between work-family conflict and employee well-being

Job satisfaction was defined as employees’ positive emotions or attitudes toward various aspects of their jobs [42, 43]. Specifically, medical staff job satisfaction can be described as their overall feelings about the job itself, the work environment, interpersonal relationships, etc. It is generally believed that job satisfaction is an important antecedent variable that affects employee well-being and that job satisfaction can positively predict employee well-being. A survey of Australian nurses in 2023 demonstrated a moderate correlation between elevated levels of well-being and increased job satisfaction [44]. A survey of 310 clinical nurses in South Korea revealed that job satisfaction directly and positively affects employee well-being [45]. Job satisfaction is often used by organizations to reflect employee satisfaction with various areas of work. There is evidence in the literature that work-family conflict is a significant predictor of job satisfaction. A survey of banking industry employees in Shanghai revealed a negative correlation between work-family conflict and job satisfaction [46]. An Australian investigation similarly revealed that employees experiencing significant levels of work-family conflict tend to experience diminished job satisfaction [47]. In addition, according to Kalliath’s survey of social workers, satisfaction not only has a strong association with work-family conflict but also mediates the association between work-family conflict and well-being [48].

Based on the above evidence in the literature, we propose the following hypothesis:

H2: Job satisfaction of physicians will be positively correlated with employee well-being.

H3: Physicians’ work-family conflict will be negatively correlated with job satisfaction.

H4: Job satisfaction will mediate the relationship between work-family conflict and employee well-being among physicians.

Work engagement mediates the relationship between work-family conflict and employee well-being

The concept of employee engagement was originally proposed by Kahn, who noted that engaged employees will be fully involved in their work roles physically, cognitively, and emotionally [49]. Tendency to engagement is an internal state that represents a willingness to engage [50]. Maslach and Leiter believed that engagement in the field of burnout was diametrically opposed to work engagement [51]. Later, Schaufeli et al. proposed a concept of engagement that was completely different from burnout, defining it as a state of mind characterized by vitality, dedication, and concentration [52]. According to the job demands-resources model, resources can directly or indirectly facilitate work engagement and can also mitigate the negative effects of perceived job demands [19]. Work-family conflict affects employees’ access to work resources, which may lead to lower work engagement. Knight et al. conducted a systematic review and meta-analysis of the effectiveness of work engagement interventions and found that employees with low work engagement may be associated with decreased well-being, that is, work engagement is a positive predictor of well-being [53]. A 2020 survey of employees at the Port of Miami revealed that work engagement positively influenced employee well-being [54].

Moreover, work engagement is negatively associated with work-family conflict. A survey of teachers at a public university in the Czech Republic found that work-family conflict could negatively predict work engagement [55]. A study conducted among construction workers in China also revealed this relationship [56]. In their survey of European workers, Zappala et al. not only highlighted this relationship but also found a significant mediating function of work engagement in the correlation between work-family conflict and well-being [57].

Therefore, we put forward the following hypothesis:

H5: Physicians’ work engagement will be positively correlated with employee well-being.

H6: Physicians’ work-family conflict will have a negative relationship with work engagement.

H7: Work engagement will mediate the relationship between work-family conflict and employee well-being of physicians.

Work engagement plays a mediating role between job satisfaction and employee well-being

Lee et al. suggested that job satisfaction and work engagement are important variables in the category of work attitude [58]and that there is a correlation between them. Research by Cuesta-Valiño et al. likewise confirms that the emotional experience of employees positively affects engagement [59]. In an organization, the better the affective experience of work, the more satisfied the work is, which can help employees fully devote themselves to work. According to Zhang’s survey of nurses, job satisfaction could significantly and positively affect work engagement, and employees with high job satisfaction could help improve their work engagement levels [60]. A study of Nigerian service industry employees showed a positive relationship between job satisfaction and work engagement [61]. Similarly, a survey conducted in eastern China indicated that rural doctors’ job satisfaction was an important positive predictor of their work engagement [42]. Hence, we believe that work engagement might act as a mediator between job satisfaction and the well-being of physicians.

According to the above research, we put forward the following hypothesis:

H8: Job satisfaction of physicians will be positively correlated with work engagement.

