Predictors of work satisfaction among physicians

Background: Work satisfaction among physicians is an important concern because it is associated with several important aspects of care, such as the continuity of care and health care costs. In this study, a brief work satisfaction questionnaire was developed, its validity was assessed, and it was used to examine the determinants of work-related satisfaction among a sample of Swiss physicians. Methods: Based on the literature, a 17-item work satisfaction questionnaire was developed that addressed five dimensions of satisfaction: patient care, work-related burden, income-prestige, personal rewards and professional relations with colleagues. This questionnaire was administered by mail to 1904 doctors practising in Geneva, Switzerland; 1184 (59%) responded. Additional data were collected on physicians' personal and work situation. Results: In general, physicians were more satisfied with the following aspects of their current work situation: patient care, professional relations and personal rewards (intellectual stimulation, opportunities for continuing medical education, enjoyment at work). The lowest satisfaction scores were found for work-related burden (workload, time available for family, friends or leisure, work-related stress, administrative burden) and work-related income and prestige. In multivariate models, variables associated with most dimensions of satisfaction included type of practice (physician in training were less satisfied), specialty (internal medicine specialists and pediatricians were more satisfied), time spent on administrative tasks (globally negative effect), time spent on continuing medical education (globally positive effect). Age and sex had only a minor influence on satisfaction scores. Conclusion: Physician work satisfaction is multidimensional and can easily be measured using a short self-administered questionnaire. This instrument could be useful to monitor changes in the near futur

Growing discontent of Swiss doctors, 1998-2007

Background: Work satisfaction of doctors is a useful indicator of the functioning of the health-care system. We documented the work satisfaction of doctors nine years apart, before and after the implementation of several health-care reforms (limitation of working hours for medical trainees, restrictions on new doctors' offices, new reimbursement fee schedule, greater administrative controls). Methods: Two surveys of all doctors working in the Canton of Geneva, Switzerland (1998: 1146 respondents, 2007: 1546 respondents). The doctors filled in a 17-item questionnaire rating their satisfaction with different aspects of their professional life, each on a scale between 1 and 7. For each item, proportions of highly satisfied (scores 6-7) and highly dissatisfied (scores 1-2) doctors were compared over time. Results: The proportion of doctors who were highly satisfied decreased significantly for 15 out of 17 items between 1998 and 2007. Meanwhile, ‘time available for family, friends, or leisure' improved, and ‘opportunity for continuing education' remained stable. Proportions of highly satisfied respondents decreased the most for ‘enjoyment of work' (−17.2%), ‘autonomy in treating your patients' (−15.8%), ‘autonomy in referring patients to a specialist' (−14.0%), ‘relations with patients' (−13.9%) and ‘global satisfaction with current work situation' (−13.3%). The proportion of respondents who were highly dissatisfied (score 1-2) increased the most for ‘administrative burden' (+8.9%) and ‘social status and respect' (+5.0%). Conclusions: Doctors' satisfaction with most aspects of their professional lives has decreased sharply during the past decade. This trend may be linked, tentatively, with specific policy change

Relationships between work satisfaction, emotional exhaustion and mental health among Swiss primary care physicians

Background: Work-related satisfaction is an important determinant of quality of care. However, its relationship with doctors' mental health is poorly understood. It could have an independent beneficial effect on mental health (direct association) or simply reduce the impact of work stress on mental health (moderating or ‘buffering' role). Methods: One thousand seven hundred and thirty-two Swiss primary care physicians (824 board-certified generalists, 436 general internists, 162 paediatricians, 147 internal medicine specialists and 163 physicians without specialty qualification) completed a mailed questionnaire. Previously, validated instruments were used to measure mental health (SF-12), emotional exhaustion [Maslach Burnout Inventory (MBI)] and work-related satisfaction. Linear regression models with mental health as dependant variable were used to study the relationships between these variables. Differences in mental health scores were standardized to represent a one standard deviation (SD) difference in the other scales [standardized beta coefficients (SBC)]. Results: In multivariate analyses, higher levels of mental health were found in respondents with higher work-related satisfaction with current income and social prestige (SBC 1.04) and professional relations (SBC 0.57), and in respondents with lower emotional exhaustion (SBC −4.98) and higher personal accomplishment scores (SBC 1.72). Interaction terms between these dimensions of work-related satisfaction and emotional exhaustion were significant, supporting a ‘buffering' role of these dimensions. Conclusion: Work-satisfaction with current income, social prestige and professional relations are important correlates of mental health among primary care physicians, as well as emotional exhaustion. Higher levels of these dimensions of work-related satisfaction seems to mitigate the relationship between emotional exhaustion and physicians' mental healt

Eflornithine Is Safer than Melarsoprol for the Treatment of Second-Stage Trypanosoma brucei gambiense Human African Trypanosomiasis

Patients with second-stage human African trypanosomiasis treated with eflornithine (n = 251) in 2003 in Kiri, southern Sudan, had an adjusted relative risk of death of 0.2 and experienced significantly fewer cutaneous and neurological adverse effects than did patients who were treated with melarsoprol in 2001 and 2002 (n = 708

Stress from Uncertainty from Graduation to Retirement—A Population-Based Study of Swiss Physicians

