Abstract
This cross-sectional survey study examines the factors associated with satisfaction at work in academic health care centers.
Mounting evidence suggests that faculty in medicine are increasingly unhappy, dissatisfied, and burned out.1 Although purported to be a national crisis, the actual understanding of the origins, consequences, and effective approaches to prevent and treat burnout remains limited.2,3 Academic medical centers have a tripartite mission to provide high-quality clinical care, to advance knowledge through research, and to train the next generation of health care professionals, each in the context of increased financial pressures and administrative burdens.4 Comprehending what factors are associated with satisfaction at work in academic health care centers is an important step toward addressing faculty burnout.
Methods
We conducted an online cross-sectional confidential survey in June 2016 of all 988 faculty members holding full-time appointments in the Department of Medicine at the Massachusetts General Hospital to examine the culture of workplace respect, collegiality, satisfaction, and mentoring. The primary outcome was each faculty member’s overall professional satisfaction (measured on a scale from very unsatisfied to very satisfied), and the secondary outcome was that member’s reported sense of feeling valued (measured on a scale from strongly disagree to strongly agree). Using multivariable logistic regression (SAS, version 9.4; SAS Institute Inc), we examined the associations of these outcomes with demographic information; personal and professional characteristics; and perceptions of leadership, diversity, collegiality, and collaboration, together with other domains associated with mentoring (experience and quality of mentorship, and role as a mentor) that were reported elsewhere.5 The final models included only those with a bivariate P < .10 from χ2 tests. All P values were from 2-sided tests and results were deemed statistically significant at P < .05. The Partners Healthcare Institutional Review Board approved this study (protocol number: 2016P000935). The Partners Healthcare Human Research Committee determined that the project met the criteria for institutional review board exemption because the research was limited to the use of survey data and was not subject to US Food and Drug Administration regulations, and there was not more than minimal risk to study participants. Completion of the survey was considered implied consent of participation. All data used were strictly anonymized; only a research coordinator, who was not involved in this study, had access to the file linking responses with identifiers.
Results
A total of 553 faculty members (56.0%) responded (Table 1); respondents were similar in sex and rank to the full Department of Medicine faculty. Multivariable analyses identified the following factors that were significantly associated with job satisfaction: feeling valued (odds ratio [OR], 4.73; 95% CI, 2.35-9.51), feeling treated with respect (OR, 3.45; 95% CI, 2.07-5.75), and working in a social and supportive environment (OR, 1.80; 95% CI, 1.05-3.09) (Table 2). Sex, race/ethnicity, and rank were not significantly associated with satisfaction after controlling for other factors. The following variables were significantly associated with outcome of feeling valued: feeling cared about as a person (OR, 28.0; 95% CI, 15.3-51.3), not feeling taken for granted (OR, 4.52; 95% CI, 2.28-8.97), feeling resources were provided for his or her professional growth (OR, 2.38; 95% CI, 1.16-4.89), and not feeling discriminated against by sex (OR, 2.29; 95% CI, 1.02-5.16). Race/ethnicity, rank, and feeling fairly compensated were not independently associated with feeling valued.
Table 1. Respondent Characteristics.
| Characteristic | No./Total No. (%) | No. (%) |
|---|---|---|
| Respondents (n = 553)a | MGH DOM (N = 988)b | |
| Demographics | ||
| Sexb | ||
| Male | 308 (55.7) | 571 (57.8) |
| Female | 245 (44.3) | 417 (42.2) |
| Race/ethnicity | ||
| Nonminorityc | 514/547 (94.0) | NA |
| Minority | 33/547 (6.0) | NA |
| Professional characteristics | ||
| Rankb | ||
| Instructor | 245/549 (44.6) | 497 (50.3) |
| Assistant professor | 167/549 (30.4) | 258 (26.1) |
| Associate professor | 79/549 (14.4) | 137 (13.9) |
| Professor | 58/549 (10.6) | 96 (9.7) |
| Degree | ||
| MD or PhD | 46/552 (8.3) | NA |
| MD or higher | 427/552 (77.4) | NA |
| PhD or higher | 71/552 (12.9) | NA |
| Other | 8/552 (1.4) | NA |
| Satisfaction with current position | ||
| Very satisfied | 158/501 (31.5) | NA |
| Satisfied | 218/501 (43.5) | NA |
| Not satisfied or neutral | 125/501 (25.0) | NA |
| Respect and value | ||
| Feel treated with respect | ||
| Strongly agree | 231/497 (46.5) | NA |
| Somewhat agree | 148/497 (29.8) | NA |
| Disagree or neutral | 118/497 (23.7) | NA |
| Feel valued | ||
| Strongly agree | 181/500 (36.2) | NA |
| Somewhat agree | 177/500 (35.4) | NA |
| Disagree or neutral | 142/500 (28.4) | NA |
Abbreviations: DOM, Department of Medicine; MGH, Massachusetts General Hospital; NA, not available.
Percentages among respondents to each characteristic question.
For the DOM population, sex and rank were from the faculty affairs tracking database; race/ethnicity and degree were not available from this database. For the survey respondents, sex and rank were from survey responses, supplemented (ie, missing data) by the tracking database.
Nonminority includes white and Asian individuals.
