Physician job satisfaction, job dissatisfaction, and physician turnover

,

Original Research

Physician job satisfaction, job dissatisfaction, and physician turnover

J Fam Pract. 2002 July;51(7):1-1

By

Donald E. Pathman, MD, MPH

PDF Download

References

1. Office of the Inspector General. National Health Service Corps: a survey of providers, facilities, and staff. Washington, DC: Office of the Inspector General; April 1994. Report OEI-09-91-01310.

2. Pathman DE, Williams ES, Konrad TR. Rural physician satisfaction: its sources and relationship to retention. J Rural Health 1996;12:366-77.

3. Kassirer JP. Doctor discontent. N Engl J Med 1998;339:1543-44.

4. Dalen JE. Managed competition: who will win? Who will lose? Arch Intern Med 1996;156:2033-5.

5. Schroeder SA. The troubled profession: is medicine’s glass half full or half empty? Ann Intern Med 1992;116:583-92.

6. Hadley J, Mitchell JM, Sulmasy DP, Bloche G. Perceived financial incentives, HMO market penetration, and physicians’ practice styles and satisfaction. Health Serv Res 1999;34:307-21.

7. Kralewski JE, Dowd B, Feldman R, Shapiro J. The physician rebellion. N Engl J Med 1987;315:339-42.

8. Belkin L. Many in medicine are calling rules a professional malaise (part one of three). New York Times. February 18, 1990; sect A:1, 13.

9. Hadley J, Cantor JC, Willke RJ, Feder J, Cohen AB. Young physicians most and least likely to have second thoughts about a career in medicine. Acad Med 1992;67:180-90.

10. Lewis CE. How satisfying is the practice of internal medicine? Ann Intern Med 1991;114:1-5.

11. Price KL. The Study of Turnover. Ames, IA: The Iowa State University Press; 1977.

12. DiMatteo MR, Sherbourne CD, Hays RD, et al. Physicians’ characteristics influence patients’ adherence to medical treatment: results from the Medical Outcomes Study. Health Psychol 1993;12:93-102.

13. Weisman CS, Nathanson CA. Professional satisfaction and client outcomes: a comparative organizational analysis. Med Care 1985;23:1179-92.

14. Melville A. Job satisfaction in general practice: implications for prescribing. Soc Sci Med 1980;14A:495-9.

15. Grol R, Mokkink H, Smits A, et al. Work satisfaction of general practitioners and the quality of patient care. Fam Pract (Great Britain) 1985;2:128-35.

16. Lichtenstein RL. The job satisfaction and retention of physicians in organized settings: a literature review. Med Care Rev 1984;41:139-79.

17. Berger JE, Boyle RL. How to avoid the high costs of physician turnover. Med Group Manage J 1992;November-December:80-91.

18. Buchbinder SB, Wilson M, Melick CF, Powe NR. Estimates of costs of primary care physician turnover. Am J Manag Care 1999;5:1431-8.

19. Herzberg F. The Motivation to Work. New York: Wiley; 1959.

20. Stamps PL. Physicians and organizations: an uneasy alliance or a welcome relief? J Fam Pract 1995;41:27-32.

21. Silver PF. Job satisfaction and dissatisfaction revisited. Educ Psychol Res 1987;7:1-20.

22. Konrad TR, Williams ES, Linzer M, et al. Measuring physician job satisfaction in a changing workplace and a challenging environment. Med Care 1999;37:1174-82.

23. Williams ES, Konrad TR, Linzer M, et al. Refining the measurement of physician job satisfaction: results from the Physician Worklife Survey. Med Care 1999;37:1140-54.

24. Council of American Survey Research Organizations (CASRO). On the Definition of Response Rates: A Special Report of the CASRO Task Force on Completion Rates. Port Jefferson, NY: CASRO; 1982.

25. Ajzen I, Fishbein M. Understanding Attitudes and Predicting Social Behavior. Englewood Cliffs, NJ: Prentice-Hall; 1980.

26. Steel RP, Ovalle NK. A review and meta-analysis of research on the relationship between behavioral intentions and employee turnover. J Appl Psychol 1984;69:673-86.

27. Price JL, Mueller CW. Absenteeism and Turnover of Hospital Employees. Greenwich, CT: JAI Press, Inc; 1986.

28. Mobley WH, Horner SO, Hollingsworth AT. An evaluation of precursors of hospital employee turnover. J Appl Psychol 1978;63:408-14.

29. Kamien M. Staying in or leaving rural practice: 1996 outcomes of rural doctors’ 1986 intentions. Med J Aust 1998;169:318-21.

30. Kleinbaum DG. Epidemiologic Research: Principles and Quantitative Methods. New York: Van Nostrand Reinhold; 1982.

31. Herzberg F. Work and the Nature of Man. New York: New American Library; 1966.

32. Reames HR, Dunstone DC. Professional satisfaction of physicians. Arch Intern Med 1989;149:1951-6.

33. Cutchin MP. Community and self: concepts for rural physician integration and retention. Soc Sci Med 1997;44:1661-74.

34. Fried M. The structure and significance of community satisfaction. Popul Environ 1984;7:61-4.

35. Pathman DE, Konrad TR, Ricketts TC. The National Health Service Corps experience for rural physicians in the late 1980s. JAMA 1994;272:1341-8.

