Research On Training Effectiveness

CHAPTER – I INTRODUCTION Job satisfaction is a part of life satisfaction. The nature of one’s environment of the job does effect one’s feelings on the job. Since, job is an important factor of the life job satisfaction influence one’s general life satisfaction. Job satisfaction is an important factor contributing to better performance of the worker which has implications on the quality and input of the work Job satisfaction is defined as a combination of psychological, physiological and environmental circumstances that causes a person truthfully to say that I am satisfied with job. Oxford University says job satisfaction is application of efforts to purpose, force in action doing something, a tasks of materials to be operated or doing or it is defined as experience of specified kind, employment especially at a means of earning. According to Pestonjee, job satisfaction can be taken as a summation of employee’s feelings in four important areas. Two of these areas encompass factor directly connected with the job and the other two include job but which are presumed to have a bearing on job satisfaction are:

1. JOB: Nature of work, dangerous interesting hours of work, fellow workers and opportunities on job for promotion advancement, interest work and physical environment etc. 2. Management Supervisory treatment participation, rewards and punishment, praise and blames, leave policy etc. 3. Social relations Friends and associations, neighbours, attitudes towards people of community, participation in social activities etc. Sinha (1956) has defined job satisfaction as “it is and over all complex of attitudes and factors where out in the worked and

conditions that emanate from the social environment of work”. Etiologically, job satisfaction is a combination of two words: ‘Job’ and ‘satisfaction’, ‘work’, ‘occupation’, job and position have generally been used inter changeably. The goals or purposes to which needs are directed are technically termed incentive fulfillment accompanies a simple feeling known as satisfaction. Job is a highly complex phenomenon in one present technical development. The more complex phenomena are job satisfaction. Job can’t be separated from individual who performs its, this motives, experiences and social inter relations with his family company and community must be considered. Thus, a part from mechanical aspects and economical aspects cuts job has psychological aspect too. It may be said that job satisfaction is governed to a large extent by perception and exceptions. Men work to satisfy their needs and they aspire or expect their work, life to fulfill these needs for job satisfaction there should exist a good fit between the perception of how much the job provides and low much one aspires. Miller and form (1964) defined, “work as a general activity centering on substance and the specific routine of this activity as occupation. Shartle (1952) has offered the following definition of the term “occupation”, “job”, “position”. “An operation is a group of similar positions in single, plant business establishment and institutions of other work place”. “A position is set of tasks performed by a person. There are a many positions as there are workers but there may be one or many person employed in the same job”. “Satisfaction is related to fulfillment of need is defined as a conditions mark by feeling of lack or want of something or of requiring the performance of some action (Drever 1961). Vroom has defined job satisfaction as, “The positive orientation of an individual towards work role which he is presently holding Locke defines “Job satisfaction as a pleasurable or positive emotional state resulting from the appraisal of one’s job or job experiences.

Job satisfaction is an important factor contributing to better performance of worker which has repercussions on quality and quantity of work. according to Elizabeth Herlock “satisfaction increase motivation of worker to do what he is capable of doing and to learn more about the work so that he can perform it more efficiently. It increases the ego involvement in the work and would also contributes to further increase in motivation of worker. In nutshell job satisfaction contribute to happiness of employee. It gives happiness and success in work and harmony to individual and progress to society. But effects of dis-satisfaction are disastrous dis-satisfaction with job plays havoc on them. A person seeks satisfaction from job and probably, it is his right to do so because he spends a substantial part of life one job. The work should provide opportunities to meet people with standing. A person should feel that his family should be proud of him for what he does. His family’s standing in the community will be determined in his occupational status.

Measuring job satisfaction Although people have many different attitudes towards various aspects of their job, these are not as easy to assess as you might think. Not only can’t you directly observe a person’s idea, but as well as note, you can not accurately in their existence on the basis of people’s behaviour. So far the most important part to understand is people’s view and ideas. We have to relay on what they tell us. However, people are generally not entirely open about their attitudes and keep much of what they feel to themselves. Moreover, sometimes our are so complex that its difficult to express them in any coherent fashion even if we are willing to do so. In view of these challenges social scientists have worked hard over the past sixty years to develop reliable and valid instruments designed to systematically measure job satisfaction. Determinants of job satisfaction While analyzing the various determinants of job satisfaction, we have to keep in mind that all individual do not have degree of satisfaction through they perform the same task in the job environment. There are individual variable which effects the job satisfaction. Thus, all

those factors which provide a fit among the individual’s variable, nature of job and situational variable determine the degree of job satisfaction. Environmental Factors: Job content: Herzberg suggested that job content in terms of achievements, recognition, advancement, responsibility and the work itself to provide satisfaction but their absence does not cause dissatisfaction. Where the job is less repetitive and there is variation in job content, job satisfaction tends to be higher. Occupational level The higher the level of the job in organizational hierarchy, the greater the satisfaction of the employee. This is because positions at higher levels involve, better pay more challenging and provide greater freedom of operation. Such positions carry greater prestige self control and need satisfaction. One study revealed that professionals people were the most satisfied, followed by salaried and factory workers were the least satisfied with their jobs. Pay and promotion All other things being equal, higher pay and better opportunities for promotion lead to higher job satisfaction. Work group: Man is a social animal and likes to be associated with other interactions in the work group help to satisfy social 7 psychological needs and therefore isolated workers tend to be dissatisfied job satisfaction is generally high when a worker is accepted by his peers and he has a high need for affiliation. Supervision Considerate supervision helps to improve job satisfaction of employee. A considerate supervisor takes personal interest in his subordinates and encourages them to participate in the decision making process. Individual Factor:Individual have certain expectations from their jobs. If these expectations are not from the jobs, they feel satisfied. These

expectations are based on an individuals level of age and other factors. 1. Age:Individuals experience different degree of job satisfaction at different stages of their life. Job satisfaction is high at the initial stage, get gradually reduced, starts rising up to certain stage, finally dips to a law degree, the possible reason. 2. Job Content Job content refers to the intrinsic value of the job which depends on the requirement of skills for performing it and the degree of responsibility and growth it offers. A higher content of these factors provides higher satisfaction. Situational variables 1. Working condition:Working condition, particularly physical work environment, like conditions of workplace and associated facilities for performing the job determine hob satisfaction. These work in two ways, first these provide means for job performance. Second, provision of these condition affects the individual’s perception about the hospital if these factors are favorable individuals experiences higher level of job satisfaction. 2. Supervision The type of supervision affects job satisfaction as in each type of supervision the degree of importance attached to individuals varies 3. Equitable rewards The type of linkage that is provided between job performance and rewards determines of job satisfaction. 3. Other factors: Besides the above two factors their can be other factors like not having favorable social and family life, he may not feel happy at the workplace similarly other personal problem associated with him may effect his level of job satisfaction. When an individual joins the organization, he may have some unrealistic assumptions about what they

are going to derive from their work. These assumption make them more satisfied. However, when these assumptions fall short of reality job satisfaction goes down. At the last, particularly the fag end of the career, job satisfaction goes down because of fear of retirement and future out come. The following chart shows the important determinants of job-satisfaction Wage structure Working conditions Occupational level Job satisfaction Work group

Quality of supervision Nature of work

Nature of job Nature of job determines job satisfaction which is in the form of occupation level and job content. 1. Occupation level:Higher level jobs provides more satisfaction as compared to lower levels. This happens because high level jobs carry prestige and status in the society which sometimes lead to dis-satisfaction towards job. 2. Job content:Job content refers to the intrinsic value of the job which depends on the requirement of skills for performing it and the degree of responsibility and growth it offers. A higher content of these factors provides higher satisfaction. Situational variables 1. Working condition:Working condition, particularly physical work environment, like conditions of workplace and associated facilities for performing the job determine job satisfaction. These work in two ways, first these provide means for job performance. Second, provision of these condition affects the individuals perception about the hospital. If these factors are favorable individuals experiences higher level of job satisfaction. 2. Supervision:The type of supervision affects job satisfaction as in each type of

supervision the degree of importance attached to individuals varies. 3. Equitable rewards:The type of linkage that is provided between job performance and rewards determines the degree of job satisfaction. If the reward is perceived to be based on job performance and equitable, it offers higher satisfaction. If the reward is perceived to based on consideration other than the job performance it affects job satisfaction adversely. 4. Opportunity for promotion:It is true that individual seek satisfaction in their jobs in the context of job nature and work environment but they also attach importance to the opportunities for promotion that these jobs offer. If the present job offers opportunity of promotion in future, it provides more satisfaction. If the opportunity for such promotion is lacking it reduces satisfaction. 5. Work Group:Either individuals work in group created formally or they develop on their own to seek emotional dissatisfaction at work place. In a cohesive group, people derive satisfaction out of their interpersonal interaction and work place becomes satisfying leading to job satisfaction. Theories of Job Satisfaction The man theoretical approaches to job satisfaction are as

follows:

1. Need fulfillment theory 2. Two factor theory 3. Equity theory 4. Equity discrepancy theory 5. Discrepancy theory

Need Fulfilment Theory: According to this theory, a person is satisfied when he gets from his job what he wants. The more he wants something or the more important it is to him, the more satisfied he is when he received

it. In other words, “Job satisfaction will vary directly with the extent to which those needs of an individual which can be satisfied are actually satisfied. Vroom views satisfaction in terms of the positively valued Outcomes that a job provides to a person Thus, job satisfaction is positively related to the degree to which one’s need are fulfilled. The fulfillment theory suffers From a major drawback. Satisfaction is a function of not only what a person receives but what he feels he should receive. What may satisfy one individual may not satisfy the other due to difference in their expectation. The strength of an individual’s desire or his level of inspiration is an important determinant of job satisfaction. Thus, job satisfaction is a function of the degree to which the employees need are fulfilled in the satisfaction Two- Factor Theory: Frederick Herzberg and his colleagues developed the two factor theory. According to this theory satisfaction and dissatisfaction are interdependent of each other and exist on a separate continuum. One set of factors known as hygiene factors (company policy and; administration, supervision, pay, working conditions and Interpersonal relations) act as dissatisfies. Their absence causes dissatisfaction but their presence does not result in positive satisfaction. The other set of factors known as satisfiers (achievement, advancement, recognition, work itself and responsibility) lead to satisfaction. Several studies designed to test the two-factor theory provide little support to this theory. The same factor may serve as a satisfier for one but a dissatisfied for another. It appears from this theory that a person can be satisfied and dissatisfied at the same time. Equity Theory: According to this theory, a person’s job satisfaction depends upon his perceived equity as determined by his input-output balance in comparison with the input-output balance of others. Every employee compares his input-output balance of others .every employee compares his rewards wit those of reference group. If he feels his rewards are equitable in comparison with others doing similar work, he feels satisfied. Job satisfaction is thus a function of the degree to which job characteristics meet the desires of the reference group. For example, one study of the effects of community features on job satisfaction revealed that workers living in a well to do neighborhood felt less satisfied than those living in poor neighborhood. 34 equity theory takes its account only the needs of an individual but also the opinion of the reference group to which the

individual looks for guidance. Equity-discrepancy theory: This is a combination of equity and discrepancy theory rather than the ratio approach of equity theory, the concept of comparison has been selected to serve as an intervening variable. From equity theory the concept of comparison has been selected to serve as an intervening variable. Under this theory, satisfaction is defined as the difference between the outcomes that one perceives he actually received and outcomes that one feels he should receive in equal to what he receives he should receive there is satisfaction. Thus, an individual’s reception of his reward is influenced by more than just the objective amount of that factor. Because of this psychological influence, the same amount of reward can be seen quite differently by two people to one it can be a large amount while to other person it can be a small amount.35 This model reveals that a persons perception of what he should receive is influenced by the inputs and outputs of others. If his inputs are similar to those of referent groups but his outcomes are less, he is likely to be dissatisfied. Lawler suggests that those Individuals are likely to be more satisfied who perceives their inputs are low, their jobs are less demanding, their reference groups are less favorable, input-output balance and their reference groups are receiving less outputs. Discrepancy Theory: Under this theory, job satisfaction depends upon what a person actually receives from this job and what he expects to receive. When the rewards actually received are less than the expected rewards, it causes dissatisfaction. In the words of Locke, “ Job satisfaction and dissatisfaction are functions of perceived relationship between what one wants from one’s job and what one perceives it is actually offerings.36 In other words, satisfaction is the difference between what he feels he should receive.37 Social

Reference Group Theory:

Reference group defines the way an individual looks at the world. According to this theory, job satisfaction occurs when the job meets the interest, desires and requirements of a person’s reference group. In other words, job satisfactions a function of the degree to which the job meets the approval of the approval of the group to which the individual looks for guidance in evaluating the world and defining

social reality. The social reference group theory is similar to the need fulfillment theory except that it takes into account not the desires needs and in tersest of the given individual but rather the point of view explanation to the groups to whom the individual looks for guidance this theory is an incomplete explanation to the extent some people are independent of group opinions and group pressure. Need of a Job Satisfaction Job satisfaction is one of the influencing factors in achieving goals of the organizations. The people who are at the helm should pay greater attentions; the reasons are: 1. Job satisfaction has some relation with the mental health of the people. 2. Job satisfaction has some degree of positive correlation with physical health of the people. 3. Spreads goodwill about the organization and attracts qualified and dynamic people. Organisation thus will be in a position to enjoy the talents of people. 4. Reduces absenteeism and turnover: High employee turnover is of considerable concern for employers. A serious consequences of job dissatisfaction can be the high labour turnover. Higher job satisfaction reduces labour turnover and absenteeism. Therefore, managers should give priority to the job satisfaction.

How to improve job satisfaction To mitigate dissatisfaction or to improve job satisfaction a number of interventions can be undertaken. Some of the most important of them. Improve working conditions One simple, prescribed solution to increase job satisfaction is to improve those conditions which are organizational sore parts. Transferring discontented workers In some cases it is also possible to mitigate dissatisfaction by transferring the disgruntled employee to another job matching his tastes & preferences. This kind of transfer may not be without certain constraints. The dissatisfied person may be unwilling to move from the position or he may be incompetent to hold other challenging job.

Changing perceptions Sometimes have misconceptions about many aspects of job. Dissatisfaction steams from the misperceptions about the organization person may be misinformed about certain issues i.e. the misperceptions might be based on inadequate or incorrect information. Initiate morale building programme Organisation conducts programmes of development where in morale building becomes a major part. Even the successful org. also conduct new programme to keep the morale and job satisfaction at higher level. JOB STRESS AT WORK PLACE Stress is the psychological and physical state that results when the resources of the individual are not sufficient to cope with the demands and pressure of the situation. Level of job satisfaction and stress can affect both individuals and organization. At the individual level, low level of job satisfaction and high level of job stress are threat to mental and physical health, quality of life, goal achievement and personal development. Whereas, for the workplace these conditions lead to increased absenteeism, conflict and turnover, and reduced quality and quantity of work. Thus identification of factors responsible for stress and its management at its primary level has long term benefits both for employee and employer. Job stress is a recognized problem in health care workers and doctors are considered to be at particular risk of stress and stress related psychosocial problems. Doctors have higher degree of psychological morbidity, suicidal tendencies and alcohol dependence than controls of comparable social class. Caplan reported that about half of senior medical staff suffers from high level of stress and a similar proportion suffers from anxiety.8 Similarly, Firth-Cozens found that half of the junior doctors in their pre-registration year were suffering from emotional disturbance. The delivery of high-quality medical care contributes to improved health outcomes. Doctor’s job satisfaction affects quality of medical cares that he/she provides, patient’s satisfaction with the doctor, patient’s adherence to treatment and decreases doctor’s turnover. Many primary physicians believe that managed care and market competition have eroded their satisfaction with medical practice. Little is known about whether physician job dissatisfaction—whether

from managed care or other sources—undermines patient perceptions of quality care and health outcomes. Job stress leads to poor performance at work and negatively affects the health of an individual. Stress is inherent in medical career, and leads to poor quality of care, affects career longevity, and causes personal distress. One factor that has been found to affect well-being and functionality in the workplace—particularly with regard to human interaction with complex systems and tasks as seen in telemedicine—is mental workload. Workload is generally defined as the “cost” to a person for performing a complex task or tasks Stress and stress-related illnesses are increasing among medical specialists. This threatens the quality of patient care. Stress-related illnesses, such as burnout, among physicians are receiving increased attention. A dramatic rise in these illnesses among Dutch physicians recently prompted disability insurance companies to raise premiums by up to 30%.The negative consequences of stress pose a serious problem, not only for physicians' well-being5 but also for the quality of patient care. Personal, interpersonal and organizational factors have been reported to relate to stress and burnout. Stress-related illnesses, such as burnout, among physicians are receiving increased attention. A dramatic rise in these illnesses among Dutch physicians recently prompted disability insurance companies to raise premiums by up to 30%.The negative consequences of stress pose a serious problem, not only for physicians' well-beingbut also for the quality of patient care. Personal, interpersonal and organizational factors have been reported to relate to stress and burnout. A confluence of forces has changed the practice of medicine in unprecedented ways during the past decade. There is increasing focus on and concern about he quality of medical care, financial constraints are being applied more frequently and stringently and the practice and management of medical care have become increasingly centralized and dominated by managed care and physician organizations. Where as physician once practiced primarily alone or in small autonomous groups, they now are more likely to practice in large groups and are increasingly subjected to profiling, administrative requirements and preapproval for procedures and treatments. Evidence suggests that some physicians are becoming unhappy in this environments. Understanding trends in physician career satisfaction and how changes in the practice environments of physician affect their career