Table 2. Multivariable Analysis of Professional Satisfaction and Reported Sense of Feeling Valued.
| Outcome | OR (95% CI) | P Value |
|---|---|---|
| Dichotomized outcome associated with being very satisfied with current position | ||
| Sex | ||
| Female | 1 [Reference] | |
| Male | 1.53 (0.93-2.52) | .09 |
| Rank | ||
| Instructor | 1 [Reference] | |
| Assistant professor | 0.76 (0.43-1.35) | .34 |
| Associate professor | 0.94 (0.46-1.95) | .88 |
| Professor | 1.63 (0.74-3.56) | .22 |
| Feel valued by leadership | ||
| Disagree or neutral | 1 [Reference] | |
| Strongly agree | 4.73 (2.35-9.51) | <.001 |
| Feel treated with respect by the DOM | ||
| Disagree, neutral, or somewhat agree | 1 [Reference] | |
| Strongly agree | 3.45 (2.07-5.75) | <.001 |
| Feel cared about as a person by division leadership | ||
| Disagree, neutral, or somewhat agree | 1 [Reference] | |
| Strongly agree | 0.85 (0.42-1.70) | .64 |
| Work in a social and supportive environment | ||
| Disagree, neutral, or somewhat agree | 1 [Reference] | |
| Strongly agree | 1.80 (1.05-3.09) | .03 |
| Feel comfortable raising personal and/or family responsibilities | ||
| Disagree, neutral, or somewhat agree | 1 [Reference] | |
| Strongly agree | 1.59 (0.92-2.77) | .10 |
| Socially interact with colleagues after work hours | ||
| Disagree, neutral, or somewhat agree | 1 [Reference] | |
| Strongly agree | 1.16 (0.50-2.65) | .73 |
| Dichotomized outcome associated with strong agreement to sense of feeling valued | ||
| Feel cared about as a person by division leadership | ||
| Disagree, neutral, or somewhat agree | 1 [Reference] | |
| Strongly agree | 28.0 (15.3-51.3) | <.001 |
| Leadership takes me for granted on a regular basis | ||
| Disagree, neutral, or agree | 1 [Reference] | |
| Strongly disagree | 4.52 (2.28-8.97) | <.001 |
| Career hampered by discrimination related to sex | ||
| To a great extent or some extent | 1 [Reference] | |
| Very little or not at all | 2.29 (1.02-5.16) | .046 |
| Career hampered by discrimination related to race/ethnicity | ||
| To a great extent or some extent | 1 [Reference] | |
| Very little or not at all | 0.73 (0.16-3.28) | .68 |
| Leadership provides resources for professional growth | ||
| Disagree, neutral, or somewhat agree | 1 [Reference] | |
| Strongly agree | 2.38 (1.16-4.89) | .02 |
| Leadership compensates me fairly | ||
| Disagree, neutral, or somewhat agree | 1 [Reference] | |
| Strongly agree | 1.38 (0.65-2.92) | .40 |
| Scheduling meeting with supervisor | ||
| Not at all difficult or not very difficult | 1.24 (0.48-3.16) | .66 |
| Somewhat, very, or extremely difficult | 1 [Reference] | |
| No supervisor | 1.49 (0.52-4.29) | .46 |
Abbreviations: DOM, Department of Medicine; OR, odds ratio.
Discussion
At a time when concern about faculty well-being is high, with much speculation about causes of burnout,2 we find that investment in social capital and sense of value and respect for employees may be most critical to faculty members’ satisfaction with work. A challenge of the fast-paced, technology-driven environment that is rapidly growing around us is the imperative to stay connected personally—not electronically—and reduce isolation. Intentional efforts to establish and nurture social and supportive environments—modifiable factors for all organizations that require relational, rather than financial, investment—will be ever more critical in the years ahead.
More important, we found no association with job satisfaction or feeling valued with sex, rank, or feeling compensated fairly, highlighting that financial incentives may not be effective alone in boosting satisfaction in the workplace. Limitations of this study include its modest size and single site, although there is no reason to postulate that similar factors associated with satisfaction would be unique to medicine or this academic health center.
Our findings call attention to the importance of promoting a sense of value and respect in the work environment for academic faculty, identifying and eliminating sources of discrimination, and expanding endeavors to facilitate collegiality. As we think about the urgent call to alleviate burnout, efforts focused in the domain of social capital seem vital.
References
- 1.Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90(12):1600-1613. doi: 10.1016/j.mayocp.2015.08.023 [DOI] [PubMed] [Google Scholar]
- 2.Schwenk TL, Gold KJ. Physician burnout—a serious symptom, but of what? JAMA. 2018;320(11):1109-1110. doi: 10.1001/jama.2018.11703 [DOI] [PubMed] [Google Scholar]
- 3.Eckleberry-Hunt J, Kirkpatrick H, Barbera T. The problems with burnout research. Acad Med. 2018;93(3):367-370. doi: 10.1097/ACM.0000000000001890 [DOI] [PubMed] [Google Scholar]
- 4.Schindler BA, Novack DH, Cohen DG, et al. The impact of the changing health care environment on the health and well-being of faculty at four medical schools. Acad Med. 2006;81(1):27-34. doi: 10.1097/00001888-200601000-00008 [DOI] [PubMed] [Google Scholar]
- 5.Walensky RP, Kim Y, Chang Y, et al. The impact of active mentorship: results from a survey of faculty in the Department of Medicine at Massachusetts General Hospital. BMC Med Educ. 2018;18(1):108. doi: 10.1186/s12909-018-1191-5 [DOI] [PMC free article] [PubMed] [Google Scholar]