Hospital Physicians Research Articles

The price of internship through COVID-19: 1st year physicians report substantial mental health symptoms during the pandemic

ObjectivesTo examine the prevalence of mental health symptoms among medical interns working for the first time as physicians in a large tertiary hospital in Israel during the 1st COVID year. MethodsAll interns who worked for at least 2 months during the 1st COVID year (March 2020–February 2021) at the Tel-Aviv Sourasky Medical Center (TASMC), a large tertiary general hospital in Israel were approached simultaneously during April–May 2021, and were requested to fill in an online survey. In each questionnaire, the interns were asked to refer to the worst time they endured the symptoms described. Included were all medical. Depression and anxiety symptoms, post-traumatic stress symptoms and Burnout measures were evaluated using validated questionnaires. Depressive/anxiety symptoms were defined as primary end measures. We assessed the association between depression and anxiety symptoms, and demographic, post-traumatic and burnout measures. Results145 out of 188 interns completed the study (77% overall response rate). The mean age was 30.36 ± 2.97. Almost half the interns (47%) reported depression/anxiety symptoms. The high depression/anxiety group was characterized by a lower mean age (29.87 ± 2.93 vs. 30.92 ± 2.91, p = 0.041), higher post-traumatic symptoms (15.62 ± 13.32 vs. 3.63 ± 5.59, p < 0.0001) and higher scores in 2/3 burnout subscales - emotional exhaustion (5.09 ± 1.29 vs. 3.61 ± 1.38, p = 0.000001) and depersonalization (3.83 ± 1.71 vs. 2.94 ± 1.46, p = 0.002). 11.4% of interns in the full sample reported they used cannabis or alcohol as “self-medication”. Conclusionsmedical interns serving for their first year as physicians during the COVID pandemic, developed mental symptoms in alarming numbers. The findings point to a crucial need to implement active interventions to protect these doctors, so that they can safely embark on their medical careers, specifically in times of global health crises.

Usability of Electronic Health Records in Germany - An Overview of Satisfaction of University Hospital Physicians.

EHR are a part of daily task of physicians in Germany. This study surveyed the satisfaction of a small group of physicians in German university hospitals using EHR with focus on usability. The questioning was carried out by an online survey. Addressed were all physicians working at university hospitals in Germany. The study showed that users are not satisfied with EHR (Grade 3.62). They pointed out some problems in general but reflected many advantages of those systems. EHR systems have to develop and adopt to users' tasks. They have to get faster and low error rates must be realized. Existing infrastructure must be improved and rolled out to users especially in times where digital healthcare services gain importance.

The Dilemmas of Leading Health Organizations in Complex Settings Comment on "Dual Agency in Hospitals: What Strategies Do Managers and Physicians Apply to Reconcile Dilemmas Between Clinical and Economic Considerations?"

Waitzberg and colleagues' research explores hospital managers, chief physicians and other physicians in German and Israeli hospitals, making use of thematic analysis to explore what they call 'dilemmas' between the commitments to clinical needs, and their hospitals' financial sustainability. This commentary will provide a summary of the paper, into which I will embed some items I will follow-up on in my second half. The second half will then explore these items in greater depth, considering the strengths and weaknesses of the article. I then make some suggestions for future work based around the findings the authors present in terms of managerial and clinical identity, how compromises are reached in hospital settings, and how we compare different health systems.

Validation of Responsiveness of Physicians Scale (ROP-Scale) for hospitalised COVID-19 patients in Bangladesh

BackgroundResponsiveness of Physicians (ROP) is defined as the social actions by physicians aimed at meeting the legitimate expectations of healthcare users. Even though patients’ expectations regarding ROP have increased during the COVID-19 pandemic, the psychometrically-validated ROP-Scale is difficult to apply in hospital settings. The goal of this study is to validate the existing ROP-Scale to measure the responsiveness of hospital physicians during the ongoing COVID-19 pandemic in Bangladesh.MethodsWe conducted a cross-sectional phone survey involving 213 COVID-19 hospital patients, randomly selected from the government database. We applied the Delphi method for content validity, exploratory and confirmatory factor analyses for construct validity, Cronbach’s alpha and corrected item-total correlation for internal consistency reliability, and Pearson’s correlation between the scale and overall patient satisfaction for concurrent validity.ResultsAfter removing survey items based on data sufficiency, collinearity, factor loading derived through exploratory factor analysis, and internal consistency, the final version of the COVID-19 ROP-Scale consisted of 7 items, grouped under Informativeness, Trustworthiness and Courteousness domains. The confirmatory factor analysis supported the three domains with acceptable model fit [Root mean squared error of approximation (RMSEA) = 0.028, Comparative fit index (CFI) = 0.997, Tucker-Lewis index (TLI) = 0.994)]. The corrected item-total correlation ranged between 0.45 and 0.71. Concurrent validity was ascertained by the high correlation (0.84) between patient satisfaction and the COVID-19 ROP-Scale. Based on the mean domain score, the highest- and the lowest-scoring responsiveness domains were ‘Trustworthiness’ (7.85) and ‘Informativeness’ (7.28), respectively, whereas the highest- and the lowest-scoring items were ‘Not being involved in illegal activities’ (7.97), and ‘Service-oriented, not business-like attitude’ (6.63), respectively.ConclusionsThe 7-item COVID-19 ROP-Scale was demonstrated to be feasible, valid, and internally consistent. