|Year : 2019 | Volume
| Issue : 3 | Page : 87-94
Predictors of career satisfaction among physicians: Observations from a tertiary care center
Abdulmalik Altaf1, Lujain Attar1, Hani Z Marzouki2, Ashraf A Maghrabi1, Hanaa Tashkandi1, Wisam Jamal3, Murad Aljiffry1
1 Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
2 Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
3 Department of Surgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
|Date of Web Publication||4-Nov-2019|
Department of Surgery, Faculty of Medicine, King Abdulaziz University, P.O. Box 80200, Jeddah 21589
Source of Support: None, Conflict of Interest: None
Introduction: Career satisfaction is vital to attain the superlative quality of work; dissatisfaction can consequently impact physicians' performance. This study was conducted to ascertain the level of physicians' satisfaction at work as well as identifying influencing factors.
Methods: This cross-sectional study was conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Participants were clinicians serving in different specialties for 2 years or more after finishing their training. Job satisfaction was assessed through a self-administered questionnaire. Response to each question to each question was devised using 5-point Likert scale on a wide range of demographics, job characteristics, and five main domains of job satisfaction. Data analysis was executed using SPSS package (v. 24).
Results: A total of 159 clinicians participated in our study. Majority of the participants were Saudi (145, 91.2%), with 113 male (71%). Age ranged between 30 and 40 years. 140 were married (88%). In general, more than one-third of the physicians were dissatisfied with their overall job condition 60 (38.0%). The most important prognosticators of career satisfaction were found to be age, years of experience, and type of practice (public vs. private or both). When a multivariate analysis, regression model was applied, “clinicians satisfaction with workload” and “time and energy spent on administrative tasks” were found to have a negative effect on job satisfaction.
Conclusion: More than one-third of the clinicians were generally dissatisfied with their overall job condition. Goals should be directed to improve the elements that adversely affect career satisfaction. Necessary interventions are indicated to improve clinicians' performance in clinical practice, maximize the quality of care, and maintain stable workforce.
Keywords: Career satisfaction, physician job satisfaction, work-related aspects
|How to cite this article:|
Altaf A, Attar L, Marzouki HZ, Maghrabi AA, Tashkandi H, Jamal W, Aljiffry M. Predictors of career satisfaction among physicians: Observations from a tertiary care center. Saudi Surg J 2019;7:87-94
|How to cite this URL:|
Altaf A, Attar L, Marzouki HZ, Maghrabi AA, Tashkandi H, Jamal W, Aljiffry M. Predictors of career satisfaction among physicians: Observations from a tertiary care center. Saudi Surg J [serial online] 2019 [cited 2020 Apr 9];7:87-94. Available from: http://www.saudisurgj.org/text.asp?2019/7/3/87/270239
| Introduction|| |
Career satisfaction can be defined as the effective feeling or an assemblage of attitudes that an employee has toward his work. This could be the job in general or the attitudes toward specific aspects of it.,, Clinicians are an essential component of any health-care system. Their high career satisfaction is associated with benefits that have impact on physician's well-being and is correlated negatively to burnout, intention to leave, and specialization change., Employee career satisfaction assessment is considered one of the cardinal organizational activities, as the study of causes and consequences of clinicians' attitude has great impact on the organizational success. Career satisfaction is under the influence of a series of factors such as the nature of work, salary, advancement opportunities, management, work groups, and work conditions. Dissatisfaction among clinicians is considered a very important factor that influences patients' satisfaction. In a study conducted in the USA, less than half of the clinicians involved were satisfied and just about half (54%) would choose medicine again as a career. Low level of job satisfaction is considered a threat to the health system as well as to doctors' goals achievement and is a leading cause of reduction in quality of care. Burnout is common among surgeons. In the 2017 Medscape Physician Lifestyle Report, burnout rates ranged from 42 to 59% across specialties. Burnout among surgeons leads to decreased effectiveness at work and increased career dissatisfaction level in comparison to other specialties. Health-care system in Saudi Arabia has been undergoing many changes. Little is known in Saudi Arabia about clinicians' career satisfaction and any association with doctor-related and practice-related factors. The desire of achieving higher level of healthcare had motivated us to scrutinize the degree of clinicians' career satisfaction. Therefore, the current study was conducted to assess the level of career satisfaction and its related factors among clinicians in different specialties at a tertiary care center in Jeddah, Saudi Arabia.