satisfaction is important for several reasons. First, physician affect their career satisfaction is associated with quality of care, particularly as measured by patient satisfaction. Second, dissatisfied physicians are more likely to leave the profession and discourage other from entering. This is disruptive to patient – physician relationships, costly to physician practices and could ultimately diminish the overall quality of care if potentially outstanding physicians are dissuaded from choosing this career. Finally career dissatisfaction might be one manifestation of physician’s perceptions of problems in delivering high – quality care to their patients. The literature suggests that changes in physician career satisfaction may be influenced by 3 general factors: changes in the physicians practice environment including the income they derive from practice and hours worked changed in physicians autonomy as measured by perceptions of their ability to provide high quality care to provide high quality care to their patients and to obtain needed medical services for them and changes in the local market. Physicians career satisfaction appears to be a complex functions of a number of variables. Overall career satisfaction among physicians may remain high despite decreases in some of these domains. It is unlikely that optimal medical care can be delivered by unhappy or maladapted physicians. A descriptions of physicians stresses and adaptations would facilitate educational, personal and social changes that could improve the quality of medical care. Physicians work yields job satisfaction but the most important sources of stress were interruptions of family life, emergency calls, monotony and practice administration and other conditions which disturb intimacy. Burnout and more generalized psychiatric morabididy warrant careful consideration not only because they reflect the personal suffering of doctor but also because of the risk of imparing the quality of care doctors are expected to deliver. One study showed that job satisfaction and occupational stress are those related to the doctor’s social life, particulars the effects of the job’s demands on the family life, and another study showed that the main sources of stress are not medical but social. Job satisfaction was related to several personal & practice characteristics. Longer reported working hours were associated with lower levels of satisfaction. Doctor’s persona & practice characteristic however explained only a small part the overall variance in job satisfaction. This suggests that the principal causes of general practitioners discontent lie within the wider environment. The organization and governance of general practice has greatly changed in recent years and doctors may be experiencing difficulty in

adapting to these changes. Job dissatisfaction among general practitioners may additionally reflect a more global discontent of doctors with their changing role in society. Strategies for improving satisfaction and hence retention require better alignment of employers expectations and job characteristics with doctors job aspirations. This was in contrast to the public’s common and long standing perception of physicians as a well respected occupational group that experiences a high level of professional satisfaction in jobs generally seen as intrinstically interesting, intellectually challenging and socially useful. The public as well as people entering the field of medicine, had generally perceived that physicians had virtually unlimited autonomy in clinical decision making had the freedom to select their clientle, held the power to determine their working conditions and enjoyed considerable financial rewards. There were various reasons for the newfound dissatisfaction including the profession’s increased fragmentation, the emergence of managed care, the dilution of physician decision-making authority and society’s increased skepticism toward the competencies and motivations of all professionals when combined, those factors were making medicine less satisfying as a professional than in once had been in turn this became a matter of concern for many in the health policy arena. It was especially important with respect to generals physicians who were experiencing the most direct impact of the decline in quality of work life

CHAPTER – II REVIEW OF LITREATURE PREDICTORS OF JOB SATISFACTION AMONG DOCTORS, NURSES AND AUXILIARIES IN NORWEGIAN HOSPITALS: RELEVANCE FOR MICRO UNIT CULTURE Unni Krogsta, Dag Hofoss Marijke Veenstr and Per HjortdahlNorwegian Knowledge Centre for the Health Services, Oslo, Norway Helse Øst Centre for Health Services Research, Akershus University Hospital, Oslo, Norway Rikshospitalet, University Hospital, Oslo, Norway Department of General Practice and Community Medicine, University of Oslo, Oslo, Norway Objective To explore what domains of work are important for job satisfaction among doctors, nurses and auxiliaries and to discuss differences

between professional groups in the perspective of micro team culture. Results A total of 1814 doctors, nurses and auxiliaries working at 11 Norwegian hospitals responded (overall response rate: 65%). The only domain of work that significantly predicted high job satisfaction important for all groups was positive evaluation of local leadership. Both steps of analyses suggested that professional development is most important for doctors. For registered nurses, experiencing support and feedback from the nearest superior was the main explanatory variable for job satisfaction. Job satisfaction of auxiliaries was equally predicted by professional development and local leadership. The results are discussed and interpreted as reflections of cultural values, loyalties and motivation. Conclusion The professional values of medicine, the organizational and holistic skills of nurses and the practical experience of auxiliaries should all be valued in the building of interdependent micro teams. MANAGED CARE, PHYSICIAN JOB SATISFACTION, AND THE QUALITY OF PRIMARY CARE David Grembowski, PhD; David Paschane, MS; Paula Diehr, PhD; Wayne Katon, MD; Diane Martin, PhD; Donald L. Patrick, PhD, MSPH Objective: To determine the associations between managed care, physician job satisfaction, and the quality of primary care, and to determine whether physician job satisfaction is associated with health outcomes among primary care patients with pain and depressive symptoms. Results: For each patient, managed care was measured by the intensity of managed care controls in the patient's primary care office, physician financial incentives, and whether the physician read or used back pain and depression guidelines. Physician job satisfaction at baseline was measured through a 6-item scale. Quality of primary care at follow-up was measured by patient rating of care provided by the primary physician, patient trust and confidence in primary physician, quality-of-care index, and continuity of primary physician. Outcomes were pain interference and bothersomeness, Symptom Checklist for Depression, and restricted activity days. Pain and depression patients of physicians with greater job satisfaction had greater trust and confidence in their primary physicians. Pain patients of more

satisfied physicians also were less likely to change physicians in the follow-up period. Depression patients of more satisfied physicians had higher ratings of the care provided by their physicians. These associations remained after controlling statistically for managed care. Physician job satisfaction was not associated with health outcomes. Conclusions: For primary care patients with pain or depressive symptoms, primary physician job satisfaction is associated with some measures of patient-rated quality of care but not health outcomes.

A SURVEY OF JOB SATISFACTION, SOURCES OF STRESS AND PSYCHOLOGICAL SYMPTOMS AMONG NEW ZEALAND HEALTH PROFESSIONALS. Anthony C Dowell, Professor of General Practice, Wellington School of Medicine, University of Otago Travis Westcott, Medical student, Wellington School of Medicine, University of Otago Deborah K McLeod, Research Manager for General Practice, Wellington School of Medicine, University of Otago Stephen Hamilton, Medical student, Wellington School of Medicine, University of Otago Aim: To assess job satisfaction, job-related stress and psychological morbidity among New Zealand physicians, surgeons and community pharmacists and provide a comparison with New Zealand General Practitioners. Results: Response rates were 70.5% for physicians, 69% for surgeons and 76% for community pharmacists. Job satisfaction scores for surgeons were similar to scores for general practitioners. Pharmacist and physicians scores were lower. Job satisfaction varied according to gender, the relative amount of time spent in public practice and the perceived ill effects of work on health. Pharmacists had the highest number of cases

with significant scores on the GHQ-12 scale, with physicians and surgeons scoring similar to general practitioners. In each of these health professional groups approximately 10% described a level of symptoms that is associated with more severe psychological disturbance. A study by Richards identified significant stress in 61% of a sample of New Zealand doctors 5and there is evidence of high levels of burnout in rural practitioners. 6 In January 1999 New Zealand general practitioners were surveyed to assess levels of job satisfaction, psychological morbidity and stress3. In that survey although general practitioners were satisfied with their jobs overall, work was perceived as affecting the physical health of 46% of the sample and 57% had often contemplated leaving general practice. Approximately one third (31.4%) of those general practitioners had a score higher than 4 on the GHQ-12 indicative of a significant level of psychological symptoms and 10% scored more than 8 indicating significant psychological distress. Major causes of stress and lack of job satisfaction were excessive paperwork, health reforms and bureaucratic interference, excessive hours and on-call work. This survey has been repeated with specialist physicians, surgeons and pharmacists to provide a comparison with general practitioners. Three sampled pharmacists, eight physicians and 10 surgeons had retired leaving final sample sizes of 397, 403 and 320 respectively. Completed questionnaires were returned by 303 pharmacists (76%), 284 physicians (70.5%) and 221 (69.0%) surgeons. A further twenty-six questionnaires were received too late to be included in the analysis. Job Satisfaction. Overall, pharmacists (median total score=42) and physicians (median=45) were less satisfied with their jobs, than GPs (median=47). There was no significant difference in job satisfaction between GPs and surgeons (median=47). (Table two). Female pharmacists (median=48) and physicians (median=47) were more satisfied with their work than their male counterparts (median=41 and 45 respectively). There were too few female surgeons to allow gender comparisons. Impact of job stress However, similar levels of satisfaction were reported for both public work and private work. Median 7 point Likert scale scores, where 1 is highly satisfying, were 2(3-4) and 3 (2-5) for physicians and surgeons respectively for public work and 2(2-3) and 2 (2-3) for private work. There was a significant correlation between job satisfaction and other

