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. 2023 Mar 4;31(4):578–584. doi: 10.1016/j.jsps.2023.02.010

Factors impacting job satisfaction among pharmacists in the Arab world: A qualitative study

Ali Azeez Al-Jumaili a,⁎, Rehab Elhiny b, Dixon Thomas c, Fawzy Elbarbry d, Maher Khdour e, Fatima Sherbeny f, Anas Hamad g
PMCID: PMC10102404  PMID: 37063440

Abstract

Purpose

This study was undertaken to investigate in-depth the factors impacting job satisfaction among pharmacists in the Arab world and the challenges they encounter in their career path. The outcome of this study should help the local policymakers to take corrective actions to improve pharmacist’s satisfaction and therefore enhance quality of patient care.

Method

This qualitative study collected responses of pharmacists from 12 Arab countries, as part of a large quantitative survey. Participants added comments to an optional open-ended question regarding work satisfaction. The Qualtrics Survey Software was used to collect the responses. The survey was distributed from March to May 2021 through multiple online channels for filling. The responses collected were analysed to develop themes. An inductive constructivist approach was used for the conceptual thematic analysis as the methodological orientation.

Results

A total of 110 responses/comments were received from the study participants. The two largest practice settings of the participants were from hospitals (44.5%) and community pharmacies (28.2%). Almost 40% of responses came from pharmacists practising in Qatar (21.8%) and UAE (18.1%). The survey data demonstrated several reasons impacting job satisfaction among pharmacists practising in the Arab countries. Underestimation of the pharmacists' role, low salaries, lack of motivation and excessive workload were reported as major contributors to job dissatisfaction. On the other hand, professional commitment and the culture of the work setting were the major contributors to job satisfaction.

Conclusions

The study provides valuable insights into the aspects concerning pharmacists’ satisfaction in the Arab world. Policymakers and other stakeholders need to act upon aspects of pharmacists’ job satisfaction and dissatisfaction to ensure potentially better working environment and patient outcomes.

Keywords: Pharmacist job satisfaction, Arab World, Qualitative

1. Introduction

Job satisfaction among employees is important in every workplace including healthcare in general and pharmacy profession in particular. Pharmacists are healthcare professionals who provide direct patient care in drug-related matters such as use, storage, adverse effects, and interactions with other medications (Anderson et al., 2011). Nowadays, the pharmacy profession is more patient-centred and integrated with other health care professions. Therefore, Job satisfaction among pharmacists in this interprofessional settings is expected to improve the quality of patient care and the institutional success (Kelly et al., 2014). A quality measure of health care can be based on the structure, process, and outcome of the system. Job satisfaction of employees has been widely used as a quality service indicator to measure process quality. As a result, determining the level of pharmacy professionals' job satisfaction offers insight into the quality of patient care in pharmacy practice settings (Best and Neuhauser, 2004, Nau, 2009).

Health care systems in developing countries have health workers struggling to provide high-quality care to increasing patient loads under increasingly difficult working conditions. Our work and others have previously demonstrated that pharmacists in the Arab world are struggling with shortages of supplies, poor compensation, and inadequate wages (Al-Jumaili, 2022, Hagopian et al., 2009, Rothman and Coetzer, 2002). The most commonly reported influencing factors on pharmacist job satisfaction were low salary compared to the workload (Al-Shaeer et al., 2021, Khaliq et al., 2021) and the Corona Virus Disease 2019 (COVID-19) because of the lack of resources and the fear of infection (Al-Jumaili et al., 2021).

However, governmental and institutional policymakers lack the adequate and in-depth (qualitative) information to enable them to bring legislation and institutional changes in order to address the ongoing job dissatisfaction among pharmacists in the Arab world. Thus, this study was conducted to explore in-depth the factors impacting pharmacists' satisfaction and the challenges they encounter in their career path in the Arab World.