| Methods|| |
Study design and participant
A web-based, self-administered, cross-sectional prospective survey was conducted at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia, between August and November 2018. Participants included were practicing clinicians at the level of consultant or specialist (senior registrars) who worked for at least 2 years following the completion of their specialty training. Clinicians from different specialties with varying qualifications and service experiences were included. These specialties were: all surgical divisions, internal medicine, family medicine, dermatology, intensive care, neurology, pediatrics, anesthesia, emergency medicine, radiology, and obstetrics and gynecology. Clinicians under training were excluded. The questionnaire was sent to all participants to voluntarily and anonymously participate in the study. Formal approval was obtained from the Institutional Review Board of King Abdulaziz University. The questionnaire was developed by authors after adopting and modifying a validated and standardized questionnaire used in previous studies., The questionnaire contains the main components of work satisfaction identified by Quantitative Research of the Society of General Internal Medicine Career Satisfaction Study Group., The first part addressed basic demographic data and academic credentials, including, gender, age, nationality, marital and family status, medical specialty, susceptibility, training duration, employment level, and practice. The second part was developed to assess the determinants of job satisfaction as described in the literature: workload, income, patient care, personal reward, and job specialty which were collectively subdivided into 29 items. The full list of items in the used questionnaire is presented in the Appendix. These were evaluated with a five-point Likert-type scale ranging from “very satisfied” to “very dissatisfied.” Other closed-ended questions to be answered with “Yes,” “No,” or “Do not know” were used when required. The average time for completion was 3–7 min. The instrument used in our study was pretested for face, length, clarity, and comprehensibility. Face validity was established by expert opinions. A successful pretest was conducted on ten (5 males and 5 females) randomly selected clinicians working at KAUH who fit the above inclusion and exclusion criteria. The questionnaire was sent to participants electronically via a secure web link. This was followed by two reminding E-mails on a weekly interval to increase the response rate.
Data analysis procedure
Data analysis was executed using the Statistical Package for Social Sciences version 24.0 for Windows (SPSS Inc., Chicago, IL, USA) for Windows. Data computation methods were only employed to the subscale scores whose half or more of the analogous items were not absent. The five dimension subscale scores were developed by summation of satisfaction factors that were assembled and the intervals as following: “workload”: 0–29; “income”: 0–12; “patient care”: 0–16; “personal rewards”: 0–16; and “job specialty”: 0–6 [Table 1]. Higher score indicates more satisfaction level and lower score indicates less satisfaction. Exception was made with workload and job specialty; the classification of the score scale is the opposite of the other factors score [Table 1]. [Table 2] shows the relationship between the overall career satisfactions and sociodemographics, job characteristics of the respondents using Pearson's Chi-squared test. ANOVA and t-test were used to compare the differences of the mean among the overall satisfaction scores and the five factors score as “continuous” between the social demographic and the job characteristics categories. Likewise, the continuous variables were also subjected to categorization and variance analysis including linear trend tests [Table 3] and [Table 4]. Multivariate model was applied and shows incorporated similar indicators for all satisfaction scores, to assist correlations [Table 4]. Two-tailed tests were utilized for every statistical procedure, with a significance level of 0.05. At 95% confidence interval and 5% margin of error, the sample size was calculated to be 204 based on the total number of distributed questionnaires (430).
|Table 2: Distribution of satisfaction among study characteristics with ANOVA and t-test|
Click here to view
|Table 4: Distribution of factors have negative effect on satisfaction among study characteristics|
Click here to view
| Results|| |
A total of 163 physicians of about 204 approached participated in this survey constituting a response rate of (79.9%). Questionnaires that were returned blank or with the majority of the questions unanswered were excluded. A total of 159 questionnaires were analyzed.