BACKGROUND: Uncertainty shapes many decisions made by physicians everyday. Uncertainty and physicians’ inability to handle it may result in substandard care and unexplained variations in patterns of care. OBJECTIVE: To describe socio-demographic and professional characteristics of reactions to uncertainty among physicians from all specialties, including physicians in training. DESIGN: Cross-sectional postal survey. PARTICIPANT: All physicians practicing in Geneva, Switzerland (n = 1,994). MEASUREMENT: Reaction to medical care uncertainty was measured with the Anxiety Due to Uncertainty and Concern About Bad Outcomes scales. The questionnaire also included items about professional characteristics and work-related satisfaction scales. RESULTS: After the first mailing and two reminders, 1,184 physicians responded to the survey. In univariate analysis, women, junior physicians, surgical specialists, generalist physicians, and physicians with lower workloads had higher scores in both scales. In multivariate models, sex, medical specialty, and workload remained significantly associated with both scales, whereas clinical experience remained associated only with concern about bad outcomes. Higher levels of anxiety due to uncertainty were associated with lower scores of work-related satisfaction, while higher levels of concern about bad outcomes were associated with lower satisfaction scores for patient care, personal rewards, professional relations, and general satisfaction, but not for work-related burden or satisfaction with income-prestige. The negative effect of anxiety due to uncertainty on work-related satisfaction was more important for physicians in training. CONCLUSION: Physicians’ reactions to uncertainty in medical care were associated with several dimensions of work-related satisfaction. Physicians in training experienced the greatest impact of anxiety due to uncertainty on their work-related satisfaction. Incorporating strategies to deal with uncertainty into residency training may be useful

Cost-consciousness among Swiss doctors: a cross-sectional survey

BACKGROUND: Knowing what influences physicians attitudes toward health care costs is an important matter, because most health care expenditures are the results of doctors' decisions. Many decisions regarding medical tests and treatments are influenced by factors other than the expected benefit to the patient, including the doctor's demographic characteristics and concerns about cost and income. METHODS: Doctors (n = 1184) in Geneva, Switzerland, answered questions about their cost-consciousness, practice patterns (medical specialty, public.vs. private sector, number of patients per week, time spent with a new patient), work satisfaction, and stress from uncertainty. General linear models were used to identify independent risk factors of higher cost-consciousness. RESULTS: Most doctors agreed that trying to contain costs was their responsibility ("agree" or "totally agree": 90%) and that they should take a more prominent role in limiting the use of unnecessary tests (92%); most disagreed that doctors are too busy to worry about costs (69%) and that the cost of health care is only important if the patient has to pay for it out-of-pocket (88%). In multivariate analyses, cost-consciousness was higher among doctors in the public sector, those who saw fewer patients per week, who were most tolerant of uncertainty, and who were most satisfied with their work. CONCLUSION: Thus even in a setting with very high health care expenditures, doctors' stated cost-consciousness appeared to be generally high, even though it was not uniformly distributed among them

Use of tobacco and alcohol by Swiss primary care physicians: a cross-sectional survey

BACKGROUND: Health behaviours among doctors has been suggested to be an important marker of how harmful lifestyle behaviours are perceived. In several countries, decrease in smoking among physicians was spectacular, indicating that the hazard was well known. Historical data have shown that because of their higher socio-economical status physicians take up smoking earlier. When the dangers of smoking become better known, physicians began to give up smoking at a higher rate than the general population. For alcohol consumption, the situation is quite different: prevalence is still very high among physicians and the dangers are not so well perceived. To study the situation in Switzerland, data of a national survey were analysed to determine the prevalence of smoking and alcohol drinking among primary care physicians. METHODS: 2'756 randomly selected practitioners were surveyed to assess subjective mental and physical health and their determinants, including smoking and drinking behaviours. Physicians were categorised as never smokers, current smokers and former smokers, as well as non drinkers, drinkers (AUDIT-C < 4 for women and < 5 for men) and at risk drinkers (higher scores). RESULTS: 1'784 physicians (65%) responded (men 84%, mean age 51 years). Twelve percent were current smokers and 22% former smokers. Sixty six percent were drinkers and 30% at risk drinkers. Only 4% were never smokers and non drinkers. Forty eight percent of current smokers were also at risk drinkers and 16% of at risk drinkers were also current smokers. Smoking and at risk drinking were more frequent among men, middle aged physicians and physicians living alone. When compared to a random sample of the Swiss population, primary care physicians were two to three times less likely to be active smokers (12% vs. 30%), but were more likely to be drinkers (96% vs. 78%), and twice more likely to be at risk drinkers (30% vs. 15%). CONCLUSION: The prevalence of current smokers among Swiss primary care physicians was much lower than in the general population in Switzerland, reflecting that the hazards of smoking are well known to doctors. However, the opposite was found for alcohol use, underlining the importance of making efforts in this area to increase awareness among physicians of the dangers of alcohol consumption

The Goal Setting Approach for Overweight and Obese Patients: Results of a Retrospective Cohort Study in a Dietetic Consultation

Purpose: To describe the performance of a dietary procedure based on a cognitive behavioral approach among overweight or obese patients. Methods: Standardized 45 minutes consultations were conducted by a dietician to obese (n=139) and overweight (n=56) patients followed between 1998 and 2003 at the dietetic consultation of the Outpatient clinic of the University Hospitals of Geneva. Outcome measures were the proportion of eating behavior changes and weight change over time. Results: Patients attended a mean of 7 consultations and reached on average 57% of their dietary behavioral goals. At the end of follow-up, 36 (19%) patients had lost at least 5% of initial weight (mean weight change 8 kg SD 3.9) and 8 (4%) had gained at least 5% of initial weight. Major life events, night eating syndrome, and a lower proportion of reached goals were associated with weight gain. Conclusions: Dietetic treatment based on behavioral goal setting shows encouraging results in terms of weight evolution and is compatible with standard care reimbursement in many countries. Dieticians and other health professionals could focus on behavioral goals to be achieved in the short term

? 2004 Kluwer Academic Publishers. Printed in the Netherlands. Perceived stress, internal resources, and social support as determinants of mental health among young adults

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