Development and psychometric validation of the 13-item physician health and quality of life (Afya MedQoL) index: a nationwide cross-sectional survey of Brazilian physicians.

Abstract

To develop and validate a concise, physician-specific quality-of-life scale (Afya MedQol) Index, and to examine sociodemographic and occupational correlates of physician well-being in Brazil. Nation-wide, cross-sectional, web-based survey employing split-sample psychometric validation: exploratory factor analysis, confirmatory factor analysis (CFA), multidimensional graded-response item-response theory calibration and post-stratification weighting to the 2025 Brazilian medical demographic census. Physicians practising in all five Brazilian macro-regions and 27 state medical councils (2 July 2024-6 August 2024). A total of 2005 fully responding physicians (56% women; mean age 38.5±12.6 years). Domain scores-F1: Quality of Life, F2: Institutional Support, F3: Perceived Stress-and a Fisher-information-weighted global score. Convergent validity with WHOQOL-Bref; subgroup differences (Cohen's d, partial η²). CFA supported a three-factor, 13-item solution (Comparative Fit Index=0.987; Root Mean Square Error of Approximation=0.050) with strict invariance across sex and graduation-year quartiles. Item-response modelling showed marginal reliability ρ=0.82. Convergent validity with WHOQOL-Bref domains was strong (r=0.55-0.73). Weighted mean (95% CI) scores were: Global 67.2 (66.5-67.9), F1 69.5 (68.9-70.2), F2 64.1 (63.4-64.8) and F3 62.5 (61.8-63.2).Women scored higher on Perceived Stress (F3) than men by 5.6 points (weighted mean difference 5.6, 95% CI 4.0 to 7.2; Cohen's d 0.28). Physicians working ≥60 hours/week scored higher on Perceived Stress than those working ≤44 hours/week by 8.8 points (weighted mean difference 8.8, 95% CI 6.7 to 10.9; Cohen's d 0.40). Well-being increased with income up to ~BRL 25 000 per month and plateaued thereafter. Afya MedQoL Index is a psychometrically robust, 13-item instrument capturing personal, organisational and stress dimensions of physician well-being. Perceived Stress-shaped by workload, institutional climate and gender-was the most discriminative domain, while additional income beyond an upper-middle-class threshold conferred negligible benefit. Findings support policies aimed at capping duty hours, fostering 'just-culture' environments and expanding flexible work models.