{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T06:30:51Z","timestamp":1787725851563,"version":"build-2784847793"},"reference-count":59,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002858","name":"China Postdoctoral Science Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002858","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Physician wellbeing is central to healthcare workforce sustainability, particularly in settings characterized by high work demands and extended working hours. In China's healthcare system, physician income remains an important occupational factor and may be linked to workload and service volume, adding complexity to the associations between working hours, income, and wellbeing. This study examined these associations and the potential mediating role of income among physicians in China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional survey was conducted among 1,324 physicians from four province-level regions in China. Physician wellbeing was measured across physiological, psychological, and work-related domains. Generalized Structural Equation Modeling (GSEM) with 5,000 bootstrap replications was employed to estimate the direct associations between weekly working hours and multidimensional wellbeing and the income-mediated indirect associations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean score for physiological wellbeing (EQ-VAS) was 70.2 \u00b1 16.7. Overall, 42.3% of physicians reported poor psychological wellbeing, defined as anxiety or depression, and 72.4% did not meet the criteria for good work-related wellbeing. Longer weekly working hours were inversely associated with physiological wellbeing (\n                      <jats:italic>B<\/jats:italic>\n                      = \u22125.057,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001), psychological wellbeing (OR = 0.685,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001), and work-related wellbeing (OR = 0.481,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001). Longer weekly working hours were also positively associated with monthly income (\n                      <jats:italic>B<\/jats:italic>\n                      = 0.049,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.01). Income-mediated indirect associations were positive for physiological wellbeing (indirect association = 0.180; 95% bootstrap CI: 0.044, 0.368) and psychological wellbeing (indirect OR = 1.020; 95% bootstrap CI: 1.005, 1.041), but not for work-related wellbeing (indirect OR = 1.011;95% bootstrap CI: 0.998, 1.032).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Among physicians surveyed in China, longer weekly working hours were associated with poorer multidimensional wellbeing. Monthly income played a modest statistical mediating role in the associations with physiological and psychological wellbeing, while the corresponding indirect association was not evident for work-related wellbeing under the primary strict definition. Further longitudinal and policy-evaluation studies are warranted to inform work-hour management and compensation reforms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1897935","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T06:04:21Z","timestamp":1787724261000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Extended working hours, income, and multidimensional wellbeing among physicians in China: a cross-sectional mediation analysis"],"prefix":"10.3389","volume":"14","author":[{"given":"Huixian","family":"Zheng","sequence":"first","affiliation":[{"name":"Department of Health Policy and Management, School of Public Health, Peking University","place":["Beijing, China"]},{"name":"China Center for Health Development Studies, Peking University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingyue","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, School of Public Health, Peking University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haoqing","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, School of Public Health, Peking University","place":["Beijing, China"]},{"name":"China Center for Health Development Studies, Peking University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuxun","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, School of Public Health, Peking University","place":["Beijing, China"]},{"name":"China Center for Health Development Studies, Peking University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyun","family":"Liu","sequence":"additional","affiliation":[{"name":"China Center for Health Development Studies, Peking University","place":["Beijing, China"]},{"name":"Beijing Institute for Health Development, Peking University","place":["Beijing, China"]},{"name":"National Health Commission Key Laboratory of Health System Reform and Governance (Peking University)","place":["Beijing, China"]},{"name":"WHO Collaborating Centre for Universal Health Coverage","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1370\/afm.1713","article-title":"From triple to quadruple aim: care of the patient requires care of the provider","volume":"12","author":"Bodenheimer","year":"2014","journal-title":"Ann Fam Med."},{"key":"B2","doi-asserted-by":"publisher","first-page":"2682","DOI":"10.1016\/j.mayocp.2021.06.005","article-title":"Physician Well-being 2","volume":"96","author":"Shanafelt","year":"2021","journal-title":"Mayo Clin Proc."},{"key":"B3","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1377\/hlthaff.2014.0386","article-title":"Pay-for-performance schemes that use patient and provider categories would reduce payment disparities","volume":"34","author":"Damberg","year":"2015","journal-title":"Health Aff."},{"key":"B4","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1111\/joim.12752","article-title":"Physician burnout: contributors, consequences and solutions","volume":"283","author":"West","year":"2018","journal-title":"J Intern Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1294","DOI":"10.1001\/jama.2009.1389","article-title":"Association of resident fatigue and distress with perceived medical errors","volume":"302","author":"West","year":"2009","journal-title":"JAMA."},{"key":"B6","doi-asserted-by":"publisher","first-page":"e214634","DOI":"10.1001\/jamahealthforum.2021.4634","article-title":"Physician compensation arrangements and financial performance incentives in US health systems","volume":"3","author":"Reid","year":"2022","journal-title":"JAMA Health Forum."},{"key":"B7","doi-asserted-by":"publisher","first-page":"113939","DOI":"10.1016\/j.socscimed.2021.113939","article-title":"Allocation of health care under pay for performance: winners and losers","volume":"278","author":"Oxholm","year":"2021","journal-title":"Soc Sci Med."},{"key":"B8","doi-asserted-by":"publisher","first-page":"5","DOI":"10.7664\/CHE20150101","volume":"34","author":"Wang","year":"2015","journal-title":"Issues and reform suggestions for the existing problems in payment policy of public hospitals in China (in Chinese). 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