2. Methods

This qualitative research was part of a large survey with items for quantitative analysis (Al-Jumaili et al., 2022). Participants filled an optional open-ended question regarding job satisfaction. The open-ended question was “Do you have any additional comments about job satisfaction in your field?“. The survey was conducted using Qualtrics Survey Software (Qualtrics, Inc, Provo, UT) from March to May 2021. Multiple social media channels including Facebook/Twitter/LinkedIn/WhatsApp groups of pharmacists were used in the Arab World (Iraq, Egypt, Jordan, Lebanon, Palestine, Saudi Arabia, Libya, UAE, Qatar, Oman, Kuwait, Yemen, Bahrain, Syria, Sudan, Tunisia, Algeria, and Morocco). Convenience sampling was used among pharmacy professionals frequently use electronic communication resources. The participation was voluntary, anonymous, and no incentive was offered for participation. This qualitative study was not a comparison between countries in the Arab World, in fact, the Arab World is considered as the population for saturation of themes.

Ethics approvals were obtained from multiple institutions of the researchers; Al-Quds University Faculty of Pharmacy, Palestine (211/REC/2021), Gulf Medical University, UAE (IRB/COP/FAC/47), Hamad Medical Corporation, Qatar (MRC-01–21-227), Jordan University of Science and Technology (41/139/2021), Lebanese International University College of Pharmacy (2020RC-035-LIUSOP), Libyan International Medical University (Phar-7–2021), and University of Baghdad College of Pharmacy (RECAUBCP542021A)

2.1. Data analysis

Thematic analysis of conceptual thematic analysis was used to generate themes from the participant comments. The six phases of thematic analysis described by Braun and Clarke were used for the data analysis, which include familiarizing with data (delving through pharmacist comments), generating initial codes, developing themes, reviewing themes, naming final themes and producing the findings (Braun & Clarke, 2006). Finally, the completed sentences (preferably with examples) were chosen as quotations. Two coders (AA, RH) independently coded the data, and a third coder (FE) did resolve conflicts arise in some codes. Multiple zoom meetings were conducted among coders for triangulation. The methodological orientation was conceptual thematic analysis. An inductive, data-driven approach of constructivist paradigm was used for the study. The research team cross-checked the transcription. The authors did not rely on an existing framework to come up with the themes but constructed the themes from common trends emerging from the participant comments. Finally, peer checking/debriefing was performed twice to validate the findings.

3. Results

The results presented in this study were derived from 110 comments (from a total of 2,137 participants as part of the large quantitative study) of pharmacist survey (Al-Jumaili et al., 2022) where participants were allowed to add any additional comments about job satisfaction via an optional open-ended question. Table 1 shows the characteristics of 110 participants who left comments about factors impacting their work satisfaction including their age, gender, primary affiliation, and country of practice. The two largest portions of the participants were practicing in hospitals (44.5%) or community pharmacies (28.2%) and more than 50% of participation came from pharmacists working in the Gulf area (Qatar, UAE, and KSA).

Table 1.

The demographic information of the study participant.

Characteristics
Age (Years) Mean: 33.5
 Range: 22–65
Subcategories N %
Gender Female 63 57.3%
Male 47 42.7%
Affiliation Hospital 49 44.5%
Community pharmacy 31 28.2%
Industry 13 11.8%
Academic 7 6.4%
Other 6 5.4%
Government 2 1.8%
Unemployed 2 1.8%
Country of practice Qatar 24
 21.8%
UAE 20 18.1%
Lebanon 12
 10.9%
KSA 12 10.9%
Egypt 10
 9.1%
Iraq 10 9.1%
Libya 5 5.5%
Kuwait 4 3.6%
Jordan 3 2.7%
Palestine 3 2.7%
Oman 2 1.8%
Other 2 1.8%
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Participants’ comments created a few themes that lower job satisfaction. Underestimation of the pharmacists' role and low salaries compared to workload were the major themes underlying poor job satisfaction. Lack of motivation and excessive workload, especially in the hospital sector, as well as management issues were reported as contributors to job dissatisfaction. In addition, some participants declared that the COVID-19 pandemic affected their job satisfaction. On the other hand, professional commitment and the area of practice setting were identified as the major contributors to better job satisfaction.

According to the gathered data, we classified the factors contributing to job dissatisfaction among pharmacists of different backgrounds into levels (e.g. society level, area of work, organization/workplace and personal level), then, levels were organized into themes and subthemes as illustrated in Table 2 and explained below.

