Understanding U.S. Physician Satisfaction: State of the Evidence and Future Directions:

Health Occupation and Job Satisfaction: The Impact of Psychological Capital in the Management of Clinical Psychological Stressors of Healthcare Workers in the COVID-19 Era

The COVID-19 pandemic greatly impacted global health. Frontline healthcare workers involved in the response to COVID-19 faced physical and psychological challenges that threatened their wellbeing and job satisfaction. The pandemic crisis, alongside pre-existing critical issues, exposed healthcare workers to constant emotional fatigue, creating an increased workload and vulnerability to stress. Maintaining such stress levels increased their levels of anxiety, irritability and loneliness. Evidence shows that the Psychological Capital (PsyCap) was a strong protective factor against these stressors. The aim of this study was to analyze the level of job satisfaction among health workers facing the COVID-19 pandemic. The possible antecedent factors to satisfaction and the role that PsyCap plays in preserving and fostering higher levels of job satisfaction were investigated. A total of 527 healthcare workers from different areas of Italy were recruited for the study. The results revealed that psychological stress factors have a considerable impact on job satisfaction. All four predictors (Stress Vulnerability, Anxiety Symptoms, Loneliness and Irritability) had the potential to decrease job satisfaction. Loneliness had a more significant effect than other factors assessed in this study. Moreover, the results showed how PsyCap could decrease the effects of psychological stressors on job satisfaction. Consistent with previous studies, our findings show that PsyCap could alleviate negative impacts in work-related circumstances.

Job Satisfaction Among Employees After a Merger: A Cross-Sectional Survey in the Local Health Unit of Sardinia Region, Italy

Job satisfaction plays an important role in healthcare organization and management; it is critical for maintaining and improving staff efficiency and consequently the quality of care provided. Organizational restructuring processes, including mergers, are likely to affect job satisfaction levels, but evidence of the impact they have is surprisingly scarce. The aim of the study was to describe a methodology used to measure job satisfaction of the employees at a Local Health Unit (LHU) in Italy immediately after a merger and to assess the determinants associated with any reduction in worker satisfaction. The study was conducted among employees of the LHU of the Sardinia Region in July 2018, after a merger of eight subregional LHUs had taken place. The entire staff was enrolled, of which a total of 1,737 employees were surveyed. We used a questionnaire exploring socio-demographic and working characteristics of the employees, the various areas related to job satisfaction and interviewee opinions on the merger process. Multivariable stepwise backward logistic regression models were built to identify factors independently associated with lower job satisfaction. The results of a multivariable analysis showed that lower job satisfaction was more likely in employees with an administrative role (aOR: 2.34, 95% CI: 1.37-4.00) or a career demotion (aOR: 1.84, 95%CI: 1.11-3.03). High levels of mental stress were strongly associated with lower job satisfaction (aOR: 5.64, 95%CI: 4.16-7.64). "More equity of employee rewards" was the only example of a set of responder suggestions found to be associated with lower job satisfaction (aOR: 2.30, 95%CI: 1.51-3.47). Generally, responders showed a good level of job satisfaction-and this was also the case following the merger-but some job profile determinants were strongly associated with low employee satisfaction. The results of the study highlighted several challenging areas and critical issues relating to working conditions. Further surveys are required to confirm these results and to monitor their evolution over time.

