Abstract
Background:
Doctors’ job satisfaction is crucial to the health service to ensure commitment, effective training, service provision, and retention. Job satisfaction matters to doctors for their happiness, fulfilment, service to patients, and duty to employers. The quality of performance in the health sector to a large extent depends on whether healthcare providers are job-satisfied or dissatisfied.
Objectives:
This study assessed the level and factors determining job satisfaction among resident doctors in a federal tertiary institution.
Material and Methods:
A cross-sectional study was conducted among the resident doctors of a government tertiary care hospital. Data were collected using a self-reported questionnaire consisting of 49 items under seven domains of job satisfaction, where higher values indicated a higher level of satisfaction. The average scores of items were computed to construct factor scores for each individual. A Chi-square test was applied.
Results:
The proportion of job satisfaction among resident doctors was found to be 80.9%. On adjustment, the odds of being satisfied were found to be higher in the older age groups, among males, and doctors posted in clinical departments.
Conclusion:
Most respondents in this study were satisfied with their jobs with minorities satisfied with their monetary and infrastructure facilities. There is a need to address these issues to enhance healthcare quality, especially in the public sector.
Keywords: Healthcare quality, job satisfaction, resident doctors, tertiary healthcare
INTRODUCTION
Job satisfaction is simply how people feel about different aspects of their jobs.[1] It is considered the extent to which people like (satisfaction) or dislike (dissatisfaction) their jobs.[2] In other words, it is a pleasurable emotional state resulting from the appraisal of one's job and an affective reaction to one's job and an attitude toward one's job.[3]
It is frequently studied in several disciplines such as psychology, sociology, economics, and management sciences. This is because many experts believe that job satisfaction can influence work productivity, work effort, employee absenteeism, and staff turnover.[2] Many studies suggest that employers can be benefitted from satisfied employees as they are more likely to profit from lower staff turnover and higher productivity.[4] Job satisfaction is the most important factor for determining the quality of service of the healthcare sector.[5] Over the past few years, especially in developing countries, the number of doctors choosing to work abroad or in non-medical professions has been growing. The process of becoming a doctor is long and demanding. Also, it is expensive both at the individual level and from a public perspective.[6] However, if the medical doctors do not achieve a level of satisfaction with their work that is appropriate for their level of commitment, the health service may risk losing their valuable expertise to other countries or other careers.[7,8]
Job satisfaction among doctors needs to be investigated in the present context where doctors are no longer held in high regard as in the past.[9] The working conditions of doctors and the way healthcare is delivered have changed over the past decade.[10] Factors such as internet-derived healthcare information, frequent malpractice suits, diminished patient relationships, and the time pressures associated with managed care can influence doctors’ job satisfaction.[11,12,13,14]
Doctors’ dissatisfaction with their job can have a significant public health implication as it may adversely affect the clinical management of patients.[15,16,17,18] It is related to the quality of healthcare, patient satisfaction with the services they receive, patient compliance, and continuity of care. Satisfied employees tend to be more productive, creative, and committed to their employers.[19] On the other hand, dissatisfaction leads to increased absenteeism, lower productivity, and increased staff turnover, each of which results in an increased cost to the health system.[20] If not properly addressed, doctors’ dissatisfaction may affect their health as well.[21] Lewis and co-workers reported that physicians who are satisfied with their work are likely to report high satisfaction in their marriages and fewer psychiatric symptoms.[22] Dissatisfied physicians may also deter future students from entering the field of medicine.[23] Ample research has been performed on client satisfaction in the health sector, but the understanding of providers’ satisfaction in the healthcare system needs more investigation. The study was performed to find job satisfaction among the resident doctors of a tertiary care hospital. The study was performed to assess perceived stress among the resident doctors.
