Although a wealth of studies have been conducted with regard to stress and occupational stressors in medical personnel, few of these have focused on smaller countries with a specific cultural setting such as Greece. The current study therefore attempts to fill this knowledge gap, by investigating key occupational stressors amongst doctors employed within the Greek National Health System, and the extent to which these may act as predictors of job satisfaction.
For some time, considerable attention has been given to the psychological health of doctors (e.g., [9, 41, 44]). Earlier research has indicated that doctors are considered to be at high risk and prone to a number of occupational stressors, which can significantly reduce their ability to respond effectively to their duties (e.g., [8, 10]).
Many studies have demonstrated that increased psychological distress within the medical profession is associated with a number of factors, including heavy workload, interruption of family life, insufficient training, patient complaints, making decisions alone, and keeping up to date with knowledge (e.g., [10, 11, 18, 45, 46]).
According to a study by King et al. , the three most important causes of occupational stress in medical doctors include: a) occupational obligations, b) workload and c) family life. In addition, across the 30 sources of stress examined in one of the most recent UK surveys  a number of key occupational stressors were identified such as: a) increasing work load b) increased demands from patients c) paper work d) inappropriate demands from patients e) insufficient time to do justice to the job.
A number of stressors are also perceived to be intrinsic to the medical profession such as experience of emotional intense, fear, failure, death (e.g., ), their exposure to an increased danger of disease and injury  and the fact that doctor’s omission, actions and potential mistakes may have a profound impact on the patient’s life .
There is a wide scope of literature available, reporting on the measurement of stress in hospital doctors (e.g., [30, 38, 40]), and the extent to which occupational stressors affect doctors differently depending on their position within the hierarchy [4, 24]. Successful coping with occupational stressors in hospital doctors has been identified as relating to seeking advice from family, friends and partners . Consulting professional help has also been shown to assist doctors in reducing symptoms resulting from professional stress.
A further issue of importance relates to the effects of occupational stressors on the perceived job satisfaction of clinicians. Grol et al. [25, 26] have demonstrated that job satisfaction can affect the quality of health care; it has been shown that doctors’ poor clinical performance as evidenced in high prescriptions rates and lack of communication with patients is associated with low job satisfaction in doctors who experience frustration, time pressure and tension. In 1992, after the introduction of new regulations in health care services in Great Britain, research involving 917 General Doctors revealed that they presented lower levels of job dissatisfaction and psychological instability than their counterparts in an earlier study . Researchers also detected a number of parameters that predicted the doctors’ job dissatisfaction, such as time pressure and strain related to the patients’ needs and expectancies, organisational structure and work environment, future prospects, and managerial duties. In particular, time pressure for patients’ consultation has been highlighted as a major stressor affecting job dissatisfaction across many studies (e.g., [37, 43]). Moreover, doctors with low levels of job satisfaction were more likely to manifest negative attitudes against the health care system as a whole .
The above constitutes a brief overview of some of the many research studies into stressors and job satisfaction, which remain somewhat limited within smaller countries such as Greece. Investigations into the extent to which different stressors might predict doctors’ dissatisfaction/satisfaction with their work, in such countries may however have useful implications for neighbouring countries of a similar cultural and economic structure.
The Greek national health system was introduced in 1983, aiming to provide health care for the entire population , and to limit the usage of the private sector. Throughout the 1980s, the Greek NHS continued to develop, and a growth in available resources was witnessed. Access to the Greek NHS is free, and is paid for by a number of health insurance schemes, financed mainly by employees and employers.
Despite ongoing intentions of equity and efficiency, since the development of the Greek NHS attempts to reform it have been slow, and various plans have failed as a result of economic, political and social factors . However, public hospitals remain under pressure to improve, particularly in terms of resources and general inefficiencies .
Tountas  has previously reported the NHS as being in a continuous crisis, caused predominantly by low productivity, administrative problems and insufficient primary care services. However, plans for a major reform of the health system were intended, and almost two decades after its development, initiatives were introduced to modernize the framework .
Because of ongoing problems encountered within the Greek NHS, it seems reasonable to assume that specific stressors may lead to job dissatisfaction among Greek hospital doctors, and that identification of these facts may enhance performance and improve psychological and physical health in Greek clinicians. A study by Falagas et al.  into the utilization of a hospital based employee health clinic revealed a number of common complaints among Greek hospital staff including abdominal pain, dizziness, respiratory tract infections, and weakness/malaise. However, it was noted that physicians visited the clinic less than other health care professionals, and as such, their symptoms could go unnoticed.
Stress and job satisfaction in Greek doctors may also put them at risk of impaired health behaviour. In an earlier study , it was reported that 44 % of internists and 54 % of surgeons smoked more than 20 cigarattes a day, and that 40 % of these reported stress in hospitals as a major cause of not-quitting. This particular study concluded that support from colleagues or families might encourage Greek doctors to stop smoking, and may help them to take a more optimistic view in terms of cancer-prevention practice. A further study by , noted that smoking in Greek doctors was related to anxiety, and that stress management programmes could be an effective technique for helping Greek doctors to stop smoking. In order to be investigated the main aims of the present study
Regarding the specific working conditions of Greek medical doctors, the main aims of the study were to examine:
the overall level of job satisfaction/dissatisfaction of the total sample
the levels of job satisfaction/dissatisfaction factors
the specific stress factors that the doctors experience
the prediction of job dissatisfaction/satisfaction levels by certain stress factors and
the prediction of job dissatisfaction/satisfaction levels by specific demographic variables.
It was hypothesized, that given the current structure of the healthcare system in Greece, and the low financing that it receives , Greek doctors would report job dissatisfaction in specific areas related to these issues, and that certain predicting stressors would be identified. On the contrary, bearing in mind the social structure of Greece, and its traditional societal values, job satisfaction among Greek doctors was expected to emerge with respect to interpersonal relationships.