Satisfaction of young ENT surgeons with their work. A Finnish national study

The objective was to investigate work satisfaction among recently graduated otorhinolaryngologist – head and neck surgeons – (ENT surgeons). An electronic questionnaire was sent to all ENT surgeons graduated in Finland during a ten-year period. Answers about work satisfaction were analyzed in detail with regards to age, gender, university of specialist training, experience, place of work and further education.Altogether 125/129 (96.9%) responded. The majority (87.8%) of the respondents enjoyed their current main occupation. The older age group (≥40 vs <40 years) was more satisfied (93.7% vs. 81.7%; p=0.042). Consultation opportunities and workplace atmosphere were reported as good by 85.6% and 90.4% of the respondents, respectively. Training opportunities were considered good by 82.4%, albeit by only 60% of the private physicians (p=0.047). Private sector practitioners were also less satisfied with the versatility of their work (p<0.001). Work at a university hospital was considered more strenuous (p<0.001). Over half (54.8%) felt insecure about continuation of their employment status. Most of the recently graduated Finnish ENT surgeons are satisfied with their current occupation, consultation opportunities and workplace atmosphere. However, work at university hospitals in particular was considered often strenuous and over half of the respondents felt insecure about the continuity of their employment.

Issues Faced by Senior Women Physicians: A National Survey

Background: As the first large numbers of female physicians complete their careers, information is needed to enable institutions and individuals to optimize the final career phase and transition to retirement of these women, as well as to help younger women physicians prepare for later phases of their careers. Materials and Methods: To identify the leading issues for older female physicians, a 34-item electronic questionnaire covering heath, finances, preparation for and attitudes about retirement, caretaking responsibilities, life-work integration, various aspects of discrimination and harassment, professional isolation, and work-related stress and burnout-incorporating standardized measures of career satisfaction was distributed through the Kansas Medical Society and nationally through the American Medical Association Senior Physicians Section newsletter to female physicians older than 60 years in 2018. A total of 155 physicians self-identified as eligible and completed at least half of the survey. Results: Respondents were 60-87 years of age, mean 70.4 (±6.4) years. The majority reported good health and being financially well prepared for retirement. Twenty percent were caretakers for grandchildren, parents, or spouses. Measures of career and job satisfaction were reasonably high, despite negative work environment and burnout scores. Problems with family/career balance, age- and gender-based discrimination and harassment, salary inequity, and professional isolation persisted throughout their careers, but diminished in frequency for senior women. Conclusions: Issues faced by younger women physicians do not disappear with age or seniority. To recruit and support female physicians, issues such as balancing family/work responsibilities, combating harassment and bias, and promoting healthy work environments must be addressed throughout their entire careers.

Indicators Associated With Job Morale Among Physicians and Dentists in Low-Income and Middle-Income Countries: A Systematic Review and Meta-analysis

IMPORTANCE

Improving health care in low- and middle-income countries (LMICs) requires a workforce with positive job morale. However, the level of job morale in this population remains unclear.

OBJECTIVE

To analyze studies measuring the job morale of physicians and dentists working in LMICs, using levels of job burnout, job satisfaction, and job motivation as indicators of job morale.

DATA SOURCES

A comprehensive search of Scopus, PubMed, PsycINFO, EMBASE, Web of Science, and the Cochrane Library, from database inception to October 30, 2018, and gray literature was performed.

STUDY SELECTION

Studies were eligible if at least 50% of the sample were qualified physicians and/or dentists working in public health care settings in LMICs. Three indicators of job morale in this population were used: job burnout, job satisfaction, and job motivation. Of 12 324 records reviewed, 79 studies were included in the systematic review and 59 were eligible for the meta-analysis.

DATA EXTRACTION AND SYNTHESIS

Data were extracted independently by several investigators in accordance with the Meta-analyses of Observational Studies in Epidemiology (MOOSE) reporting guidelines. Random-effects meta-analyses, planned subgroup analyses, and metaregression were performed. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess bias.

MAIN OUTCOMES AND MEASURES

Levels of job burnout, job satisfaction, and job motivation as indicators of job morale.

RESULTS

Overall, 12 324 records were identified. Of them, 80 records, representing 79 studies and involving 45 714 participants across 37 LMICs, met the inclusion criteria for the review; however, only 3 were from low-income countries. In 21 studies with 9092 participants working mainly in middle-income countries, 32% (95% CI, 27%-38%; I2 = 95.32%; P < .001) reported job burnout, and in 20 studies with 14 113 participants, 60% (95% CI, 53%-67%; I2 = 98.21%; P < .001) were satisfied with their job overall. Sufficient data were not available for a meta-analysis of job motivation.