MATERIALS AND METHODS
The cross-sectional study was carried out among the resident doctors of a tertiary hospital. The hospital is a government healthcare facility, which is a referral center in the south district of Delhi with under-graduate and post-graduate teaching programs. There were about 220 resident doctors, which include residents of all specialities during the study period during 2019. The study included senior and junior residents of all broad and super specialities – pre-clinical, para-clinical, and clinical disciplines. Those residents with a minimum of 1 year of experience in the institute were recruited. Those who are non-academic junior residents (non-postgraduates) were excluded from the study. A complete enumeration of all the residents was performed. The study was conducted after the approval of Institutional Ethics Committee on 01.11.2018.
Study tool: After obtaining written informed consent from the study participants, the residents were enrolled in the study. The data were collected using a pre-tested, validated study questionnaire that had baseline characteristics and a job satisfaction assessment scale. The job satisfaction scale used was based on the questionnaire developed by Kumar P et al.,[20] which had 49 items under seven domains such as 1. Additional privileges of the job, 2. Inter-personal professional relations, 3. Work environment, 4. Physician–patient relationship, 5. infrastructure facilities of the institute, 6. Future career prospects, and 7. Health manpower. The questions under the seven domains are plotted in a 5-point Likert scale from 1 to 5 with 5, very satisfied; 4, satisfied; 3, neutral; 2, unsatisfied; and 1, very unsatisfied. The overall score is calculated from the individual 49 items. A total score of more than 120 was considered to be satisfactory. A score of more than 120 was used to classify the study participants into satisfied and not satisfied classes.
Data analysis: The data were entered and analyzed in SPSS IBM version 21.0. Normality was checked before applying tests of significance. Multi-variate regression analysis was performed to compare the predictors of job satisfaction. A P value <0.05 was considered to be significant.
Results: The study was conducted among 220 resident doctors working in different specialities and super specialities working in a government healthcare facility in North India. The mean age of the participants was 26 (±7) years. 17% were married, and the males (66%) out-numbered the females (34%). Doctors from clinical departments comprised 65.5% of the study population, and 60% were working from the past 1 to 3 years [Table 1].
Table 1.
Baseline characteristics of the study population (n=220)
| Variables | n (%) |
|---|---|
| Age group | |
| 23-26 | 16 (7) |
| 27-30 | 100 (45) |
| 31-35 | 102 (46) |
| >35 | 2 (1) |
| Sex | |
| Male | 145 (66) |
| Female | 75 (34) |
| Resident | |
| Junior resident | 179 (81) |
| Senior resident | 41 (19) |
| Speciality | |
| Pre-clinical | 66 (30) |
| Clinical – broad speciality | 130 (59) |
| Clinical super speciality | 24 (11) |
| Marital status | |
| Single | 182 (83) |
| Married | 38 (17) |
| Current place of stay | |
| Residence quarters | 44 (20) |
| Home | 176 (80) |
| Duration of employment in the present institute | |
| 1-3 years | 131 (60) |
| 3-5 years | 77 (35) |
| >5 year | 12 (5) |
Job satisfaction level and additional privileges of the job: The major factors of satisfaction relating to the additional privileges of the job were loan eligibility prospects, salary additional allowances, and retirement age limit. The major factors of dissatisfaction were benefits in pension, children education assistance, maternity/paternity benefits, provident fund benefits, conveyance reimbursement, and leave benefits.
Job satisfaction level and inter-personal professional relations: The factors of the highest satisfaction relating to inter-personal relations were easy relationship with colleagues, respect from juniors, collaboration as a team, professional guidance by seniors, and imposing of rules, and that of dissatisfaction was the acknowledgement of work.
Job satisfaction level and work environment: The major factors of satisfaction relating to the work environment included satisfaction with a free hand in work, and the overall work environment major factor of dissatisfaction was staff strength in work and distribution of work among colleagues.
Job satisfaction level and physician–patient relationship: The factor of the highest satisfaction relating to the physician–patient relationship was patient compliance in drug compliance, and that of dissatisfaction was patients’ expectations [Table 2].
Table 2.