36. Frank E, McMurray JE, Linzer M, Elon L. Career satisfaction of US women physicians: results from the Women Physicians’ Health Study. Arch Intern Med 1999;159:1417-26.

37. Cooper CL, Rout U, Faragher B. Mental health, job satisfaction, and job stress among general practitioners. Br Med J 1989;298:366-70.

38. Asch DA, Jedrziewski MK, Christakis NA. Response rates to surveys published in medical journals. J Clin Epidemiol 1997;50:1129-36.

Address reprint requests to Donald Pathman, MD, MPH, Cecil G. Sheps Center for Health Services Research, University of North Carolina, CB# 7590, Chapel Hill, NC 27599-7590. E-mail: don_pathman@unc.edu.

To submit a letter to the editor on this topic, click here:jfp@fammed.uc.edu.

ABSTRACT

OBJECTIVES: We studied how physicians’ relative satisfaction and/or dissatisfaction with 10 distinct aspects of their work protected against or promoted their plans for leaving their jobs.

STUDY DESIGN: We used a cross-sectional mail survey.

POPULATION: We used questionnaire data from 1939 practicing generalists and specialists across the United States.

OUTCOMES MEASURED: Using logistic regression analysis, we assessed whether physicians in the top and bottom quartiles of satisfaction for each of 10 aspects of their work and communities were more or less likely to anticipate leaving their jobs within 2 years, compared with physicians in mid-satisfaction quartiles. Separate analyses were compiled for generalists vs specialists, and physicians by age groups (27-44 years, 45-54 years, and 55 years and older).

RESULTS: Generalists and specialists had generally comparable levels of satisfaction, whereas physicians in the oldest age group indicated greater satisfaction than younger physicians in 8 of the 10 work areas. One quarter (27%) of physicians anticipated a moderate-to-definite likelihood of leaving their practices within 2 years. The percentage that anticipated leaving varied with physicians’ age, starting at 29% of those 34 years or younger, steadily decreasing with age until a nadir of 22% of those from 45 to 49 years, then reversing direction to steadily increase thereafter. Across the 5 groups (ie, the 2 specialty clusters and 3 age groups), there were only 14 instances in which physicians in the lowest satisfaction quartiles were more likely to anticipate leaving than those of average satisfaction. In only 2 cases were physicians in the highest satisfaction quartiles less likely to anticipate leaving. Relative dissatisfaction with pay and with relationships with communities was associated with plans for leaving in nearly all physician groups. For specific specialty and age groups, anticipated departure also correlated with relative dissatisfaction with other selected areas of work.

CONCLUSIONS: To promote retention, these data suggest that physicians and their employers should avoid physician dissatisfaction in particular; building particularly high levels of satisfaction generally is not helpful for this end. Avoiding relative dissatisfaction with pay and with community relationships appears broadly important.

Until recently, the satisfaction of physicians was studied only among those working in special settings, such as in rural and urban underserved areas. In these settings, a less than satisfying work environment sometimes leads physicians to leave their jobs, with subsequent costs for needy communities.^1,2 Now, with US physicians often employed by others, physicians’ autonomy constrained, medicine managed as a business, and incomes falling for some specialties, the satisfaction of rank and file physicians in all locations and specialties can no longer be assumed.^3-5 Indeed, unhappiness is increasing among physicians, with growing numbers considering job changes, nonclinical work, and early retirement.^6-8 Some physicians regret ever pursuing a medical career.^8-10

Dissatisfaction among physicians is a concern even if medical work still pays handsomely and medical schools still have an abundance of applicants. Physicians’ satisfaction relates to their job effectiveness, including the quality of care they render, their patients’ compliance with recommended care, patients’ satisfaction with care, and patients’ health outcomes.^6,9,11-15 The most obvious consequence of a dissatisfying job, however, is that physicians will quit to work elsewhere, disrupting patient-physician continuity and creating organizational instability and replacement costs, estimated at nearly $250,000 per physician lost.^16-18 A job change also brings personal and financial costs to physicians and their families.

Although common experience and prior studies show that physicians’ job satisfaction generally influences whether they leave their jobs, little more is known about how satisfaction relates to job changes for physicians. From studies of other professions, we know that satisfaction is a multidimensional concept in which individuals can be satisfied with some aspects of work while dissatisfied with others.^16,19 Further, we know that workers’ satisfaction with only some aspects of work correlates with turnover.^16,20 For example, in 1 recent study rural generalist physicians who were satisfied with their local communities remained longer in their jobs, whereas their satisfaction with most other aspects of work, including with autonomy and doctor-patient relationships, was unrelated to their retention.² The effects of workers’ satisfaction and dissatisfaction may also require separate assessment, because greater dissatisfaction with a given aspect of work may lead a worker to leave a job, but increasingly higher levels of satisfaction with the same issue may not lead to ever-increasing chances of retention, or vice versa.^15,21

The goal of this study was to better understand the relationship between physicians’ satisfaction with various aspects of their work and whether or not they have thoughts or plans to leave their jobs. We assessed whether anticipated job departure related to satisfaction at both the upper and lower ends of its range; that is, whether particularly high satisfaction levels relative to other physicians protected against job change plans and significant relative dissatisfaction promoted such plans. We also assessed how the satisfaction/job-change relationship varied for physician groups with differing needs and values, specifically for generalists compared with specialists, and for younger, midcareer, and older physicians.