CONCLUSIONS AND RELEVANCE

The findings suggest that, among physicians and dentists working mainly in middle-income countries, more than half reported having positive job morale. Positive job morale among physicians and dentists may help with recruitment and retention and thus support programs for improving health care in LMICs.

Physicians' satisfaction with providing buprenorphine treatment

Background

Buprenorphine is a critically important treatment for addressing the opioid epidemic, but there are virtually no studies of physicians’ job satisfaction with providing buprenorphine. Physicians’ job satisfaction has been linked to burnout and turnover as well as patients’ adherence to treatment recommendations, so it is important to understand how physicians’ satisfaction with providing buprenorphine treatment compares to their overall job satisfaction.

Methods

As part of a cluster randomized clinical trial (RCT) focused on expanding access to medication for opioid use disorder, 55 physicians working in 38 organizations in Florida, Ohio, and Wisconsin completed a baseline web-based survey. Study measures included global job satisfaction, career satisfaction, and specialty satisfaction. Physicians who were waivered to prescribe buprenorphine were asked to rate their satisfaction with their current buprenorphine practice.

Results

Overall, physicians were generally satisfied with their jobs, their careers, and their specialties. When waivered physicians (n = 40) were compared to non-waivered physicians (n = 15) on 13 satisfaction items, there were no statistically significant differences. Among waivered physicians, ratings for buprenorphine work were significantly lower than ratings for general medical practice for finding such work personally rewarding, being pleased with such work, and overall satisfaction.

Conclusions

Although waivered and non-waivered physicians both reported high global job satisfaction, these data suggest that some waivered physicians may view their buprenorphine work as somewhat less satisfying than their global medical practice. Given that job dissatisfaction is a risk factor for turnover and burnout, managers of treatment organizations should consider whether strategies may be able to mitigate some sources of lower satisfaction in the context of buprenorphine treatment.

Trial registration ClinicalTrials.gov. NCT02926482. Date of registration: September 9, 2016. https://clinicaltrials.gov/ct2/show/NCT02926482

Satisfaction of physicians working in hospitals within the European Union: state of the evidence based on systematic review

BACKGROUND

Despite the wide range of studies concerning physician satisfaction in different European countries, there is a lack of literature reviews synthesizing and analyzing current evidence evaluating satisfaction of physicians working in European hospitals. The goal of our research was to provide a general overview of the studies in this area and their results.

METHODS

We searched MEDLINE, Embase, PsycINFO, CINAHL and the Cochrane Library from January 2000 to January 2017 including both MESH/Emtree terms and free text words related to the subject with no language restrictions. The eligibility criteria included: (i) target population: physicians working in European hospitals, (ii) quantitative research aimed at assessing physician satisfaction and (iii) validated tools. We performed a narrative synthesis and meta-analysis.

RESULTS

A total of 8585 abstracts and 368 full text articles were independently screened by 2 reviewers against inclusion/exclusion criteria. Finally 61 studies were eligible for qualitative analysis. Included studies enrolled a total of 50 001 physicians from 17 countries. Sample sizes varied between 54 and 7090 participants (median: 336). According to our review ∼59% of physicians working in European hospitals are overall satisfied, 3.54 was the mean satisfaction among studies reporting data on a scale from 1 to 5, 4.81 for studies with a scale from 1 to 7, 6.12 among studies reporting data on a scale from 1 to 10, and 59.65 among studies with a scale from 0 to 100.

CONCLUSIONS

The level of physician satisfaction in Europe is moderate. There is a large variety of tools and scales used to assess it.

Moms in medicine: Job satisfaction among physician-mothers in obstetrics and gynecology

BACKGROUND

Physician satisfaction is linked to positive patient outcomes. Mothers form an increasing fraction of the obstetrics and gynecology (ob/gyn) workforce.