H9: Work engagement will play a mediating role between job satisfaction and employee well-being of physicians.

In summary, work-family conflict among physicians has many adverse consequences, like reduced work engagement and impaired well-being. In order to comprehensively explore the effect of work-family conflict on the well-being of physicians and its underlying mechanisms, this study proposes 9 hypotheses. The theoretical model is presented in Fig. 1.

Fig. 1
figure 1

Theoretical model

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Methods

Participants and procedures

We conducted a cross-sectional survey utilizing on-site questionnaires in March 2023 to investigate physicians working in public hospitals in Jilin Province, China. This survey obtained sample hospitals through stratified random sampling and participants through quota sampling. Firstly, as urban hospitals have higher clustering characteristics, 46 hospitals were randomly selected from urban public hospitals as sample hospitals, based on the type and level of hospitals. Due to the scattered distribution of counties and the heterogeneity of county-level public hospitals, a comprehensive hospital and a traditional Chinese medicine hospital were randomly selected from each county as sample hospitals, with a total of 78 county public hospitals selected. Secondly, 20 physicians were randomly selected from each public hospital. The inclusion criteria for the surveyed physicians were employed in public hospitals in Jilin Province, China, and consent to engage in the research. A total of 2480 questionnaires were distributed, excluding unqualified questionnaires with missing information or logical errors. A total of 2288 valid questionnaires were collected, for a valid response rate of 92.26%.

This survey was approved by the Medical Ethics Committee of the author’s institute (No. 20230326). Before the survey, the researchers provided detailed explanations to the participants (including the purpose of investigation) and obtained informed consent from the participants.

Construct measurements

Employee well-being

The employee well-being of physicians was evaluated by using the Employee Well-Being Scale developed by Zheng et al. [12]. This scale comprises three dimensions of life well-being (6 items, such as “My life is fun”), workplace well-being (6 items, such as “I find real happiness in my work”), and psychological well-being (6 items, such as “I handle daily affairs well”). Each project is evaluated using a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree), with higher scores indicating happier employees. This scale has good internal consistency reliability, with a Cronbach’s alpha of 0.92 for life well-being, 0.93 for workplace well-being, and 0.88 for psychological well-being [12].

Work-family conflict

In this study, the 8-item work-family conflict scale developed by Carlson et al. and translated by Liu et al. was used to measure physicians’ work-family conflict problems [62, 63]. This scale includes two dimensions: work interference with family conflict (4 items, e.g., “work tension and anxiety, affecting my family life”) and family interference with work conflict (4 items, such as “pressure from family affecting my work”). The subjects rated each item according to the severity of work-family conflict using a 5-point Likert scale ranging from 1 (completely disagree) to 5 (completely agree), with greater scores demonstrating more severe work-family conflict. This scale has shown good internal consistency reliability in previous studies; for example, in a study on a Chinese population, the Cronbach’s alpha values of two dimensions were 0.81 and 0.83, respectively [62].

Work engagement

Work engagement was measured by the Utrecht Work Engagement Scale (UWES-17) developed by Schaufeli [52]. The Chinese version of this scale includes 17 items, with three dimensions—vigor, dedication, and focus—used to measure work dedication. Work engagement related to vigor and focus was evaluated by 6 items, while dedication was evaluated by 5 items. Each item on this scale was assessed on a 7-point Likert scale ranging from 0 (never) to 6 (always), with greater scores demonstrating greater motivation to work. This scale has shown strong internal consistency reliability within the health care population, with a Cronbach’s alpha of 0.94 [64].

Job satisfaction

The Job Satisfaction Scale stemmed from the Job Descriptive Index [65] and a scale for correlational research [66]. In a previous study, this scale exhibited high internal consistency reliability, with a Cronbach’s alpha coefficient of 0.93 [67]. It includes 8 items, namely, salary and benefits, workload, collegiality, workplace environment, career development, hospital management, work significance, and occupational risks, which are used to measure the satisfaction of physicians with their work. All these items were assessed using a Likert scale ranging from 1 (very dissatisfied) to 5 (very satisfied). Higher scores indicate higher levels of job satisfaction.