The majority of the respondents involved in this study were male (113, 71%). Majority of the participants were Saudi Arabian (145, 91.2%). Age ranged between 30 and 40 years, indicating young participants (88, 55.3%), (140, 88%) comprised married individuals [Table 5]. With regard to the participant's job characteristics, (60, 37.7%) of the respondents were surgeons. More than three quarters of the participants (122, 76.7%) held academic job positions. Those who possessed consultant level were (126, 79.2%). In addition, (105, 66.4%) of the participant clinicians had an experience of 5 years or more since board certification. Most of the respondents worked in both public and private sectors (96, 60.4%) [Table 6]. More than one-third of the respondents were dissatisfied with their overall job condition 60 (38.0%) [Table 1]. The main components of work satisfaction (i.e., “Workload,” “Income,” “Patient Care,” “Social Reward,” and “Job specialty”) were examined across the demographic and work characteristics [Table 2]. Age and period of board certification were found to be the most affected confounders. Older clinicians reported significantly higher satisfaction scores with all five domains of job satisfaction (P< 0.001). When we looked at the association between current job satisfaction, the demographic and work characteristics, we found that surgical specialties were less satisfied with their job in general when compared to nonsurgical specialties (P = 0.049). Similar results were seen for older clinicians (≥40 years) and those with more years of experience (≥5 years) when compared to younger age participants and who have less experience years (P< 0.001). Women were significantly less satisfied than men with their income score (6.00, P = 0.013). Consultants tended to be more satisfied than specialists with income (P = 0.027). Clinicians who trained for <5 years had the lowest satisfaction score in workload domain (10.97, P < 0.001). Data showed that consultants who work in both private and public sectors were more satisfied with their job specialty (P = 0.026) than those who worked in public only [Table 2].
Multivariate modeling analysis
A multivariate analysis, regression model was applied to determine the effect of each statement studied in each of the five work satisfaction domains and their effect on the overall job satisfaction. The main focus was on those areas showed a negative impact on the overall job satisfaction [Table 3]. “Clinicians satisfaction with workload” and “time and energy spent on administrative tasks” were found to have a negative effect on job satisfaction. Clinicians who spent longer time on administrative tasks were found to be less satisfied (P = 0.047).
Both surgical and nonsurgical participants have acceptable satisfaction report with workload; however, surgeons were more dissatisfied with the time they spent engaged in administrative activities (P = 0.028) [Table 4]. Participants who considered changing their job to nonmedical one had less job satisfaction (0.247, P = 0.002). In terms of workload and likelihood of shifting career, those who practice both public and private services seem to be satisfied (P = 0.026) [Table 4].
| Discussion|| |
The mainstay of this study was to identify the personal characteristics and job attributes that are associated with the five elements of work satisfaction among different medical specializations. Few previous studies were conducted across different cities in Saudi Arabia, but to the best of our knowledge, none was published discussing this issue in Jeddah, Saudi Arabia.,,, Most of the participants were Saudi (91.2%) which might reflect the dominance of Saudi clinicians in big cities' hospitals in Saudi Arabia. In consonance with other studies conducted locally, job dissatisfaction was highly encountered in Al-Madinah and Al-Munawwara and in Riyadh. 52.4% and 30% of the clinicians were dissatisfied, respectively., In a study conducted in Pakistan, 26% of clinicians were dissatisfied with their profession. In India 26% and in Australia 14.3% of the doctors were dissatisfied about their job. Compared with our results, a higher percentage of dissatisfied clinicians (38%) was encountered. Our results show that age, years of experience, and type of practice-public versus both (public and private work) were the most important predictors of job satisfaction. The low scores reported by young clinicians who have less experience years observed in our study might be due to several causes; less confidence in their work, less income, higher level of expectations, and workload. This finding is also evident in several other studies.,,, Higher levels of satisfaction among older clinicians might be attributed to better adjustment at work. Moreover, survey responses obtained online show generally lower levels of satisfaction among younger respondents than those obtained by other methods. In our opinion, job satisfaction of young clinicians needs to be enhanced further by improving their work environment, as this will pave the way for effective delivery of health care.