Job satisfaction scale among the study population (n=220)
| Domains | VS n (%) | S n (%) | N n (%) | US n (%) | VUS n (%) |
|---|---|---|---|---|---|
| Additional privileges of the job | |||||
| Benefits in pension | 12 (5) | 11 (5) | 1 (0.004) | 20 (9) | 176 (80) |
| Loan eligibility prospects | 43 (20) | 134 (60) | 41 (19) | 2 (0.9) | 0 |
| Gratuity/Provident fund benefits | 7 (3) | 16 (7) | 5 (2) | 36 (16) | 156 (71) |
| Children education assistance | 0 | 0 | 12 (5) | 189 (86) | 19 (9) |
| Maternity/Paternity benefits | 12 (5) | 21 (10) | 9 (4) | 134 (60) | 44 (20) |
| Residential accommodation | 8 (3) | 11 (5) | 56 (25) | 124 (56) | 21 (10) |
| Salary additional allowances | 79 (36) | 112 (51) | 12 (5) | 17 (8) | 0 |
| Conveyance reimbursement | 0 | 3 (0.01) | 18 (8) | 71 (32) | 128 (58) |
| Leave benefits | 0 | 1 (0.004) | 21 (10) | 11 (5) | 187 (85) |
| Retirement age limit | 176 (80) | 21 (10) | 11 (5) | 12 (5) | 0 |
| Inter-personal professional relations | |||||
| Acknowledgement of work | 0 | 17 (8) | 35 (16) | 45 (20) | 123 (56) |
| Encouragement and appreciation | 11 (5) | 31 (14) | 155 (70) | 23 (10) | 0 |
| Easy relationship with colleagues | 56 (25) | 132 (60) | 11 (5) | 21 (10) | 0 |
| Superior support in family issues | 0 | 23 (10) | 173 (79) | 22 (10) | 2 (0.01) |
| Senior–junior coalition | 23 (10) | 145 (66) | 31 (14) | 2 (0.01) | 19 (9) |
| Respect from juniors | 14 (6) | 166 (75) | 21 (10) | 15 (7) | 4 (0.02) |
| Collaboration as a team | 39 (18) | 144 (65) | 21 (10) | 16 (7) | 0 |
| Professional Guidance by seniors | 86 (39) | 121 (55) | 12 (5) | 1 (0.004) | 0 |
| Imposing of rules | 77 (35) | 136 (62) | 8 (3) | 0 | 0 |
| Work environment | |||||
| Job security | 23 (10) | 31 (14) | 133 (60) | 22 (10) | 11 (5) |
| Freehands in work | 56 (25) | 132 (60) | 21 (10) | 11 (5) | 0 |
| Staff adequacy in work | 0 | 0 | 21 (10) | 65 (30) | 134 (60) |
| Equi-distribution of work among colleagues | 0 | 0 | 20 (10) | 25 (11) | 175 (80) |
| Overall work environment | 132 (60) | 45 (20) | 38 (17) | 5 (0.2) | 0 |
| Physician–patient relationship | |||||
| Patients’ expectation | 0 | 20 (9) | 43 (20) | 45 (20) | 112 (51) |
| The behavior of patients toward the physician | 14 (6) | 58 (26) | 145 (66) | 3 (0.01) | 0 |
| Patients’ understanding of the disease course | 21 (9) | 34 (15) | 11 (5) | 154 (70) | 0 |
| Patients turning up for review | 78 (35) | 22 (10) | 96 (44) | 24 (11) | 0 |
| Patients’ cooperation in drug compliance | 98 (45) | 112 (51) | 10 (5) | 0 | 0 |
| Infrastructure facilities of the institute | |||||
| Working space adequacy | 4 (2) | 78 (35) | 34 (15) | 89 (40) | 19 (9) |
| Drinking water facility | 121 (55) | 88 (40) | 10 (5) | 1 (0.004 | 0 |