Table 2.

Main themes and subthemes influencing pharmacist job satisfaction in the Arab world.

graphic file with name fx1.gif
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The first schematic level is the Society level, which incorporates the following themes: under-appreciation of the pharmacy profession, society distrust due to the presence of non-pharmacist intruders, low wages, pharmacists working in other countries, the COVID-19 effect, and professional challenges. Each theme was subdivided into subthemes. For example, the theme of “pharmacists getting a low salary” is subdivided into high workload with low salaries, high risk with low salary and high responsibility for low salary. Similarly, the theme of “pharmacists working outside their countries” is subdivided into subthemes including salary based on nationality, career growth opportunity based on nationality and workload and promotion based on nationality.

The second schematic level is the work area/environment which is subdivided into lack of motivation either in community or hospital settings, favouritism in public sector, lack of social time with work at community pharmacy and blaming culture at the workplace.

The third schematic level is related to the institution, which is divided into themes such as slow career growth/no promotions, high stress, long work hours, organization management, and inadequate managerial training.

The fourth schematic level is the personal issues. including community pharmacy does not meet the expectations of the community pharmacists.

Themes and subthemes are listed in Table 2 and each theme is illustrated through quotations from the participants. In addition, pharmacists are identified by a participant number, the country, the work setting and gender.

3.1. Theme 1: Pharmacy profession is undervalued in the society (N = 20)

A wide range of participants reported feeling that their role as pharmacists in the society is less appreciated in the Arab region compared to physicians, and compared to pharmacists in the western world. The majority of these comments came from pharmacists who practise in the community setting. Approximately 35% of the participants commented that the presence of non-pharmacist intruders is the main reason for this public perception as those intruders may undermine the patients trust toward the pharmacists. Below are select examples of such comments:

“There is no respect for the pharmacist from anyone and not giving his right at all” [P 1090 Community Pharmacy].

“Pharmacy profession is more appreciated in the USA and European countries, but it is less appreciated in our Arabic world” [P 723 other sector]

I hope that the workers in the pharmacy are exclusively pharmacists. The large number of non-pharmacists in pharmacies has led to decrease the value of the certificate and underestimate this profession. I hope that this matter will be brought under control [P1155 Community Pharmacy].

3.2. Theme 2: Pharmacists get low salary (N = 13)

Low salaries compared to the high workload, responsibilities, stress and the risk that the pharmacists may face, especially during the COVID-19 pandemic, is the reason for job dissatisfaction among the respondents. Below are select examples of such comments:

''Salaries for pharmacist should be scaled up to match the average income for such profession worldwide'' [P 445 Academia/Research]

“Too much work and very little income'' [P 584 Community Pharmacy]

''I prefer the salary should be high for pharmacists; the wage we get is less when compared to our stress and strain. We are the health professionals who work during this COVID-19. We work for the people who are ill with no hesitation. We have sacrificed our lives and health for the better of society and country and hope we will get a benefit from our work'' [P1358; Community Pharmacy]

3.3. Theme 3: Pharmacists facing discrimination when working outside their countries (N = 4)

The respondents stated that they suffer from discrimination when working in a different country other than their birth country. This discrimination was reflected in lower salary rare opportunities for career growth and promotions, and higher workload. Below are select examples of such comments:

''There is total discrimination where they are calculating salaries not by experience or hard work but only by nationality'' [P2049; Hospital Pharmacy]

“Discrimination based on nationality on the same position in terms of the benefits package and workload, promotion pathway is stagnant” [P1475; Hospital Pharmacy]

3.4. Theme 4: Impact of the COVID-19 pandemic on job satisfaction (N = 5)

COVID-19 has a detrimental impact on the satisfaction level among the respondents to the extent that some respondents stated that their satisfaction level was significantly reduced during the pandemic because of the economic recession and the stressful conditions they encountered. Below is a select exampleof such comments:

“The current economic situation has drastically decreased my satisfaction with my work. My salary has lost its value, but my responsibilities are still the same or even more. I am mentally drained due to remote work because of COVID-19 along with the very bad economic situation. I used to love my job and was very satisfied, but not anymore!!” [P162; Academia/ Research]