Income had a great influence on job satisfaction; our data showed that consultants tended to be more satisfied than specialists. In a study conducted in Riyadh, Saudi Arabia, Aldrees et al. showed similar findings domestically. Leigh et al. and Qianand Lim. reported similar results in the literature internationally. However, another study conducted among breast surgeons in the USA showed no significant relation between job satisfaction and clinicians' income. Gender played a significant role with income in our study; women were significantly less satisfied than men with their income score. We think this might be related to some local cultural factors. In Saudi Arabia, female clinicians usually tend to choose to work in the government sector only compared to their male counterparts who usually, in addition to their government job, work extra hours in the private sector. The obvious reasons for that are the family/social matters that female clinicians have to manage in addition to pursuing their job career. Likewise, Rizvi et al. concur with our results in his study conducted in the USA. Clinicians who work in both private and public sectors (higher income) were more satisfied and had no regret choosing their job specialty when compared to clinicians who worked in private or public only.
Physician's family time and time for personal interests have an influence on satisfaction., In our study, surgeons were less satisfied in general than nonsurgeons although both of them were satisfied with their career. This could be expected as surgical specialties have more work-related burden and less free time. Troppmann et al. outlined that 65.9% of surgeons were not satisfied with the amount of time available for their families, although 85% of them were satisfied about their career.
With regard to workload, our study supports previously reported results in the literature; specialists tended to be less satisfied than consultants. We have found out that a decreasing number of “nights on-call per month” has a positive effect on job satisfaction, although the two were found to have no association in the study conducted by Aldrees et al. in Riyadh. Balch et al. identified the factors that are strongly correlated to burnout and career satisfaction among surgeons. He found out that number of hours worked and nights on call per week appear to have a substantial impact on surgeons, both professionally and personally. Time devoted by clinicians in different activities (time spent in administrative tasks and involvement in research activities) had an effect on the corresponding domain of job satisfaction. As expected, clinicians who spent more time in administrative tasks were less satisfied with work-related “burden.” Our study concurs with many studies demonstrating that administrative work reduces work satisfaction.,, There was no significant impact of marital status and number of children on satisfaction.
One limitation of our study is the involvement of a single hospital. A future multicentric study may give a better view of the predictors of career satisfaction among clinicians in Saudi Arabia. This might limit the ability to generalize our study results.
| Conclusion|| |
More than one-third of the clinicians were generally dissatisfied with their overall job condition. Goals should be directed to improve the elements that adversely affect career satisfaction. Necessary interventions are indicated to improve clinicians' performance in clinical practice, maximize quality of care, and maintain stable workforce.
The authors would like to thank Dr. Shaza Abo'ouf and Mr. Salah Barnawi for their contribution to the statistical analysis of this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Aziri B. Job satisfaction: A literature review. Manage Res Pract 2011;3:77-86.
Spector PE. Job Satisfaction: Application, Assessment, Causes, and Consequences. Thousand Oaks, CA: Sage; 1997.
Locke EA. The nature and causes of job satisfaction. In: Dunnette MD, editor. Handbook of Industrial and Organizational Psychology. 1st
ed. Chicago IL: Rand McNally; 1976. p. 1297-349.
Bhatnagar K, Srivastava K. Job satisfaction in health-care organizations. Ind Psychiatry J 2012;21:75-8.
] [Full text]
Ramirez AJ, Graham J, Richards MA, Cull A, Gregory WM. Mental health of hospital consultants: The effects of stress and satisfaction at work. Lancet 1996;347:724-8.
Sundquist J, Johansson SE. High demand, low control, and impaired general health: Working conditions in a sample of swedish general practitioners. Scand J Public Health 2000;28:123-31.
Haas JS, Cook EF, Puopolo AL, Burstin HR, Cleary PD, Brennan TA. Is the professional satisfaction of general internists associated with patient satisfaction? J Gen Intern Med 2000;15:122-8.
Tanne JH. Income and job satisfaction fall among US doctors. BMJ 2012;344:e3109.
DiMatteo MR, Sherbourne CD, Hays RD, Ordway L, Kravitz RL, McGlynn EA, et al.
Physicians' characteristics influence patients' adherence to medical treatment: Results from the medical outcomes study. Health Psychol 1993;12:93-102.
Peckham C. Medscape 2017 Physician Lifestyle Report; 11 January, 2017. Available from: https://www.medscape.com
. [Last accessed on 2019 Jan 06].