Data analysis

We described the scores of employee well-being, work-family conflict, job satisfaction and work engagement and examined the differences in demographic characteristics in terms of employee well-being. In the difference test, a t test was used for comparisons between two groups, and one-way ANOVA was used for comparisons between multiple groups. The above procedures were performed using SPSS Version 25. Furthermore, partial least squares structural equation modeling (PLS-SEM) was performed using SmartPLS 3, which involves the analysis of measurement models and structural models. The reliability of the model in this study was based on indicator loadings and internal consistency reliability. The validity of the model was evaluated utilizing convergent validity and discriminant validity as the criteria. Hair et al. recommended that the factor loading of the reflective index should be higher than 0.708 [68]. The internal consistency indicators of the latent variables, including Cronbach’s alpha (α), composite reliability (CR), and rho_A values, greater than 0.7 are considered fine [69]. Convergent validity is evaluated through average variance extracted (AVE) evaluation, and 0.50 or higher is considered acceptable [68]. Discriminant validity was evaluated using the Fornell-Larcker criterion and heterotrait-monotrait (HTMT) ratio of the correlations. Fornell and Larcker suggested that the AVE of each construct should be greater than the square of the correlation coefficients between the same construct and all other constructs in the model [70]. The upper threshold of the HTMT value is 0.90, and a value below 0.90 indicates acceptable discriminant validity [71]. The fitting index of the structural model evaluated in this study was based on the standardized root mean square residual (SRMR). According to the recommendations of Henseler et al., the model was considered to have a good fit when the SRMR was less than 0.08 [72]. In addition, the explanatory ability of the evaluation model was based on the coefficient of determination (R2), and an R2 greater than 0.10 indicated that the model had acceptable explanatory power [68].

Results

Descriptive statistics

The number of male (45.1%) and female (54.9%) respondents in this survey was basically the same, as shown in Table 1. Among the participants, 54.5% were physicians aged between 31 and 45 years, 19.1% were between 18 and 30 years, and 26.4% were aged 46 years or above. The majority of physicians (78.6%) were married, while 21.4% had unmarried, divorced, or widowed. Among the participants, 19.1% had a college degree or below, 63.0% had a bachelor’s degree, 15.8% had a master’s degree, and only 2.1% had a doctoral degree or above. In addition, 91.4% of respondents had professional titles, including 32.6% with senior professional titles, 31.4% with intermediate professional titles, and 27.4% with junior professional titles.

Results of employee well-being and work-family conflict

In Table 1, the employee well-being and work-family conflict scores of respondents with different characteristics are shown. The mean score for employee well-being among all participants was 5.16 ± 1.20. Physicians aged 18–30, unmarried, and without a professional title had a greater sense of well-being. The mean score for work-family conflict among all physicians was 2.56 ± 0.84. Participants who were male, aged 46 and above, were married, had a doctoral degree and a senior professional title had a higher level of work-family conflict.

Table 1 Demographic characteristics and employee well-being of respondents
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Evaluation of measurement model

Table 2 indicates the reliability and validity results of each latent variable. The ranges of each indicator loadings for constructs including employee well-being, work-family conflict, job satisfaction, and work engagement were 0.785–0.911, 0.695–0.910, 0.729–0.906, and 0.963–0.974, respectively. The loading of one indicator for work-family conflict was lower than 0.708 but basically close (the loading of FIW_3 was 0.695). After thorough deliberation, we opted to keep this item.

The Cronbach’s alpha values for employee well-being, work-family conflict, job satisfaction, and work engagement were 0.968, 0.877, 0.944, and 0.967, respectively. The rho_A values of the four constructs were 0.970, 0.893, 0.946, and 0.967, while the CRs of the four constructs were 0.971, 0.904, 0.954, and 0.978, respectively. The Cronbach’s alpha, rho_A and CR for each construct exceeded 0.7, which achieved the recommended values. Moreover, the AVE values for employee well-being, work-family conflict, job satisfaction, and work engagement were 0.653, 0.547, 0.721, and 0.938, respectively, which fulfilled an acceptable level of ≥ 0.5. All of the above results presented good internal consistency reliability and convergent validity for each construct.

