Physician job satisfaction, job dissatisfaction, and physician turnover

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Original Research

Physician job satisfaction, job dissatisfaction, and physician turnover

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

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References

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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.

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Younger, midcareer, and older physicians. Among physicians in the youngest group-aged 27 through 44 years-those who were least satisfied with their pay (OR, 4.62; P < .0001) and with their relationships with their communities (OR, 2.79; P < .0001) more often anticipated leaving their jobs than those of median satisfaction Table 3). For no facets of work among younger physicians were those who were most satisfied less likely to anticipate leaving.

For physicians aged 45 through 54 years, anticipated job departure was more common for those least satisfied with 5 areas of work, including again those least satisfied with pay (OR, 11.60; P < .0001) and with their community relationships (OR, 2.11; P < .01). One unexpected association was noted for these midcareer physicians: those in the highest quartile of satisfaction with their pay more often anticipated leaving their practices than those with midrange pay satisfaction scores (OR, 3.36; P < .01).

In the oldest physician group, those least satisfied with their community relationships (OR, 3.31; P < .01) and least satisfied with the administrative aspects of their work (OR, 2.64; P < .01) more often anticipated leaving their jobs. Fewer of those most satisfied with patient care issues foresaw leaving (OR, 0.30; P < .01). Unexpectedly, older physicians who were least satisfied with their relationships with other physicians were less likely to anticipate leaving their practices (OR, 0.36; P < .01).

Discussion

Our study has demonstrated 3 aspects of how physicians’ regard for their work relates to their plans to leave their jobs: (1) physicians’ plans to leave correlate with their satisfaction with only some aspects of their work; (2) the aspects of work for which satisfaction is associated with plans for leaving differ somewhat for generalists and specialists, and for physicians at various stages of their careers; and (3) anticipated job departure is more common among physicians who are relatively dissatisfied with any of a variety of aspects of their work, whereas satisfaction higher than median levels generally does not protect physicians from thoughts of leaving their jobs. To our knowledge, these last 2 features of the relationship between satisfaction and anticipated departure have not been demonstrated previously.

Even when physicians are displeased with a given aspect of their work, they are not always inclined to leave their jobs. For example, physicians in this and other studies^2,31 were least satisfied with the administrative requirements of their work, yet dissatisfaction in this area was not associated with the departure plans of most physician groups. In some cases, a dissatisfying issue is simply not important enough to individuals to warrant a job change. Physicians also have options to leaving, such as problem-solving with managers and coworkers, and taking comfort in the more satisfying aspects of their work.³² Thus, to know when dissatisfaction leads to job changes, one must actually test for statistical associations between the two.

In tests of this kind in the present study, we found 14 instances in which physicians in the lowest satisfaction quartiles were more likely to anticipate leaving than were those of average satisfaction. We found only 2 situations in which physicians in the highest satisfaction quartiles were less likely to anticipate leaving. To promote retention, these data suggest that physicians and their employers should avoid relative dissatisfaction in particular. These data also suggest that building ever-increasing higher levels of satisfaction generally does not prevent turnover. Thus, to foster workforce stability, practice managers should address aspects of physicians’ work or jobs causing them dissatisfaction, or more specifically, satisfaction lower than that of physicians working elsewhere. For aspects of work about which physicians are already satisfied, managers need not foster even higher satisfaction.

Satisfaction with specific aspects of work and turnover

Relative dissatisfaction with one’s community was associated with departure plans for all physician groups. An individual’s relationship with a community-measured in this study through questions about feeling “at home,” a sense of belonging, respected, and strongly connected²³-is basic to human existence,^33,34 but its importance has been underappreciated in physicians’ lives and careers.^33,35 Practices might promote workforce stability by providing opportunities and incentives for employed physicians to participate in local and state professional and community service organizations. Expectations can be set and time allocated for physicians to work with school health programs and volunteer clinics, speak to community groups, and become involved in other ways that build a sense of membership and contribution. These activities will be new for some physicians, will not always come naturally, and may need to be taught and encouraged.

Relative dissatisfaction with pay was associated with departure plans for all of this study’s physician groups, except for physicians older than 55 years. Further and unexpectedly, midcareer physicians who were particularly satisfied with their pay were also more likely to anticipate leaving. Perhaps midcareer physicians who are and feel well paid also more often feel that they can afford to retire or pursue second careers. We have no data to test this explanation. Similarly, we cannot know why older physicians who were least satisfied with their collegial relationships less often planned to leave their jobs. We wondered if this surprising finding was a result of confounding by physicians’ employment in group vs solo practices; we reasoned that among older physicians, those in solo practice may not get along as well with local physicians, but for unrelated reasons may be more attached to their practices and thus less likely to retire or otherwise plan to leave. This possibility proved not to be the case when we added an indicator of solo vs group practice to the statistical model for the older physician group.