question responses for pharmacists, physicians, and surgeons. Low job satisfaction correlated with contemplation of giving up work due to stress (r=-0.40; -0.35; -0.31 respectively), disinterest in pharmacy/medicine due to work stress (r=-0.44; -0.44; - 0.33 respectively), feeling overwhelmed by paperwork (r=-0.26; -0.35; -0.23 respectively) and feeling stressed by financial concerns (r=-0.22; -0.34; -0.32 respectively). Physicians and surgeons were more likely to have lower job satisfaction scores if they felt unable to remain competent in their field of work. Lower job satisfaction for pharmacists and physicians correlated with bureaucratic interference. Increased time spent in private practice correlated with increased job satisfaction for physicians and surgeons. Respondents from all health professional groups commented about stress related to the impact of government reforms and ‘bureaucratic interference’. Conclusions: All three groups were generally satisfied with their jobs. Pharmacists were significantly less so. Physicians and surgeons reported similar levels of psychological morbidity to general practitioners, which have been previously reported as a cause for concern. COMPARISON OF JOB SATISFACTION AND STRESS AMONG MALE AND FEMALE DOCTORS IN TEACHING HOSPITALS OF KARACHI Ali Khan Khuwaja, Riaz Qureshi,Marie Andrades, Zafar Fatmi, Nadya Khan Khuwaja Department of Community Health Sciences, *Family Medicine, and Diagnostic Center, The Aga Khan University, Karachi Results: Majority (68%) of the doctors was not satisfied with their jobs. Overall, the mean scores for satisfaction were low for workplace characteristics. Lowest scores were found for pay and benefits 2.12 (SE 0.8), safety and security 2.15 (SE 0.8) and workload 2.69 (SE 0.9). Female doctors had significantly lower satisfaction about workload (mean job satisfaction score difference = 0.60; 95%CI, 0.24-0.97), relation with colleagues (mean job satisfaction score difference = 0.49; 95%CI, 0.11-0.87) and autonomy (mean job satisfaction score difference = 0.45; 95%CI, 0.07-0.82) as compared to their male counterparts. Overall, 48% of doctors graded job stress from high to very high levels. Demographic and professional characteristics of respondents are shown

in table 2. There were 58% male and 42% female doctors. Majority of them was 35 years or older (61%) and married (79%). Fifty three percent of the doctors were qualified since more than 10 years. Nearly half of the respondents had post-graduation diploma/degree and 46% were seeing more than 100 patients per week. Thirty-three percent respondents were trainee doctors, 29% Family/General practitioners and 38% Faculty/Consultants. Majority (68%) of the doctors were not satisfied with their jobs, females more than males (males 65% and females 72%; Mean score for workplace characteristics for job satisfaction are given in table 3. Characteristics with least satisfaction were pay and benefits safety and security workload (2.69, adequate resources (2.69, SE 0.9) and physical working conditions (2.79, SE 0.8). Significant differences for job characteristics by sex were found for workload (mean job satisfaction score difference 95% relation with colleagues and fellows (mean job satisfaction score difference 95% and autonomy (mean job satisfaction score difference 95% About half (48%) of the doctors graded job stress from high to very high levels. The mean stress score was 3.32 Females had higher level of stress than males (mean scorebut this was not statistically significant (mean difference 95% Percentages of different affects of stress on doctor’s personal lives are shown in figure 2. Affect on family life was reported by 66% of doctors (female 79% and male 57%) and this was statistically significant Forty-five percent of doctors reported that job stress affects on their physical health and 53% said that it affects their mental health; however these results were not significantly different in different sex. Conclusion: Majority of doctors working at these teaching hospitals of Karachi had poor satisfaction level for workplace characteristics and higher levels of job stress. This suggests that immediate steps should be taken for their control and management. This study invites further research to explore, implement and evaluate intervention strategies for prevention of stress and improvement in job satisfaction. Affects of job stress among doctors Whereas for male general practitioners, the work-home interface was the least important factor. In this study also, female doctors reported more about job stress and its affect on their family lives compared to male doctors. Female doctors have greater household responsibilities and are required to take care of the children and

other family members as compared to their male counterparts. Majority of respondents from both sexes also identified the affects of stress on physical and mental health, which is again alarming. Your browser may not support display of this image. The best way to deal with stress is to eliminate it at its origin i,e., the stress should be dealt in terms of preventive rather than as a curative strategy. Recognizing problems and dealing with them positively and pro-actively, is the cost-effective way forward in the management of stress. These results imply that the focus of change should be on prevention at the primary level. For example, providing security to doctors, appropriate pay and benefits, revising job plans, ensuring adequate hours of work and adequate number of doctors to share the workload and responsibilities and provision of adequate resources and physical working conditions. Your browser may not support display of this image. In addition, the role of social support and relaxation techniques as stress coping strategies should not be overlooked as contributory factors for the well being of the doctors. Thus an integrated approach for successful occupational stress management should be advocated, which seeks to manage stress at the individual and organizational levels. Individual approaches include stress management training and one-to-one psychology service - clinical, occupational and health counseling while organizational interventions ranging from structural (for example work schedules, physical environment) to psychological (for example social support, control of over-work, participation). However, it is also necessary that doctors are encouraged to use these services. JOB SATISFACTION AMONG SENIOR DOCTORS GENERALLY HIGH September 25, 2002 - Levels of job satisfaction among senior doctors have been generally high, but many do not plan to work to the age of 65, finds a study in this week's BMJ. All traceable 1974 UK medical school graduates were sent questionnaires about their employment history, current job satisfaction, and plans for the future. Some 97% of those who responded were in medical employment and 85% worked in the NHS. Overall, job satisfaction was rated reasonably highly, but there were

significant differences between occupational groups, with hospital doctors reporting greater satisfaction than GPs. Among GPs, women were more satisfied than men and part-timers were more satisfied than those working full-time. 86% of NHS hospital doctors and 78% of GPs said they definitely intended to continue working for at least another five years. Reasons given for considering leaving medicine included disillusionment with the NHS, work-related stress, and the desire to work in a developing country. The results demonstrate the extent to which the medical workforce has changed. In 1974 only a quarter of graduates were female and women were less likely than men to become consultants. The majority of medical school entrants are now female and in the future many more senior posts will be filled by women. The study concludes that senior doctors have been committed to the NHS and generally satisfied with their work. Nevertheless, many of the respondents commented that their work was close to the limit of what they considered acceptable, and said that they would retire before the age of 65. ROLE STRESS AND JOB SATISFACTION AMONGST DOCTORS The present study was undertaken with the intention of examining the nature of role stress and job satisfaction among doctors, and to explore the relationship between these variables. A group of 35 junior doctors working at the primary health centres and another group of 35 senior doctors attached to various district level hospital served as sample of the study. To attain the objectives of the study, two psychometric instruments – the Organizational Role Stress Scale (Pareek, 1983) and the Employees’ S-D Inventory (Pestonjee, 1981) – were administered to the sample population to obtain data pertaining to role stress and job satisfaction variables. The data were analysed in terms of the t-test and coefficients of correlation. Results of the study revealed no significant differences between the two groups except in the case of management area of job satisfaction and inter-role distance (IRD) dimension of role stress. Further, job satisfaction variables correlated negatively with all the dimensions of role stress in the case of both groups. ASSESSING PHYSICIAN JOB SATISFACTION AND MENTAL WORKLOAD Oscar W. Boultinghouse, Glenn G. Hammack, Alexander H. Vo, Mary Lynne Dittmar. Telemedicine and e-Health. 2007Mary Lynne Dittmar, Ph.D.

Dittmar Associates, Inc., Houston, Texas. Web-based surveys administered at an interval of six months at a single site evaluated the physicians in the telemedicine workplace. Job satisfaction among the five physicians was high and stable compared to other clinicians. A NASA instrument for mental workload showed the physicians had scores comparable to quality control engineers and air traffic controllers. There was no correlation between relative mental workload and job satisfaction. The workplace of the telemedicine physician must be more fully understood to keep that workplace stable and productive. Physician job satisfaction and mental workload were evaluated in a pilot study of five physicians engaged in a telemedicine practice at The University of Texas Medical Branch at Galveston Electronic Health Network. Several previous studies have examined physician satisfaction with specific telemedicine applications; however, few have attempted to identify the underlying factors that contribute to physician satisfaction or lack thereof. One factor that has been found to affect well-being and functionality in the workplace—particularly with regard to human interaction with complex systems and tasks as seen in telemedicine—is mental workload. Workload is generally defined as the “cost” to a person for performing a complex task or tasks; however, prior to this study, it was unexplored as a variable that influences physician satisfaction. Two measures of job satisfaction were used: The Job Descriptive Index and the Job In General scales. Mental workload was evaluated by means of the National Aeronautics and Space Administration Task Load Index. The measures were administered by means of Web-based surveys and were given twice over a 6-month period. Nonparametric statistical analyses revealed that physician job satisfaction was generally high relative to that of the general population and other professionals. Mental workload scores associated with the practice of telemedicine in this environment are also high, and appeared stable over time. In addition, they are commensurate with scores found in individuals practicing tasks with elevated information-processing demands, such as quality control engineers and air traffic controllers. No relationship was found between the measures of job satisfaction and mental workload. Stress, satisfaction and burnout among Dutch medical specialists Mechteld R.M. Visser, Ellen M.A. Smets, Frans J. Oort and Hanneke C.J.M. de Haes Results: The final response rate was 63%. Of the respondents, 55% acknowledged

high levels of stress, and 81% reported high job satisfaction. Personal and job characteristics explained 2%–6% of the variance in job stress and satisfaction. Perceived working conditions were more important, explaining 24% of the variance in job stress and 34% of the variance in job satisfaction. Among perceived working conditions, the interference of work on home life 1.54, 95% confidence interval and not being able to live up to one's professional standards were most related to stress. Feeling poorly managed and resourced diminished job satisfaction. Burnout was explained by both high stress and low satisfaction (41% of variance explained) rather than by stress alone. Of the 2400 questionnaires mailed, 1573 (66%) were returned. We excluded 138 questionnaires because they did not meet the inclusion criteria. This left 1435 questionnaires (63%) for our analyses. Of the 816 nonresponse forms sent, 441 (54%) were returned. The non respondents were on average 1 year older and experienced less stress than the respondents. Effect sizes, however, were small or very small Of the respondents, 13% were psychiatrists, 9% internists, 7% anesthesiologists, 7% surgeons, 7% pediatricians, 6% radiologists, 5% neurologists, 5% gynecologists and 41% other specialists Of the respondents, 55% reported experiencing high or very high levels of stress, whereas 81% reported high or very high job satisfaction Personal characteristics and job characteristics explained only 2%–6% of the variance in stress and satisfaction Perceived working conditions, however, explained 24% of the variance in stress and 34% of the variance in satisfaction. When all of the variables were combined, 25% of the variance in job stress and 35% of the variance in job satisfaction were explained. Factors associated with stress were work–home interference, impossibility of living up to one's standards and experiencing societal pressure. Satisfaction was best explained by feeling poorly managed and resourced. Job security, feeling valued, intellectual stimulation, communicative responsiveness and social support by colleagues contributed about equally. Job stress and job satisfaction both appeared important predictors of emotional exhaustion (41% of the variance explained) That is, when stress is high 95% confidence interval and satisfaction is low 95% confidence interval emotional exhaustion is most likely. Stress and satisfaction were less important in predicting depersonalization (13% of variance explained) and personal accomplishment (11% of variance explained).