3.5. Theme 5: Lack of motivation (16)

Poor job satisfaction has been linked with the lack of innovation especially in the community pharmacy sector. Respondents stated that the repeated routine in the community pharmacy setting restricts any new ideas in the pharmacy profession. In addition, underutilization of the clinical skills in the community sector where most of the time is spent on the dispensing of medications rather than providing clinical service. Below are select examples of such comments:

''Routine and lack of anything new and space for us to go innovative'' [P718; Community Pharmacy]

“Community Pharmacy rob away the soul of being a pharmacist as a profession; it always focuses on sales and the use of the actual pharmacist during opening hours” [ P1643; Community Pharmacy]

3.6. Theme 6: Bias in the public sector (N = 5)

Participants expressed their feeling of injustice and inequality among employees especially in the public sector. Such problem usually leads to unequal opportunities and lack of career advancements among employees. Below is a select example of such comments:

“There is a lot of injustice when it comes to working in governmental hospitals. if you don’t have a strong connection to the manager or to whoever is in charge of the sector you work in, you will be treated like a slave.. the environment surrounding our workplace is toxic and there’s nothing to do about it” [ P69; Hospital Pharmacy]

3.7. Theme 7: High workload in hospital pharmacy (N = 1)

Most respondent reported that their workload is high especially in the hospital pharmacy sector. This was attributed to the inadequate number of pharmacists in relation to patients’ number and workload needed. Below is a select example of such comments:

“There are some barriers that prevent the clinical pharmacists from practicing their role: there number is lower than the number of patients and the hospital managers ignore the pharmacist reports and their needs to improve the quality of the healthcare provided” [P 8; Hospital Pharmacy]

3.8. Theme 8: Institutional issues (N = 6)

Lack of career progression, high stressful conditions and long working hours were strongly associated with the dissatisfaction among the respondents. Below are select examples of such comments:

''I am working under very high stress, no off days (one day every month), Always night shift. This has very bad effects on my health. The company does not care about that. They care only about money. The biggest chain of pharmacy in this country is not good with the pharmacists and all afraid to talk'' [P1803; Community Pharmacy]

''You spend lots of years at the same position'' [P620: Hospital Pharmacy]

3.9. Theme 9: Organization management effect (N = 18)

Managers play an integral role in creating a healthy and prosperous working environment and determining employees’ turnover rate. Therefore, poor management and lack of managerial experience/training were among the reported reasons for job dissatisfaction. Below are select examples of such comments:

“A good manager will always have the big picture in mind and guide the employees through a series of small targets to achieve overall success” [P 1287; Hospital Pharmacy]

''A lot of our pharmacist colleagues, who fill in managerial positions has never received courses about management, therefore finding a variety of difference in management styles. One can be a good pharmacist, but not necessarily a good manager or leader''. [P1357; Hospital Pharmacy]

3.10. Theme 10: Pharmacy education issue (N = 2)

One of the reported issues is the outdated courses being taught to the pharmacy curricula in most Pharmacy schools in the Arab countries. Some participants stated that there is a huge gap between what they had learned in pharmacy school and what is actually expected from them in their practice sites. Below is a select example of such comments:

“There is a difference between what I had studied in the pharmacy college and the real work, therefore you need to start learning everything from the beginning” [P228; Other health care sector]

3.11. Theme 11: Practice setting (N = 4)

It seems that the working sector influences pharmacists' satisfaction levels. Compared to pharmacists working in industry or community settings, clinical pharmacists were more satisfied because they can provide patient care and apply their clinical knowledge. Similarly, job satisfaction by community pharmacists improves when their service is appreciated by patients and supervisors. Below are select examples of such comments:

“Highly satisfied with my career as clinical pharmacist” [P1452; Hospital Pharmacy]

“I like my job because of the patients prays for me; however, I hate negativity and illegal sale of expired medications in some pharmacies” [P 491; Community Pharmacy]

4. Discussion

In this qualitative study, we were able to identify many themes related to job satisfaction among pharmacists in the Arab world. Though most of these themes were also identified to affect pharmacist job satisfaction globally, the contents discussed in this study were peculiar to the current practice context in the Arab World. While many other regions in the world made significant progress (Caroline A. Gaither, 2015), pharmacists surveyed in this study expressed concerns that need action plans from health authorities and government agencies. Findings from similar studies are discussed below to reinforce our exploratory research.