Table 2 Measurement model
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The findings of discriminant validity are presented in Table 3. The correlation coefficient between each construct and all other constructs was less than the square root of the AVE value of that construct, and all HTMT values were lower than 0.90. This indicated that among the latent variables of employee well-being, work-family conflict, job satisfaction and work engagement possessed good discriminant validity. Moreover, the negative association between work-family conflict and employee well-being was − 0.588. The value of 0.764 presented a positive association between job satisfaction and employee well-being. Furthermore, the result of 0.702 demonstrated a positive relationship between work engagement and employee well-being.

Table 3 Fornell-Larcker Criterion and Heterotrait-Monotrait (HTMT)
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Assessment of structural model

The SRMR of this study is 0.078, which is less than 0.08, indicating that the model has good goodness of fit. In addition, the results in Fig. 2 show that the R2 values of the endogenous variables ranging from 0.327 to 0.709 are all greater than 0.10, indicating that the model has good explanatory power.

This study employed the Bootstrapping method (subsamples = 5000) to evaluate the path coefficients’ values and assess their significance. The results for the structural model are presented in Table 4. Work-family conflict has a negative correlation with employee well-being (β=-0.172, P < 0.001). However, job satisfaction is significantly positively correlated with employee well-being (β = 0.454, P < 0.001), and work engagement is also significantly positively associated with employee well-being (β = 0.373, P < 0.001). The above results confirm H1, H2, and H5.

The findings indicate significantly negative relationships between work-family conflict and job satisfaction (β=-0.572, P < 0.001), and between work-family conflict and work engagement (β=-0.140, P < 0.001). The above results support H3 and H6, respectively. Moreover, the results also indicate a significant positive correlation between job satisfaction and work engagement (β = 0.488, P < 0.001), supporting H8.

Furthermore, the study demonstrated that work-family conflict can affect employee well-being through the separate mediating effects of job satisfaction (β=-0.259, P < 0.001) and work engagement (β=-0.052, P < 0.001), while job satisfaction can also indirectly and significantly affect the well-being of physicians through work engagement (β = 0.182, P < 0.001). Thus, H4, H7, and H9 were supported.

Fig. 2
figure 2

Structural model. Note: ***P < 0.001

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Table 4 Hypothesis testing
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Discussion

In medical practice, significant work stress can impair the well-being of physicians, reduce the quality of care, and even have a serious impact on the functioning of the healthcare system [73]. In China, where there is a high demand for medical services, physicians often face heavy workloads and extended working hours, leading to potential conflicts between work and family duties. This study seeks to explore the intrinsic relationship mechanism between work-family conflict and the well-being of physicians, with a specific focus on the mediating effects of job satisfaction and work engagement.

This study revealed that the average employee well-being score for physicians in Jilin Province was 5.16 (standard deviation of 1.20). Our findings differ somewhat from those in other regions. A study in Malaysia showed that full-time administrative professionals (including those in healthcare) had an average well-being score of 5.41 [74]. In Turkey, a survey revealed that employees in the service industry (including healthcare) had an average well-being score of 5.0 [75]. Disparities in employee well-being also exist among different regions in China. Deng et al.’s research indicated that employees in the nonprofit sector in China had an average well-being score of 5.0 [76] Huang et al.’s study on a hospital in Northwest China revealed that full-time nurses in the hospital had an average workplace well-being score of 5.88 [77]. A survey conducted in southern China found that medical staff in public hospitals had an average well-being score of 4.565 [78]. These differences may stem from variations in the study cohorts. General characteristics including age, gender, and marital status differ among physicians in different regions, potentially influencing observed employee well-being levels. The diversity of job tasks faced by physicians in different regions leads to varying levels of work pressure, alongside potential differences in salary levels, all of which may affect employee well-being. Additionally, the influence of the research duration on the research outcomes must be considered.

Our research indicated that work-family conflict had a significant inverse effect on the well-being of physicians. This finding is consistent with a previous study [28]. As one of the primary professionals in the healthcare field, physicians shoulder the heavy responsibility of saving lives and healing the sick, requiring high quality and a sense of social responsibility. In China, due to the large population and constantly growing demand for medical services, doctors are often in a state of overwork [79]. According to role conflict theory, individuals with more roles tend to experience role stress and overload [80]. Therefore, physicians may feel greater pressure and tension when juggling multiple roles, potentially reducing their well-being. Additionally, research conducted by Yu and others on nurses confirmed the negative effect of work-family conflict on employee well-being [40].