JOB SATISFACTION OF PHYSICIANS EMPLOYED IN THREE HOSPITALS IN KIRIKKALE Dr.Meral SAYGUN, Dr.Aytül ÇAKMAK, Dr.S. Kenan KÖSE Halk Sağlığı AD, Kırıkkale Üniversitesi Tıp Fakültesi, KIRIKKALE Biyoistatistik AD, Ankara Üniversitesi Tıp Fakültesi, ANKARA Objective: An investigation of job satisfaction among physicians could conceivably serve to document major issues and aid in devising appropriate solutions for this important workforce. Areas of interest, authority and obligation of physicians differ depending on their association and working places. The aim of this study was to attempt to establish job satisfaction levels of physicians from three different centers in Kırıkkale (Hospital of Kırıkkale University Medical School, Kırıkkale Hospital of Social Insurance Institution and Kırıkkale State Hospital of Ministry of Health) and, in so doing, to detect the main factors of dissatisfaction, and finally, to suggest appropriate solutions. Results: The Mean General Job Satisfaction Score (MGJSS) of all physicians from the three centers was 172.51±39.12. There were statistically significant differences between the MGJSS of physicians working in the different centers. University hospital physicians had the highest scores. There was, however, no significant difference between the physicians of state hospital physicians and those employed at the social insurance hospital, which had similar characteristics. None of the physicians from any of the centers attained the maximum score. Categories exhibiting a strong relationship with MGJSS in each of these three institutions were “organisational culture’’ and “loyalty and trust to institution”. Improvement in these categories may contribute to a lessening of job dissatisfaction. Conclusion: A number of specific measures can and should be undertaken to improve factors which negatively affect physician job satisfaction. JOB SATISFACTION, WORK-RELATED STRESS AND INTENTIONS TO QUIT OF SCOTTISH GPS Steven Simoens, Anthony Scott, Health Economics Research Unit, University of Aberdeen, Foresterhill,

Aberdeen AB25 2ZD Aims: This study purports to elicit the views of Scottish GPs on job satisfaction, stress, intentions to quit, and to examine any patterns by demographic, job, and practice characteristics. Results: The response rate was 56%. GPs were most satisfied with their colleagues, variety in the job, and amount of responsibility given. The most frequently mentioned sources of job stress were increasing workloads, paperwork, insufficient time to do justice to the job, increased and inappropriate demands from patients. White, female, young (under 40 years) and old (55 years and over) GP non-principals and PMS GPs who work less than 50 hours per week as a GP were more likely to be satisfied with their job and reported lower levels of stress. The survey was conducted in August 2001. Non-respondents were mailed up to two more times at intervals of three weeks. After two months, 802 usable questionnaires had been completed and returned, yielding a response rate of 56%

The absence of clear differences in measured characteristics between respondents and non-respondents indicated that each sample was broadly representative of the range of characteristics of its population, except for the sample of GP non-principals. Responding GP non-principals were older and worked in general practices with fewer GPs and fewer patients. Therefore, data were weighted to ensure that responding GP non-principals were representative of Scottish GP non-principals nationally in terms of doctors’ age, number of GPs in the general practice, and number of patients on the practice list.

General Practioner job satisfaction The mean score for overall satisfaction indicated that GPs are more satisfied than not with their job. GPs expressed most satisfaction with colleagues and fellow workers, amount of variety in job, and amount of responsibility given, but were least satisfied with remuneration (except for PMS GPs) and hours of work.

General Practioner job stress The mean scores for stress at work suggested that GPs experience moderate pressures at work The highest sources of job stress related to increasing workloads, paperwork, insufficient time to do justice to the job, increased and inappropriate demands from patients.

Around one-third of GPs stated that it is likely that they will reduce their working hours within five years. The proportion of GPs who are likely to leave their current general practice within two years was 11% for GP principals, 38% for GP non-principals, and 14% for PMS GPs. A higher proportion of GP principals was likely to leave general practice medicine, leave direct patient care, or leave medical work entirely within five years than GP non-principals. PMS GPs were least likely to reduce work hours or intend to quit.

Conclusions: General Practioner participation in the workforce could be promoted by introducing more flexible working patterns (e.g. part-time work), by expanding the scope of contractual arrangements, and by making patient expectations more realistic by clearly communicating what the role of a GP actually encompasses. STRESS, SATISFACTION AND BURNOUT AMONG DUTCH MEDICAL SPECIALISTS Mechteld R.M. Visser, Ellen M.A. Smets, Frans J. Oort and Hanneke C.J.M. de Haes The authors are with the Department of Medical Psychology, Academic Medical Centre, Amsterdam. Results: The final response rate was 63%. Of the respondents, 55% acknowledged high levels of stress, and 81% reported high job satisfaction. Personal and job characteristics explained 2%–6% of the variance in job stress and satisfaction. Perceived working conditions were more important, explaining 24% of the variance in job stress and 34% of the variance in job satisfaction. Among perceived working conditions, the interference of work on home life, 95% confidence interval and not being able to live up to one's professional standards

were most related to stress. Feeling poorly managed and resourced, 95% diminished job satisfaction. Burnout was explained by both high stress and low satisfaction (41% of variance explained) rather than by stress alone.

MENTAL HEALTH, JOB SATISFACTION, AND JOB STRESS AMONG GENERAL PRACTITIONERS. C L COOPER , U ROUT , B FARAGHER OBJECTIVE--To identify sources of job stress associated with high levels of job dissatisfaction and negative mental wellbeing among general practitioners in England. RESULTS--Women general practitioners both had job satisfaction and showed positive signs of mental wellbeing in contrast with other normative groups. Conversely, male doctors showed significantly higher anxiety scores than the norms, had less job satisfaction, and drank more alcohol than their women counterparts. Multivariate analysis disclosed four job stressors that were predictive of high levels of job dissatisfaction and lack of mental wellbeing; these were demands of the job and patients' expectations, interference with family life, constant interruptions at work and home, and practice administration. CONCLUSIONS--There may be substantial benefit in providing a counselling service for general practitioners and other health care workers who suffer psychological pressure from their work.

MENTAL HEALTH OF HOSPITAL CONSULTANTS: THE EFFECTS OF STRESS AND SATISFACTION AT WORK. A J RAMIREZ, J GRAHAM, M A RICHARDS, A CULL ,W M GREGORY FINDINGS: Of 1133 consultants, 882 (78%) returned questionnaires. The estimated prevalence of psychiatric morbidity was 27%, with no significant differences between the four specialist groups. Radiologists reported the highest level of burnout in terms of low personal accomplishment. Job satisfaction significantly protected consultants' mental health against job stress. Three sources of stress were associated with both burnout and psychiatric morbidity; feeling overloaded, and its effect on home life; feeling poorly managed and resourced; and dealing with patients' suffering. Burnout was also

associated with low satisfaction in three domains: relationships with patients, relatives and staff; professional status/esteem; intellectual stimulation. In addition, being aged 55 years or less and being single were independent risk factors for burnout. Burnout was also more prevalent among consultants who felt insufficiently trained in communication and management skills JOB SATISFACTION AMONG GENERAL PRACTITIONERS: A SYSTEMATIC LITERATURE REVIEW van Ham, I.; Verhoeven, A.A.; Groenier, K.H.; Groothoff, J.W.; de Haan, J. Objective: In recent years, the incidence of being overworked and burnt out has increased among general practitioners (GPs). One of the factors that influences the development of burnout is the job satisfaction that physicians experience. Results: We found 24 relevant citations. Factors increasing job satisfaction which were mentioned more than twice were: diversity of work, relations and contact with colleagues, and being involved in teaching medical students. Factors decreasing job satisfaction were: low income, too many working hours, administrative burdens, heavy workload, lack of time, and lack of recognition. Conclusion: Aspects of job satisfaction concerning the content of the profession seem to increase job satisfaction, and aspects concerning employment conditions seem to decrease job satisfaction

JOB SATISFACTION OF PRIMARY HEALTH CARE PHYSICIANS AT CAPITAL HEALTH REGION, KUWAIT Objectives: To evaluate the extent of job satisfaction of primary health care physicians working in Capital Health Region Results: A total of 89 participants in the study consisted of 42 males and 47 females; 56.2% were Kuwaiti 82.0% were married and 73.0% had children. The overall satisfaction was 61.8%. Significantly the higher the age the higher the job satisfaction. There were no significant differences in overall job satisfaction for nationality, sex, marital status and number of children. The GPs were less satisfied with their rate of pay but more satisfied with their colleagues.