The pharmacy profession in the Arab World faces several challenges and professional services offered by pharmacists are one of the main areas which were overlooked (Al-Ghananeem et al., 2018, Al-Shaeer et al., 2021, Al-Jumaili, 2022, Hasan et al., 2011). Another study revealed that public awareness of pharmacy services needs improvements even in developed countries (Rodgers et al., 2016). Therefore, it is not surprising to find out that pharmacists face moral dilemmas because their autonomy in making clinical decisions is challenged by patients and other healthcare professionals (Kruijtbosch et al., 2018). These findings are similar to theme 1 we identified in this research. Many pharmacists were concerned about lack of social recognition and appreciation of their clinical services. The good news is that acknowledgment and respect to pharmacists are identified as modifiable factors that pharmacists can control (Gregory & Austin, 2021). Efforts for the value creation of pharmacy services need to be more systematic and intense. Regulation should be even more strictly implemented that unqualified practitioners are appropriately disciplined and removed from any pharmacy practice settings. Other healthcare professionals and the public need to be aware of what pharmacists can offer to improve healthcare (Babar, 2021). All of these efforts are expected to assure the quality of pharmacy services and build the trust and respect of society.

The low salary was a major concern for pharmacists in this study identified as theme 2. Financial income was a big influencer on how much risk people took on their jobs. Many of the study participants were willing to take more stress at work if it came with financial incentives. This finding is in agreement with other studies that also identified low salary as being a major factor for pharmacist dissatisfaction at work (Balkhi et al., 2017). Similarly, pharmacy students perceive that having an attractive salary influences their career choices (Gregory & Austin, 2021). On the contrary to the situation in the Arab World, a study from the USA shows the projected career salary of pharmacists is better in the community setting compared to the academic setting (Chisholm-Burns et al., 2016). Remuneration for pharmacist work is one of the most important issues to be addressed to improve pharmacist job satisfaction in the Arab World.

As per theme 3 of this study, working outside their countries added equity issues for pharmacists. Some pharmacists in this study believed that they get different salary scales when they work outside their native country. There were many factors noticed by some pharmacists used as measures of salary determination that need further research and policy reform.

Our findings per theme 4 of this study indicated that the COVID-19 pandemic affected the morale of healthcare professionals, and participants felt like it has been difficult to work during the pandemic due to stress and/or lack of resources. Earlier reports documented more pharmacists job dissatisfaction during the pandemic because of stress and burden at the workplace [(Chisholm-Burns et al., 2016) (Afulani et al., 2021). Similarly, job dissatisfaction has been aggravated by the lack of resources and fear of COVID-19 infection (Algunmeeyn et al., 2020). The COVID-19 pandemic has significantly impacted the social norms of healthcare providers (Al-Jumaili et al., 2021). Therefore, maintaining the expected quality of pharmacy services was challenging (Al-Jumaili et al., 2021, Gregory and Austin, 2020, Noor Raouf Al-Hasani, 2022).

Practising at community and hospital pharmacy settings was perceived as redundant as per theme 5. The long time spent managing regular and repeated pharmacy work restricts adding professional services to pharmacy practice, especially when pharmacists are faced with chronic high workload and routine dispensing (Lea et al., 2012). High workload increases chances of errors that worsen job satisfaction and add to existing stress (Carrez et al., 2019). Underutilizing pharmacy services in the healthcare system other than the basic pharmacist responsibilities is a general concern among the pharmacy workforce (Assiri et al., 2021). Promotion opportunities add to the factors that motivate pharmacists at work. Being satisfied at work due to some reasons is a motivator to continue to put in efforts that generate more satisfaction (Slimane, 2017). Clinical pharmacists, in general, are satisfied with their work due to the possibility of working more closely with other healthcare professionals and relatively better income (Nguyen-Thi et al., 2021).