Shanafelt TD, Balch CM, Bechamps GJ, Russell T, Dyrbye L, Satele D, et al.
Burnout and career satisfaction among American surgeons. Ann Surg 2009;250:463-71.
Bovier PA, Perneger TV. Predictors of work satisfaction among physicians. Eur J Public Health 2003;13:299-305.
McMurray JE, Williams E, Schwartz MD, Douglas J, Van Kirk J, Konrad TR, et al.
Physician job satisfaction: Developing a model using qualitative data. J Gen Intern Med 1997;12:711-4.
Al Juhani AM, Kishk NA. Job satisfaction among primary health care physicians and nurses in al-Madinah al-Munawwara. J Egypt Public Health Assoc 2006;81:165-80.
Al-Rubaish AM, Rahim SI, Abumadini MS, Wosornu L. Job satisfaction among the academic staff of a Saudi university: An evaluative study. J Family Community Med 2009;16:97-103.
Kalantan KA, Al-Taweel AA, Abdul Ghani H. Factors influencing job satisfaction among primary health care (PHC) physicians in Riyadh, Saudi Arabia. Ann Saudi Med 1999;19:424-6.
Aldrees T, Al-Eissa S, Badri M, Aljuhayman A, Zamakhshary M. Physician job satisfaction in Saudi Arabia: Insights from a tertiary hospital survey. Ann Saudi Med 2015;35:210-3.
Ashraf H, Shah N, Anwer F, Akhtar H, Abro MA, Khan A. Professional satisfaction of family physicians in Pakistan – Results of a cross-sectional postal survey. J Pak Med Assoc 2014;64:442-6.
Sharma M, Goel S, Singh SK, Sharma R, Gupta PK. Determinants of Indian physicians' satisfaction and dissatisfaction from their job. Indian J Med Res 2014;139:409-17.
] [Full text]
Joyce CM, Schurer S, Scott A, Humphreys J, Kalb G. Australian doctors' satisfaction with their work: Results from the MABEL longitudinal survey of doctors. Med J Aust 2011;194:30-3.
Clark A, Oswald A, Warr P. Is job satisfaction U-shaped in age? J Occup Organ Psychol 1996;96:57-81.
Brown SP, Peterson RA. Antecedents and consequences of salesperson job satisfaction: Meta-analysis and assessment of causal effects. J Mark Res 1993;30:63-77.
Leigh JP, Tancredi DJ, Kravitz RL. Physician career satisfaction within specialties. BMC Health Serv Res 2009;9:166.
Qian F, Lim MK. Professional satisfaction among Singapore physicians. Health Policy 2008;85:363-71.
Bendorf DC, Helmer SD, Osland JS, Tenofsky PL. Income, productivity, and satisfaction of breast surgeons. Am J Surg 2010;199:405-9.
Rizvi R, Raymer L, Kunik M, Fisher J. Facets of career satisfaction for women physicians in the United States: A systematic review. Women Health 2012;52:403-21.
Troppmann KM, Palis BE, Goodnight JE, Ho HS, Troppmann C. Career and lifestyle satisfaction among surgeons: What really matters? The national lifestyles in surgery today survey. J Am Coll Surg 2009;209:160-9.
Caniano DA, Sonnino RE, Paolo AM. Keys to career satisfaction: Insights from a survey of women pediatric surgeons. J Pediatr Surg 2004;39:984-90.
Balch CM, Shanafelt TD, Dyrbye L, Sloan JA, Russell TR, Bechamps GJ, et al.
Surgeon distress as calibrated by hours worked and nights on call. J Am Coll Surg 2010;211:609-19.
Kerr EA, Hays RD, Mittman BS, Siu AL, Leake B, Brook RH. Primary care physicians' satisfaction with quality of care in California capitated medical groups. JAMA 1997;278:308-12.
Kerr EA, Mittman BS, Hays RD, Zemencuk JK, Pitts J, Brook RH. Associations between primary care physician satisfaction and self-reported aspects of utilization management. Health Serv Res 2000;35:333-49.
Mawardi BH. Satisfactions, dissatisfactions, and causes of stress in medical practice. JAMA 1979;241:1483-6.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]