Conclusion: Job satisfaction of primary health care physicians is critical for improvement of health systems. The results of our study showed that GPs were less satisfied with the rate of pay and the amount of variety in work. Young physicians appear to need more attention. NATIONAL SURVEY OF JOB SATISFACTION AND RETIREMENT INTENTIONS AMONG GENERAL PRACTITIONERS IN ENGLAND Bonnie Sibbald, professor of health services research, Chris Bojke, research fellow, Hugh Gravelle, professor of economics. Objectives: To measure general practitioners' intentions to quit direct patient care, to assess changes between 1998 and 2000, and to investigate associated factors, notably job satisfaction. Results: The proportion of doctors intending to quit direct patient care in the next five years rose from 14% in 1998 to 22% in 2001. In both years, the main factors associated with an increased likelihood of quitting were older age and ethnic minority status. Higher job satisfaction and having children younger than 18 years were associated with a reduced likelihood of quitting. There were no significant differences in regression coefficients between 1998 and 2001, suggesting that the effect of factors influencing intentions to quit remained stable over time. The rise in intentions to quit was due mainly to a reduction in job satisfaction together with a slight increase in the proportion of doctors from ethnic minorities and in the mean age of doctors. Doctors' personal and practice characteristics explained little of the variation in job satisfaction within or between years. Conclusions: Job satisfaction is an important factor underlying intention to quit, and attention to this aspect of doctors' working lives may help to increase the supply of general practitioners. Job satisfaction among male physicians – perspective from northern Iraq Your browser may not support display of this image. J Coll Physicians Surg Pak May 2006; Erbil and Kirkuk, Iraq Objective: To determine the level of job satisfaction among male physicians in northern Iraq. Results: Out of 174 male physicians participating in this study, 132

(75.8%) responded as always or usually, satisfied with their career as a physician Ninety-seven (55.7 %) physicians reported their work related stress as either severe or moderate, But 153 (87.9 %) physicians reported as always or usually being in control of their professional work-related activities, while mean level of stress at home/personal life Conclusion: Over seventy percent of male physicians in public-sector hospitals were satisfied with their jobs; however, links between working conditions and levels of job satisfaction were not clearly discernible. A SURVEY OF PROFESSIONAL SATISFACTION AMONG CANADIAN ANESTHESIOLOGISTS Kathryn Jenkins , BM BS FRCA and David Wong, MD Purpose: To assess overall job satisfaction among Canadian anesthesiologists and examine contributing factors. Results: Of 1659 surveys sent, 946 were returned (57% response rate). Seventy-five percent of the respondents were male and 25% female. Staff comprized 91%, residents 9%. The average working week was 59 ± 11.9 hr. Seventy-five percent of respondents reported overall job satisfaction. Job satisfaction was associated with intellectual stimulation, good quality of care and interaction with patients. Dissatisfaction stemmed from treatment from the provincial government, hospital politics and long hours. Job satisfaction was associated with satisfaction with the level of operating room (OR) assistance, perceived high surgical regard and public image. Residents were more satisfied than staff anesthesiologists. Overall satisfaction was not affected by age, gender, region of practice, type of hospital or clinical work. Conclusions: Job satisfaction among anesthesiologists is significantly associated with intellectual stimulation, quality of care, interaction with the patients, treatment from the provincial government, hospital politics, working hours, OR assistance and perceived attitude of surgeons. Improving these contributing factors may lead to higher job satisfaction. SATISFACTION WITH WORK AND QUALITY OF LIFE AMONG BRITISH COLUMBIA’S PHYSICIANS: Harvey V. Thommasen, MD, CCFP, Marlene P. van der Weyde, MD, CCFP, Alex C. Michalos, PhD, FRSC, Bruno D. Zumbo, PhD, and Catherine A

Hagn, MD, CCFP In July 1998, the British Columbia Medical Association sent questionnaires to 380 physicians (87% general practitioners; 13% specialists) working, living, and taking call in rural isolated communities and to 388 physicians (87% general practitioners; 13% specialists) working in urban areas. Urban areas were considered to be the major provincial referral centres, including Greater Vancouver, the Capital Health Region, as well as Courtenay/Comox, Cranbrook, Kamloops, Kelowna, Nanaimo, Penticton, Prince George, Trail, and Vernon. Thommasen and colleagues sent questionnaires to 198 primary care physicians living in isolated rural communities in October 1998. Urban physicians were not surveyed. In addition to most of the same survey questions included in the van der Weyde survey, these physicians were also asked to complete questionnaires pertaining to depression and burnout In all surveys, physicians were asked to rate their satisfaction with issues pertaining to quality of life, overall job satisfaction, work-week activities, and work-week job satisfaction. Quality-of-life issues include things such as satisfaction with health, housing, finances, relationships, recreation, and self-esteem. Likert scales were used to grade level of satisfaction in all studies. In two of these surveys a five-point Likert scale, ranging from very unsatisfied to very satisfied) was used to grade the level of satisfaction. In the other two studies a seven-point Likert scale, ranging from very dissatisfied to very satisfied was used to grade the level of satisfaction. To account for the differences, scores reported in these studies are expressed as a percent of the maximal Likert Scale. For example, a Likert score of 70%, whereas a score of 50%. The test-retest reliability and validity of using Likert scales to measure job satisfaction has been demonstrated in previous studies. For the most part, the surveys are quite comparable. There are, however, differences in methodologies and in questions asked. The rural physician population in the November 1989 survey came from communities with fewer than 10 000 people and includes physicians working in both rural isolated communities and rural non-isolated communities. The rural physician population in the latter three surveys came from rural isolated communities, some of which have a population greater than 10 000 people (e.g., Creston, Dawson Creek) and so would have been excluded from the November 1989 survey. According to our calculations, 244 NIA physicians live in communities of fewer than 10 000 people, which means at least half (244 of 490) of the physicians surveyed in

the November 1989 survey were probably physicians from rural isolated communities. Some questions were surprisingly similar across all surveys. For example, with the satisfaction with on-call time question, in the November 1989 survey physicians were asked to indicate their level of satisfaction with “length of working hours (on call).” In the July 1998 survey physicians were asked to indicate their satisfaction with “on-call schedule.” In the January 1997 and October 1998 surveys physicians were asked to rate their satisfaction with “number of on-call shifts/month.” Another example is specialist availability. In the November 1989 survey physicians were asked to indicate their level of satisfaction with “access to specialist expertise.” In the July 1998 survey physicians were asked to indicate their satisfaction with “access to specialists.” In the January 1997 and October 1998 surveys physicians were asked to rate their satisfaction with “ease of obtaining specialist backup.” These questions were judged to be sufficiently similar that the answers could be categorized in our table under the heading “job satisfaction with specialist availability.” There were sometimes subtle differences in how questions were asked in different surveys. Take global job/career satisfaction, for example. In the November 1989 survey physicians were asked to rate the statement, “When I think of my professional career I am quite satisfied with it and there is very little I would like to change.” In the July 1998 survey physicians were asked to rate the statement, “How satisfied are you with your practice.” In the January 1997 and October 1998 surveys, physicians were asked to rate their satisfaction with “Job.” These questions were judged to be sufficiently similar to be classified under global job satisfaction and the answers added to the summary tables. Occasionally, the questions asked on a similar topic were so different that answers were not comparable. Take relocation plans, for example. All surveys had at least one question on relocation plans. The January 1997 survey and the October 1998 survey asked, “Do you currently wish to relocate?” In the 1989 survey, physicians were asked “How long do you plan to continue practising in this area?,” and in the July 1998 survey physicians were asked “Within the next year, do you intend to move your practice?” The questions are sufficiently different that one cannot compare results among the four studies, though we did think it was fair to compare the answers of the November 1989 survey and the July 1998 survey to one another, and to compare the answers of the January 1997 and October 1998 surveys.