Along with the global evolution of adding more professional patient-care services to pharmacist portfolio, a radical change shall happen to community and hospital pharmacy settings in the Arab World.

As theme 6, equity at public settings of work was also a concern identified in this study. Fairness in the workplace is a major concern for pharmacists' job dissatisfaction. Managers at various pharmacy practice settings hold important responsibilities in providing equal opportunities to all pharmacists. Any favouritism at work is perceived as an equity issue.

Themes 7, 8, and 9 show high workload and organizational issues. This study also showed lack of leadership skills of managers has negative impact on pharmacist job satisfaction. Managers play a major role in keeping up the self-esteem of pharmacists at work (Carvajal & Popovici, 2018). Several studies have shown that the managerial and administrative factors are key elements of job satisfaction and employee retention (Al-Jumaili, 2022, Berassa et al., 2021). Even satisfied pharmacists at work might also have an intention to leave their workplace if they experience moral hazard due to poor administrative support (Al-Muallem & Al-Surimi, 2019). Organizational factors are complex and need to be studied contextually, considering situational factors of the Arab World.

Pharmacy education and continuing education also contribute to work effectiveness and progress as per theme 10. Pharmacy education should be customized to meet the evolving learning objectives of pharmacy students and match the modern technology of pharmacy carrier given that some Arabic schools of pharmacy are still working to enhance their teaching technology (Ahmed et al., 2020, Al-Jumaili et al., 2021, Ahmed, 2021). Opportunities for career development and continuing education are a factor of job satisfaction (Payakachat et al., 2011). Pharmacists who are satisfied with their pharmacy education are also satisfied with their duties as they believe their education enabled them to perform their duty appropriately (Gustafsson et al., 2021). Pharmacists who advance their career with added qualifications (certification, residency), and professional privileges (vaccination, limited-prescribing) are likely to be more satisfied with their professional choice (Gustafsson et al., 2021).

Theme 11 reiterates variations at areas of work or setting. Quality of practice varies considerably which calls for immediate action.

The major limiting factor of or study is the fact that participation was only limited to pharmacists who have access to internet and active of social media platforms. Therefore, the findings of our study may not be accurately applied to all practising pharmacists in the Arab world.

5. Conclusion

This study is the first to provide in-depth exploration of key factors impacting job satisfaction among pharmacists in the Arab world. Among the most frequently cited factors are underestimation of the pharmacists' role, non-pharmacist intruders working as pharmacists, low salary, lack of motivation, work outside the country of nationality, slow career growth, inadequate leadership onsite, stressful work conditions, blame culture, impact of the COVID-19 pandemic, and outdated pharmacy curriculum and lack of sufficient experiential education in pharmacy schools. The author strongly urges local policy makers and stakeholders to take our findings into consideration in order to implement changes that improve pharmacist job satisfaction, and therefore patient care.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgments

Acknowledgement

The authors would like to thank all pharmacists who helped in collecting the data: Dr. Bushra Hijazi (Jordan), Dr. Mohamad Rahal (Lebanon), Dr. Salma Bukhatwa (Libya), and Dr. Sherief Khalifa (UAE). The authors would like to thank the editor and editorial board members of the Saudi Pharmaceutical Journal for their help to publish this research article.

Footnotes

Peer review under responsibility of King Saud University.

Appendix A

Supplementary data to this article can be found online at https://doi.org/10.1016/j.jsps.2023.02.010.

Contributor Information

Ali Azeez Al-Jumaili, Email: ali.baraak@copharm.uobaghdad.edu.iq.

Rehab Elhiny, Email: rehab.hassan@mu.edu.eg.

Dixon Thomas, Email: dr.dixon@gmu.ac.ae.

Fawzy Elbarbry, Email: fawzy.elbarbry@pacificu.edu.

Maher Khdour, Email: mkhdour@staff.alquds.edu.

Fatima Sherbeny, Email: fatimah.sherbeny@famu.edu.

Anas Hamad, Email: ahamad6@hamad.qa.

Appendix A. Supplementary material

The following are the Supplementary data to this article:

Supplementary data 1
mmc1.pdf (705.3KB, pdf)

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