| Cafeteria facility | 12 (5) | 32 (15) | 56 (25) | 109 (50) | 11 (5) |
| A cooling facility in summer | 9 (4) | 11 (5) | 34 (15) | 134 (61) | 32 (15) |
| Central warming facility in winter | 0 | 0 | 0 | 189 (86) | 31 (14) |
| Location of facilities within the campus | 21 (10) | 34 (15) | 82 (37) | 77 (35) | 6 (3) |
| Electricity and generator facilities | 199 (90) | 11 (5) | 10 (5) | 0 | 0 |
| Waiting time for patients | 0 | 11 (5) | 134 (60) | 57 (26) | 18 (8) |
| Cleanliness of the premises | 0 | 0 | 21 (10) | 56 (25) | 143 (65) |
| Future career prospects | |||||
| Scope of learning new skills | 167 (76) | 45 (20) | 8 (4) | 0 | 0 |
| Training infrastructure and provision | 45 (20) | 112 (50) | 55 (25) | 8 (4) | 0 |
| Opportunities for training in higher specialist centers of the country | 12 (5) | 14 (6) | 88 (40) | 100 (45) | 6 (3) |
| Career growth and promotion | 122 (60) | 45 (20) | 24 (10) | 29 (13) | 0 |
| Health manpower | |||||
| Transparency in selection | 134 (61) | 55 (25) | 18 (8) | 13 (6) | 0 |
| Time taken for recruitment | 45 (20) | 66 (30) | 64 (30) | 32 (15) | 13 (6) |
| Rules and regulations of employees | 145 (66) | 67 (30) | 8 (4) | 0 | 0 |
| The workload at the working place | 0 | 10 (5) | 12 (5) | 75 (34) | 123 (56) |
| Comfortable working hours | 12 (5) | 44 (20) | 78 (35) | 55 (25) | 31 (14) |
| Hierarchical structure | 34 (15) | 77 (35) | 78 (35) | 25 (11) | 6 (3) |
| Work–life balance | 15 (7) | 22 (10) | 77 (35) | 89 (40) | 17 (8) |
VS-very satisfied, S-satisfied, N-neutral, US-unsatisfied, VUS-very unsatisfied
Job satisfaction level and infrastructure facilities of the institute: The major factors of satisfaction relating to the infrastructure facilities of the institute included drinking water facilities and electricity and generator facilities. The major factors of dissatisfaction were central warming facilities in winter, cooling facilities in summer, and cleanliness in the premises.
Job satisfaction level and future career prospects: Concerning future career prospects, doctors were satisfied with the scope of learning new skills, training provision, and career growth and promotion.
Job satisfaction level and health manpower: The majority of the participants were satisfied with transparency in selection and rules and regulations of an employee. A major factor of dissatisfaction was workload at the working place.
The proportion of job satisfaction was found to be 80.9% in the study population. On adjustment, the odds of job satisfaction were significantly higher in the older age groups. Higher odds were also found among males and doctors posted in clinical branches [Table 3].
Table 3.