Conclusion Low job satisfaction is associated with both intention to relocate from rural family practice and/or undertaking job action. In terms of overall quality of life and overall job satisfaction, there are no obvious differences between British Columbia’s rural and urban physicians. These data suggest that rural physicians as a whole are not as unhappy as is generally believed. There are, however, certain aspects of work (e.g., on-call responsibilities, daily workload issues, on-call remuneration) and profession where rural physicians are clearly more dissatisfied than urban physicians. Physician dissatisfaction with these items also appears to have increased over the past decade or so. Professional and work-related dissatisfaction is associated with intention to relocate, but it does not appear to be the only factor associated with physician retention. Non-work factors including personal/family (e.g., educational opportunities for children), community (e.g., cultural and recreational opportunities), and environmental (e.g., climate) also play a role in a physician’s decision to relocate. Sorting out the relative importance of these factors is the next logical step of any future British Columbia physician satisfaction and retention study. MENTAL HEALTH, JOB SATISFACTION, AND JOB STRESS AMONG GENERAL PRACTITIONERS. Cooper CL, Rout U, Faragher B. University of Manchester, Institute of Science and Technology. OBJECTIVE--To identify sources of job stress associated with high levels of job dissatisfaction and negative mental wellbeing among general practitioners in England. MAIN RESULTS--Women general practitioners both had job satisfaction and showed positive signs of mental wellbeing in contrast with other normative groups. Conversely, male doctors showed significantly higher anxiety scores than the norms, had less job satisfaction, and drank more alcohol than their women counterparts. Multivariate analysis disclosed four job stressors that were predictive of high levels of job dissatisfaction and lack of mental wellbeing; these were demands of the job and patients' expectations, interference with family life, constant interruptions at work and home, and practice administration. CONCLUSIONS--There may be substantial benefit in providing a

counselling service for general practitioners and other health care workers who suffer psychological pressure from their work. MANAGED CARE AND PRIMARY PHYSICIAN SATISFACTION David Grembowski, PhD, Cornelia M. Ulrich, PhD, David Paschane, MS, Paula Diehr, PhD, Wayne Katon, MD, Diane Martin, PhD, Donald L. Patrick, PhD, MSPH and Christine Velicer, MS Results: Bivariate analyses revealed that salary compensation, productivity bonuses, and withholds for referrals were associated with job and referral dissatisfaction. However, after controlling for physician, practice, and office characteristics, only the association between salary payment and job dissatisfaction remained significant. Practice in offices with more physicians had the strongest association with physician job dissatisfaction. Conclusions: Although managed care features are correlated with physician job and referral dissatisfaction, the source of dissatisfaction may originate from being an employed physician in a large medical group with more physicians, which may be more likely to impose bureaucratic controls that limit physician autonomy. MANAGED CARE, TIME PRESSURE, AND PHYSICIAN JOB SATISFACTION: RESULTS FROM THE PHYSICIAN WORKLIFE STUDY. Linzer M, Konrad TR, Douglas J, McMurray JE, Pathman DE, Williams ES, Schwartz MD, Gerrity M, Scheckler W, Bigby JA, Rhodes E. OBJECTIVE: To assess the association between HMO practice, time pressure, and physician job satisfaction. RESULTS: Of the 2,326 respondents, 735 (32%) were female, 607 (26%) were minority (adjusted response rate 52%). HMO physicians reported significantly higher satisfaction with autonomy and administrative issues when compared with other practice types (moderate to large effect sizes). However, physicians in many other practice settings averaged higher satisfaction than physicians with resources and relationships with staff and community (small to moderate effect sizes). Small and large group practice and academic physicians had higher global job satisfaction scores than physicians and private practice physicians had quarter to half the odds of physicians of intending to leave their current practice within 2 years. Time pressure detracted from satisfaction in 7 of 10 satisfaction facets and from job, career, and specialty satisfaction Time allotted for new patients was less than that allotted in solo and academic practices

(44 min), while 83% of family physicians felt they needed more time than allotted for new patients versus 54% of family physicians in small group practices CONCLUSIONS: physicians are generally less satisfied with their jobs and more likely to intend to leave their practices than physicians in many other practice settings. Our data suggest that physicians' satisfaction with staff, community, resources, and the duration of new patient visits should be assessed and optimized. Whether providing more time for patient encounters would improve job satisfaction or other practice settings remains to be determined. CAREER SATISFACTION OF US WOMEN PHYSICIANS Results From the Women Physicians' Health Study Erica Frank, MD, MPH; Julia E. McMurray, MD; Mark Linzer, MD; Lisa Elon, MPH; for the Society of General Internal Medicine Career Satisfaction Study Group Results Women physicians were generally satisfied with their careers (84% usually, almost always, or always satisfied). However, 31% would maybe, probably, or definitely not choose to be a physician again, and 38% would maybe, probably, or definitely prefer to change their specialty. Physician's age, control of the work environment, work stress, and a history of harassment were independent predictors of all 3 outcomes, with younger physicians and those having least work control, most work stress, or having experienced severe harassment reporting the most dissatisfaction. The strongest association 95% confidence interval, was between work control and career satisfaction. Other significant predictors of outcomes included birthplace, ethnicity, sexual orientation, having children, stress at home, religious fervor, mental health, specialty, practice type, and workload. Conclusions Women physicians generally report career satisfaction, but many, if given the choice, would not become a physician again or would choose a different specialty. Correctable factors such as work stress, harassment, and poor control over work environment should be addressed to improve the recruitment and retention of women physicians. BURNOUT AND JOB SATISFACTION IN NEW ZEALAND PSYCHIATRISTS: A NATIONAL STUDY Shailesh Kumar

Department of Psychiatry, Waikato Clinical School, New Zealand, Jesse Fischer Elizabeth Robinson Simon Hatcher R.N. Bhagat Objectives: To estimate the prevalence of burnout and the level of job satisfaction among New Zealand psychiatrists, and to ascertain relationships between socio-demographic variables, job satisfaction and burnout in the target population. Results: The results showed that the prevalence of burnout in New Zealand psychiatrists is cause for concern. Two-thirds of all psychiatrists described moderate to severely high levels of emotional exhaustion, with a similar proportion describing low levels of personal accomplishment. Depersonalisation did not appear to be a major problem in the population. Job satisfaction remained relatively high despite the high prevalence of burnout, although there was a relationship between burnout and job satisfaction scores. Conclusions: This study has demonstrated a high prevalence of burnout and factors associated with it among New Zealand psychiatrists. Further research is needed to ascertain why job satisfaction remains high in the presence of burnout, and factors predisposing to, or protective of, burnout. NATIONAL SURVEY OF JOB SATISFACTION AND RETIREMENT INTENTIONS AMONG GENERAL PRACTITIONERS IN ENGLAND Bonnie Sibbald, professor of health services research, Chris Bojke, research fellow, and Hugh Gravelle, professor of economics Objectives To measure general practitioners' intentions to quit direct patient care, to assess changes between 1998 and 2000, and to investigate associated factors, notably job satisfaction. Results The proportion of doctors intending to quit direct patient care in the

next five yeaurban physicians. These data suggest that rural physicians as a whole are not as unhappy as is generally believed. There are, however, certain aspects of work (e.g., on-call responsibilities, daily workload issues, on-call remuneration) and profession (e.g., lack of time for CME) where rural physicians are clearly more dissatisfied than urban physicians. Physician dissatisfaction with these items also appears to have increased over the past decade or so. Professional and work-related dissatisfaction is associated with intention to relocate, but it does not appear to be the only factor associated with physician retention. Non-work factors including personal/family (e.g., educational opportunities for children), community (e.g., cultural and recreational opportunities), and environmental (e.g., climate) also play a role in a physician’s decision to relocate. Sorting out the relative importance of these factors is the next logical step of any future British Columbia physician satisfaction and retention study. IMPORTANCE OF AND SATISFACTION WITH WORK AND PROFESSIONAL INTERPERSONAL ISSUES: A SURVEY OF PHYSICIANS PRACTICING GENERAL INTERNAL MEDICINE IN ONTARIO. D J Cook, L E Griffith, and D L Sackett Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ont. OBJECTIVES: To explore the importance of and satisfaction with clinical responsibilities, teaching, research and interpersonal issues among general internists; to understand the barriers to satisfaction in these domains and the usefulness of potential solutions to these problems. RESULTS: The respondents were satisfied with their primary role as clinicians dealing with complex, undifferentiated problems caring for the total patient and providing consultation. Guidelines for the referral of patients to general internists, computerization of test results, recruitment of general internal medicine fellows and more confidence in the future of general internal medicine were some of the solutions considered likely to increase professional satisfaction. The respondents involved in teaching suggested additional solutions, such as an opportunity to improve their teaching and evidence-based

medicine skills and a greater recognition for their teaching efforts. Few of the general internists conducted research, barriers included lack of personal and project funding, and pressure to generate clinical earnings. In the domain of professional interpersonal issues, women were significantly more likely than men to rate having a mentor, peer support groups, ongoing career counselling, promotion and tenure guidelines for parental leave, availability of on-site day care, addressing gender discrimination and adoption of gender-neutral language as likely to improve the work environment. CONCLUSIONS: The primary role of general internists is that of patient-centred clinician. Our findings suggest that general internists want to take responsibility for revitalizing this discipline. The potential solutions generated in this survey may help to promote action that will improve professional satisfaction in the area of clinical responsibilities, teaching, research and interpersonal issues. A SURVEY OF JOB SATISFACTION, SOURCES OF STRESS AND PSYCHOLOGICAL SYMPTOMS AMONG GENERAL PRACTITIONERS IN LEEDS. Appleton K, House A, Dowell A. Academic Unit of Child and Adolescent Mental Health, Leeds University. AIM: To determine levels of psychological symptoms, job satisfaction, and subjective ill health in GPs and their relationship to practice characteristics, and to compare levels of job satisfaction since the introduction of the 1990 GP contract with those found before collected. RESULTS: A total of 285/406 GPs (70%) returned the questionnaires. One hundred and forty-eight (52%) scored 3 or more on the General Health Questionnaire which indicates a high level of psychological symptoms. One hundred and sixty GPs (56%) felt that work had affected their recent physical health. Significant associations were found between, total job satisfaction scores, and GPs' perceptions that work had affected their physical health. Problems with physical and mental health were associated with several aspects of workload, including list size, number of sessions worked per week, amount of time spent on call, and use of deputizing services. In the qualitative part of the survey, GPs reported overwork and excessive hours, paperwork and administration, recent National Health Service changes, and the 1990 GP contract as the most stressful aspects of their work. CONCLUSIONS: Fifty-two per cent of GPs in Leeds who responded showed high levels of psychological symptoms. Job satisfaction was lower than in a national survey conducted in 1987, and GPs expressed the least

