Abstract
IntroductionLow physician workplace satisfaction may negatively impact patient care. Dissatisfaction may begin during residency training, where trainees face lower autonomy and less control over work conditions. The theoretical and empirical literature on trainees is couched mainly in terms of burnout. Theories of satisfaction, a different construct, are derived from studies of independent physicians. Identifying specific correlates of trainee satisfaction may be a clearer path to preparing a sustainable physician workforce.MethodsWe surveyed 3300 residents and fellows (response rate of 7.2% to 46,574 surveys sent) across multiple specialties and institutions in the US. The instrument was adapted from a previous large-scale survey of physician satisfaction, with changes reflecting factors theorized to specifically affect trainee satisfaction. We applied generalized linear regression to identify correlates of higher satisfaction.ResultsA total of 1444 (44%) residents/fellows reported they were very satisfied and 1311 (40%) reported being somewhat satisfied. Factors associated with satisfaction included positive perceptions of supporting clinical staff, the electronic health record, and stability of personal mental health. Surprisingly, a strong negative perception of completing insurance and/or disability forms was also associated with higher satisfaction. Factors often presumed to correlate with satisfaction, such as duty hours, debt load, and specialty, did not show significant associations.DiscussionMultiple workplace factors are correlated with trainee satisfaction, but they are not the factors (such as financial debt) that we initially hypothesized. The factors we identified, including clinical staff support and personal mental health, may be targets for further study and/or pilot interventions aimed at improving satisfaction.Electronic supplementary materialThe online version of this article (10.1007/s40037-019-00555-2) contains supplementary material, which is available to authorized users.
Highlights
Low physician workplace satisfaction may negatively impact patient care
The factors we identified, including clinical staff support and personal mental health, may be targets for further study and/or pilot interventions aimed at improving satisfaction
Efforts to combat dissatisfaction have been advanced by a model of dissatisfaction derived from a large qualitative and survey-based study from the RAND Corporation and the American Medical Association (AMA)[2]
Summary
Low physician workplace satisfaction may negatively impact patient care. Dissatisfaction may begin during residency training, where trainees face lower autonomy and less control over work con-Disclaimers aspects of the American Medical Association (AMA) governance structure assisted with data collection and study coordination, this report does not reflect the official work product of the AMA or any of its components. Satisfied physicians may remain in practice longer, increasing access to care and the return on the public’s investment in their training [1, 2] They deliver greater continuity of care and their patients appear to be more engaged in their own health management [2,3,4,5]. Efforts to combat dissatisfaction have been advanced by a model of dissatisfaction derived from a large qualitative and survey-based study from the RAND Corporation and the American Medical Association (AMA)[2]. This theory focuses on three primary drivers of satisfaction: the overall health system context, features of the specific practice/institution, and individual characteristics of the physician. Poor experiences with the electronic health record, in contrast, are strongly associated with dissatisfaction [2, 7, 8]
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