Our research findings demonstrated that work engagement and job satisfaction had a significant positive impact on employee well-being. Previous studies have indicated that work engagement is a key factor in employee well-being [81]. Employees with high levels of work engagement strive to work because of their dedication rather than being driven by irresistible compulsion [82]. Physicians with high work engagement can achieve greater happiness by fulfilling their psychological needs. A study conducted by Brad Shuck and colleagues on 216 healthcare employees confirmed the positive impact of work engagement on employee well-being [20]. Job satisfaction is another important variable influencing employee well-being [83]. A survey of Spanish citizens by Núnez-Barriopedro et al. found a correlation between satisfaction and well-being [84], which is consistent with the present study, i.e., employees who are satisfied with all aspects of their job experience more positive emotions and are thus more likely to be happy. From Maslow’s hierarchy of needs theory, physicians, as a highly knowledgeable and skilled group, not only pursue basic physiological and safety needs but also aspire to esteem and self-actualization [85]. When physicians feel a sense of achievement and fulfillment in their profession, they tend to feel happier and more content. A study on 412 nursing staff in Pakistan confirmed the positive correlation between job satisfaction and employee well-being [23].

Our findings also suggested that job satisfaction mediates the association between work-family conflict and employee well-being among physicians. In an environment that demands high levels of morality, responsibility, and professionalism, coupled with heavy workloads, work-family conflict may become a detrimental factor, potentially resulting in a decline in doctors’ satisfaction with their jobs [86]. This study found that when physicians faced work-family conflict, their job satisfaction was affected, thereby indirectly influencing their well-being. Kalliath’s survey of social workers found that job satisfaction mediated the association between work-family conflict and employee well-being [48]. Similarly, research on Mexican garment factory workers has demonstrated the mediating role of job satisfaction between work-family conflict and employee well-being [87].

Furthermore, our study provided evidence that work engagement had a mediating effect on the association between work-family conflict and employee well-being, consistent with previous research. When physicians face work-family conflict, they can feel exhausted and mentally drained, leading to difficulties in focusing on their work and consequently affecting their well-being. Zappala et al.’s survey of European workers revealed that work engagement could significantly mediate the association between work-family conflict and well-being [57]. Additionally, our research showed that work engagement served as a mediator in the association between job satisfaction and employee well-being. This hypothesis was verified via structural equation modeling. According to social exchange theory, individuals who derive a pleasurable experience (i.e., high satisfaction) from their work tend to increase their work engagement in return to the organization [88]. This idea has also been confirmed in studies of podcast consumers, where pleasurable experiences have a positive effect on work engagement [89]. Thus, when physicians are satisfied with their work, they are more motivated and dedicated to their work, resulting in greater well-being.

Our research also revealed higher levels of employee well-being among physicians between the ages of 18 and 30, as well as among unmarried and untitled physicians. A study in China found that physicians in these groups had fewer work-family conflicts and may have a greater sense of well-being [90]. First, younger physicians between the ages of 18 and 30 years were enthusiastic about their work, had higher levels of motivation and adaptability, and thus enjoyed higher levels of well-being, a finding that was validated in a group of nurses [91]. Second, unmarried physicians may have fewer family responsibilities and more energy to dedicate to their work and personal development than those who are married. Finally, as physicians advance in title, they often face more intense competition for promotion and need to dedicate more time and effort to pursuing professional development. This could intensify conflict between work and family, which in turn reduces well-being.

There are several limitations to this study. First, only physicians from Jilin Province were selected as research subjects, which may limit the generalizability of the results, suggesting that the situation of physicians in other parts of China may differ from that of physicians in Jilin Province. Future research could consider sampling from a wider range to obtain more comprehensive information, thus enhancing the study’s representativeness. Second, due to the cross-sectional design of this study, causal relationships cannot be established, necessitating longitudinal research to better understand causality.