satisfaction with their hours, recognition for their work, and rates of pay. Nearly 60% felt that their physical health had been affected by their work. These results point to a need to improve working conditions in primary care and for further research to determine the effect of any such changes. CHANGES IN CAREER SATISFACTION AMONG PRIMARY CARE AND SPECIALIST PHYSICIANS, 1997-2001 Bruce E. Landon, MD, MBA; James Reschovsky, PhD; David Blumenthal, MD, MPP Objectives To describe changes in career satisfaction in a large, nationally representative sample of physicians and to examine market and practice factors associated with changes in physician satisfaction. Results Physician satisfaction levels declined marginally between 1997 and 2001, with most of the decline occurring between 1997 and 1999. Among primary care physicians, 42.4% were very satisfied in 1997, as were 43.3% of specialists, compared with 38.5% and 41.4%, respectively, in 2001. There were nearly equal increases in those who reported that they were somewhat satisfied. Overall means mask significant differences across the 60 sites. Among 12 sites randomly selected for more intensive study, the proportion of respondents who were somewhat or very dissatisfied ranged from 8.8% of physicians in Lansing, Mich (1999), to 34.2% in Miami, Fla (1997). Between 1997 and 1999, 25.6% of primary care physicians reported decreased satisfaction and 18.1% reported improved satisfaction, while approximately equal percentages reported increased (19.8%) and decreased (20.4%) satisfaction between 1999-2001. Findings were similar for specialist physicians. In multivariable models, the strongest and most consistent predictors of change in satisfaction were changes in measures of clinical autonomy, including increases in hours worked and physicians' ability to obtain services for their patients. Changes in exposure to managed care were weakly related to changes in satisfaction. Conclusions Our findings demonstrate that overall physician satisfaction levels over this time period did not change dramatically. In addition, satisfaction and changes in satisfaction vary greatly among sites. Rather than declining income, threats to physicians' autonomy, to their ability to manage their day-to-day patient interactions and their time, and to their ability to provide high-quality care are most strongly associated with changes in satisfaction.

CAREER SATISFACTION AMONG PHYSICIANS Bruce E. Landon, MD, MBA Harvard Medical School, Boston, Mass JAMA. 2004;291:634. Despite reports of dissatisfaction among practicing physiciansand a 22% decrease in applications to US medical schools since 1997, recent data suggest that the majority of physicians remain satisfied with their careers, although there may be substantial variability across geographical areas In a nationally representative telephone survey of physicians from 1997 to 2001, we found that more than 80% of physicians with direct patient care responsibilities were somewhat or very satisfied with their careers. Physician career satisfaction appears to be a complex function of a number of variables. Overall career satisfaction among physicians may remain high despite decreases in some of these domains. The Society of General Internal Medicine (SGIM) Career Satisfaction Study Group defined 10 domains of professional satisfaction. Among the highest predictors of global job satisfaction were patient care issues and relationships with patients and colleagues. The SGIM study group defined autonomy as "independence of action," including the ability to treat patients according to the best clinical judgment. We found that both primary care physicians and specialists who rated their autonomy lower and those that reported more difficulty obtaining high-quality outpatient services and inpatient services were more likely to report decreased satisfaction with their careers over the 4-year period. Similarly, in a cross-sectional study, Stoddard et alfound clinical autonomy to be significantly related to career satisfaction. Conversely, while physicians may be largely satisfied with their careers in medicine, they may be less satisfied with particular aspects of practice, including income, control over personal time, and the administrative aspects of practice. In a 1999 study in Massachusetts, more than 60% of physicians reported dissatisfaction with managed care Many of these physicians also rated the fee schedules or capitation rates they received from managed care companies as "fair" or "poor." Similarly, the study by Stoddard et alfound that the level of income was associated with satisfaction. Another studyfrom the SGIM study

group found that physicians' dissatisfaction with pay was associated with an increased likelihood of leaving their jobs within 2 years. Rates of increases in physician income have barely kept pace with inflation. In addition, within medicine, primary care specialties have been particularly affected because of continued increases in practice expenses accompanied by relatively flat reimbursement rates. In our national longitudinal study, we found that primary care physicians who reported lower income were significantly more likely to become less satisfied, although primary care physicians with increases in income did not become more satisfied over time. Among specialists, neither increases nor decreases in income were related to changes in satisfaction. Another aspect of practice that has changed in the recent past is control over work. Whereas physicians once practiced primarily alone or in small autonomous groups, they now are more likely to be employed in large groups and are increasingly subjected to profiling, administrative requirements, and preapproval for procedures and treatments.7 Financial constraints are also prevalent. Patients report less trust in physicians, and physicians are no longer respected as highly as they once were Among the most important changes related to this area of practice are control over work and personal time. Linzer et al reported that physicians in health maintenance organizations were less satisfied with their careers and that the adequacy of time with patients was an important predictor. The data on physician satisfaction cannot be fully understood without examining the principal domains determining physician career satisfaction. Although physicians have traditionally derived career satisfaction from their services to patients, other aspects of satisfaction including income and personal time are also important and appear to be more subject to change over time. If the balance between these factors continues to shift, this could potentially lead to increasing levels of dissatisfaction among physicians.

CONCLUSION: Personal information Under this heading researcher concluded that more young professionals are interacted and they were married and acquired higher eduational

status. Family information Researcher concluded that more respondents having joint family and maintained small family norms Job satisfaction Here depending on the findings researcher concluded that more respondents are working with good materials equipments &drugs and more respondents thinks that good people are respected in society and feels that superiors are not sympathically listen their difficulties and mostly respondents are rewarded for good work which is again in favour of job satisfaction and still believe that good people are respected in society.Mostly respondents are anxious about their future and they have reliable acquaintance and they feels that superiors are not sympathetic towards their diffculties which shows poor sign and suggest dissatisfaction and they believe that job provide good opportuntitines for promotion.Mostly respondents does not believe that poor health is responsibles for not getting promotion in their job still believe that social cohesiveness exist in our society because neighbour always helpful our society and most of the respondents have inferiority complex among them which can hamper the level of job satisfaction and most of the respondents are working with those people whom they are averse.Mostly the respondents are satisfied with the services and rules of organization and they felt that superiors thinks they are not hard working and they are in favour that there is no one with whom they can share the confidential things. Most of respondents are anxious and have negative things which keep them awake at night also. Most of respondents believe that superiors behave well with their subordinates and respondents have found their work interesting and they thought that promotion is given impartially. Mostly respondents have psychologically weak structure as they got upset for a long time due to criticism by someone else. They are not satisfied with condition of work place.Mostly respondents have positive feeling toward the organization will help in case of emergency and sometimes hesitate in accepting the responsibilities of social functions and they themselves are engaged in medical profession still worried about the health of their family members.Mostly respondents feel that their neighbors gentle and worth mixing with other which show good social relationship between respondents and their neighbours and sometimes superiors gave attention to the suggestion from the respondents. they felt that they has selected the right job for themselves. Most of respondents family members are of care giving nature and they are not changing house due to neighbours which show social bondage.and family

cohesiveness exist in majority of respondents family and they can earn more in some other job which shows job dissatisfaction.Mostly respondents believe that good people are not more than bad people and feel that their job do not allow sufficient time for rest and recreation.Most of respondents has good feeling about their superiors and and shows that superiors believes in the potentials of respondent. They are believe that people exploit the weakness and short comings of others and they are very emotional and sensitive.Most of respondents felt that their superior do not harshly punish people for simple mistakes and mostly colleagues help the respondents in their bad time. Most of respondents felt there is corruption and presence of personal pulls to get promotion which may affect the work satisfaction of the respondents and believes that their relatives does not frequently bother and trouble them and they are change job for the other facilities.Most of the respondents felt that people are not dismissed from the job on simple and trivial matters and they felt hesitation in talking to strange. Mostly respondents sometimes left tasks unfinished and their are friends are sincere to them.Mostly respondents does not want to treat their subordinates the same as superiors and they wanted to have some difference in the treatment and they are experiencing load of work in their organization and which can affect their work and experienced unpleasant things during their childhood and believe that social customs and conditions are trouble some as they do not find time to attend those functions due to job.Most of respondents pass their time pleasantly at home and feel that their work is hard and difficult again is a parameters for job dissatisfaction.Mostly respondents believe in the dignity of their work and still people perspective towards this profession is respectful and they are sometimes feel that they are taking up some other job. Most of respondents felt that their superiors praise good workers which is a sign for job satisfaction. Most of respondents felt that their work provides opportunities to display talent and skills and they needs more training on this job and their colleagues are not avoid their company.Most of the respondents felt that their job is restricting social freedom.