Multi-variate logistic regression for prediction of risk factors of job satisfaction
| Variables | Satisfied n=178 n (%) | Not satisfied n=42 n (%) | OR (95% CI) |
|---|---|---|---|
| Age group | |||
| ≤30 years | 86 (48) | 30 (71) | 1 |
| >30 years | 92 (52) | 12 (29) | 2.1 (1.1-3.4) |
| Duration of service | |||
| ≤3 years | 110 (62) | 28 (67) | 1 |
| >3 years | 68 (38) | 14 (33) | 2.1 (0.8-3.3) |
| Sex | |||
| Male | 107 (60) | 38 (80) | 1 |
| Female | 71 (40) | 4 (20) | 0.6 (0.1-0.9) |
| Resident | |||
| Junior resident | 144 (80) | 35 (83) | 1 |
| Senior resident | 34 (20) | 7 (17) | 1.8 (0.5-3.3) |
| Speciality | |||
| Pre-clinical | 54 (30) | 12 (28) | 1 |
| Clinical – broad speciality | 103 (58) | 26 (62) | 2.3 (1.1-4.8) |
| Clinical super speciality | 21 (12) | 4 (10) | 3.1 (2.8-3.6) |
| Marital status | |||
| Single | 172 (97) | 10 (24) | 1 |
| Married | 6 (3) | 32 (76) | 2.1 (0.6-4.2) |
Chi-square test, a P<0.05 is significant
DISCUSSION
In the present study, different domains of job satisfaction were considered, which included additional privileges of the job, inter-personal professional relations, work environment, physician–patient relationship, infrastructure facilities of the institute, future career prospects, and health manpower. In this study, the majority of the participants (80.9%) were satisfied with their job, compared to the previous study among resident doctors, who showed 80.9% Nigeria,[2] 78.5% Delhi,[24] and 74% Chandigarh.[25] This is higher than 69.5% (Madaan et al.),[26] 50% (Nylenna et al.),[27] 40% (Chaudhury and Bannerjee),[28] and 30% (Omolase et al.)[29] elsewhere.
One reason for this seeming disparity in a similar set of participants may be because of the use of diverse instruments for measuring job satisfaction. However, studies performed in developing and developed countries have shown differences in job satisfaction. In a study covering ten nations of the European Union, it was found that only a quarter of the doctors were dissatisfied.[30] On the other hand, studies performed in Karachi[31] and Srilanka[32] have shown the proportion of satisfied doctors to be 32% and 43.6%, respectively. This may be because of the perks and privileges attached to the job, mainly salary, in developed countries. In our study, an increasing age was found to be significantly associated with higher levels of satisfaction. A longitudinal study among Norwegian doctors by Nylenna et al.[27] showed a positive correlation with age and job satisfaction better with growing age. This may be attributed to the fact that as the age increases, expectations decrease and are replaced with gradual acceptance of the situation and adaptation. In contrast, a younger age is associated with restlessness and increased expectations from the job, which if not met may result in dissatisfaction. However, this is in contrast with another study where younger doctors expressed more satisfaction with their jobs.[26] This finding needs to be reviewed in the context of the distribution of satisfaction against the years of service performed by these doctors.
In this study, males were significantly more satisfied than females. Women were less satisfied than men with work-related ’burdens’, which may reflect a greater pressure on women to manage family matters, in addition to their careers. This is in contrast to similar studies in which females were found to be more satisfied than their male colleagues.[26,33,34] Speciality: In our study, in comparison with pre-clinical branches, doctors working in clinical branches (both speciality and super speciality) were more significantly more satisfied. This was in contrast to a study performed by Bhattacherjee S et al.[5] among doctors of eastern India.
Other factors such as the duration of service and their designation and marital status were not significantly associated with their level of job satisfaction. However, many studies have reported that a very large proportion of doctors who had been in the service longer expressed satisfaction with their job, whereas those who have been in the service for a shorter duration expressed more dissatisfaction.[35,36] The major factors related to non-satisfaction reported in our study were insufficient benefits in pension (89%), children education assistance (95%), leave befits (90%), staff inadequacy in work (90%), distribution of work among colleagues (91%), central warming facilities in winter (100%), and cleanliness of the premises (90%). The doctors were satisfied with the retirement age limit (90%), professional guidance by seniors (94%), imposing of rules (97%), patient compliance in drug compliance (96%), drinking water facilities (95%), electricity backup (95%), scope of learning new skills (96%), and rules and regulations of the employee (96%). Research has consistently identified factors such as monetary benefits and dissimilar workload that can affect satisfaction[37] (Stoddard, Hargraves & Reed, 2001). Many doctors are dissatisfied with their jobs because of long working hours and overwork.[24]
CONCLUSION
The satisfaction with the job was pretty well among a majority of the medical professionals. The key factors of the satisfaction included remuneration and career development. Satisfaction was much higher among those working at clinical departments, although there is a need to enhance healthcare infrastructure facilities.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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