Theoretical, practical and social implications

Theoretically, the empirical study of physician well-being adds to the existing academic literature on well-being management and provides data support for theoretical research in the field of well-being. It also provides a new perspective for hospital managers to improve employee well-being by analyzing the negative impact of work-family conflict on physician well-being and emphasizing the mediating role of job satisfaction and work engagement in this context.

In terms of practical implications, this study provides valuable practice guidance for hospital administrators. Firstly, considering the adverse effects of declining physician well-being on the healthcare system, it is incumbent upon hospital administrators to take steps to promote physician well-being. The study suggests developing manageable schedules and improving working conditions to enhance physicians’ well-being. Secondly, the study found that job satisfaction and work engagement played a key role in buffering the negative impact of work-family conflict on well-being. Therefore, hospital administrators should pay attention to the physical and mental health of doctors and establish reasonable incentives to enhance job satisfaction and work engagement, thereby improving doctors’ well-being.

In terms of social impact, increasing social competition and pressure have significantly diminished doctors’ sense of well-being. Physicians’ well-being not only affects their personal health and professional performance but also has a profound impact on the service quality of the entire healthcare system and public health. Therefore, enhancing physicians’ well-being is of great social significance and contributes to the improvement of overall healthcare services and the promotion of public health and well-being. This study reveals the negative correlation between physicians’ work-family conflict and well-being and highlights the important role of increasing job satisfaction and work engagement in improving this relationship, thereby contributing to the promotion of social well-being.

Limitations and future research

There are some limitations to this study. First, only physicians in Jilin Province were selected for this study, which may limit the generalizability of the findings. This suggests that the situation of physicians in other regions may be different. Future studies could enhance the representativeness of the study by sampling a larger area to obtain more comprehensive information. Second, because this study used a cross-sectional design, it was not possible to determine causality; therefore, future studies could use a longitudinal study or experimental design to better understand causality. Finally, one study was limited, and future research could further explore other possible mediating variables or influencing factors to more fully understand the relationship between work-family conflict and physician well-being.

Conclusions

This study investigated the effects of work-family conflict, job satisfaction, and work engagement on the employee well-being of physicians. Work-family conflict was found to have a significant negative impact on employee well-being, while job satisfaction and work engagement were identified as key factors with significant positive effects. Moreover, job satisfaction and work engagement were shown to mediate the relationship between work-family conflict and employee well-being, with work engagement playing a mediating role between job satisfaction and employee well-being. Given that physician well-being is an important component of sustainable healthcare, it is recommended that hospital administrators allocate resources effectively and develop manageable schedules to enhance physicians’ employee well-being.

Data availability

The datasets supporting the conclusions are not publicly available due to data confidentiality agreements but are available from the corresponding author (Yu X, xhyu@jlu.edu.cn) upon reasonable request.

Abbreviations

EWB:

Employee well-being

LWB:

Life well-being

WWB:

Workplace well-being

PWB:

Psychological well-being

WFC:

Work-family conflict

WIF:

Work interference with family

FIW:

Family interference with work

JS:

Job satisfaction

WE:

Work engagement

VI:

Vigor

DE:

Dedication

AB:

Absorption

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  1. Xin Yang and Xiangou Kong contributed equally to this work.

Authors and Affiliations

  1. School of Public Health, Jilin University, Changchun City, Jilin Province, 130021, China

    Xin Yang, Xiangou Kong, Meixi Qian, Xiaolin Zhang, Lingxi Li, Shang Gao, Liangwen Ning & Xihe Yu

  2. School of Public Administration, Jilin University, Changchun City, Jilin Province, 130012, China

    Liangwen Ning

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Contributions

The study was conceptualized and designed by Xihe Yu. Xiaolin Zhang, Meixi Qian and Lingxi Li conducted the investigation. Xin Yang performed the data analysis. The original manuscript was drafted by Xiangou Kong and Xin Yang. Xihe Yu, Liangwen Ning, and Shang Gao reviewed and revised the manuscript. All authors have read and approved the final version of the manuscript.

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Yang, X., Kong, X., Qian, M. et al. The effect of work-family conflict on employee well-being among physicians: the mediating role of job satisfaction and work engagement. BMC Psychol 12, 530 (2024). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s40359-024-02026-8

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