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.

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

How physicians felt about their relationships with patients and about their autonomy was not related to their intentions to leave their practices. Perhaps these once-central features of doctoring have lost their importance to physicians, or maybe physicians believe they will not find better relationships or more autonomy elsewhere, and thus see no benefit in changing jobs.

Age, satisfaction, and anticipated job changes

As in previous studies,^36,37 the older physicians of this study were generally more satisfied than the younger physicians. Older physicians, nevertheless, more often anticipated leaving their jobs. We suspect that in many cases an older physician’s thoughts of leaving a position are related to their retirement plans, but our data did not allow us to explore this relationship in detail. We also suspect that physicians’ satisfaction with their jobs influences their plans not only for leaving that particular job but also their plans for leaving the practice of medicine entirely; however, satisfaction with somewhat different aspects of work may influence each of the 2 types of career moves. For example, relative dissatisfaction with relationships with patients may push a physician toward retirement even though it did not seem to promote thoughts of a job change for this study’s physicians.

Common beliefs about physicians’ careers would have predicted the “J”-shape relationship between anticipated job departure rates and increasing physician age Figure 1). Young physicians fresh from training are thought to change jobs once or twice during an initial period of professional experimentation, then settle into suitable practice situations and raise their families. Later in life, job departures again become more common when children leave home, work takes on new meaning in middle age, and physicians become interested in and able to retire or pursue new jobs or second careers. Data from this study generally confirm these common notions, although the nadir in anticipated job departures occurred later than we expected.

Limitations

This study’s 52% response rate, although typical for physician studies,³⁸ may have yielded results not representative of physicians as a whole. To assess this possibility, we compared survey data from this study’s early and late respondents and found meaningful time trends in only 4 of 140 questionnaire items, providing some evidence that nonrespondents-if assumed to be in effect very late respondents-were similar to respondents. Nevertheless, to help adjust for any response bias we weighted analyses.

Statistical associations may not reflect causal relationships in a cross-sectional study such as this. Further, this study’s findings may have differed if actual job departure was available as an outcome measure, even though anticipated departure is a validated and frequently used proxy indicator of workers who will leave their jobs.^26-28 A measure of convergent validity was demonstrated in this study, as 16 of the 18 statistical associations between anticipated departure and satisfaction were in the expected direction, and age fluctuated with anticipated departure as we had expected it would with actual departure.

Conclusions and implications

These findings suggest that physicians who are relatively dissatisfied with specific aspects of their work more often plan to leave their jobs, and that these particular work aspects differ somewhat with age and specialty. Practice managers and employers concerned with maintaining a stable physician workforce should address relative dissatisfaction among physicians-particularly with income and community relationships-but need not build high levels of satisfaction. Physicians looking for stable employment should seek positions that they feel offer appropriate compensation and are located in communities to which they can connect. Once there, they should devote time and energy building ties in their communities.

Further research must confirm whether retention indeed improves by remediating relative dissatisfaction with the areas of physicians’ work flagged as important in this study. It also remains to be seen whether other outcomes of physicians’ work, such as the quality of care they provide, also relate primarily to relative dissatisfaction rather than satisfaction, and, specifically, to dissatisfaction with the same aspects of work seeming to affect job departure plans.

Acknowledgments

The authors thank the physician-fellows of UNC’s Primary Care Research Fellowship and the JFP’s reviewers for their thoughtful suggestions for strengthening this report. We also thank the many physician respondents who shared their time and revealed to us important aspects of their lives.