OBJECTIVE

Define factors that affect physician satisfaction among ob/gyn physicians who are also mothers.

METHODS

We constructed and validated a Redcap survey and invited members of online ob/gyn-mom groups to participate. Characteristics of participants' professional and personal lives were evaluated for possible association with the satisfaction outcomes. Comparison testing was performed using Chi-squared test or Fisher's exact test for categorical variables, Student's t-test for parametric variables, and Wilcoxon Rank-Sum test for non-parametric variables.

RESULTS

Responses were received from 232 participants. A majority reported being unsatisfied with their time to spend with children (66%), partner (70%), and on personal hobbies/activites (75%). Eighty-percent rate professional morale as very/somewhat positive. Women who rated their morale as very/somewhat positive worked fewer hours per week than women with neutral/negative responses (43.6 vs 49.7, p = 0.01). Women with positive morale were also less likely to work over 50 h/week (39.5% vs 56.8%, p = 0.04).

CONCLUSIONS

Ob/gyn physician-mothers have high professional morale but are dissatisfied with time for extra-professional activities. Longer clinical hours correlate with dissatisfaction based on several measurements.

Factors Associated with Satisfaction of Hospital Physicians: A Systematic Review on European Data

BACKGROUND

Physician satisfaction is a multidimensional concept related to many factors. Despite the wide range of research regarding factors affecting physician satisfaction in different European countries, there is a lack of literature reviews analyzing and summarizing current evidence. The aim of the article is to synthetize the literature studying the factors associated with physician satisfaction.

METHODS

We searched: MEDLINE, Embase, PsycINFO, CINAHL and the Cochrane Library from January 2000 to January 2017. The eligibility criteria included: (1) target population: physicians working in European hospitals; (2) quantitative research aimed at assessing physician satisfaction and associated factors; (3) use of validated tools. We performed a narrative synthesis.

RESULTS

After screening 8585 records, 368 full text articles were independently checked and finally 24 studies were included for qualitative analysis. The included studies surveyed 20,000 doctors from 12 European countries. The tools and scales used in the analyzed research to measure physician satisfaction varied to a large extent. We extracted all pre-specified factors, reported as statistically significant/non-significant. Analyzed factors were divided into three groups: personal, intrinsic and contextual factors. The majority of factors are modifiable and positively associated with characteristics of contextual factors, such as work-place setting/work environment. In the group of work-place related factors, quality of management/leadership, opportunity for professional development and colleague support have been deemed statistically significant in numerous studies.

CONCLUSIONS

We identified more studies appraising the effect of contextual factors (such as work environment, work-place characteristics), highlighting a positive association between those factors and physician satisfaction, compared with personal and intrinsic factors. Numerous studies confirmed statistically significant associations between physician satisfaction and quality of management, professional development and colleague support/team climate. Due to the health workforce crisis, knowledge regarding physician satisfaction and associated factors is essential to healthcare managers and policy makers for more stable human resources management.

Finding meaningful work in difficult circumstances: A study of prison healthcare workers

Prisons are rigidly structured institutions housing-in some cases-violent and unstable residents. To discover the positive job attributes and perceived challenges in this extreme practice environment, we employed exploratory qualitative content analysis on the written-in responses of 269 prison health workers in one state's Department of Corrections. Two researchers independently analyzed and coded the data. Using an iterative process, we categorized the responses into themes and critical underlying meanings. Positive job attributes included meaningful work, stability, variety of ailments treated, and feelings of support. Perceived challenges included ineffective leadership, constraints on the ability to effectively execute the role, perceived inequity, and organizational culture. The results of our study suggest that there are lessons to be learned from correctional health workers that could inform policy and management outside of the prison walls specifically as it pertains to motivating and engaging providers through meaningful work. Specifically, health organizations would improve the experience of their clinicians by offering a broader scope of practice experience, schedule stability, reducing bureaucratic redundancies, and-ultimately-restoring the sense of purpose within the work itself.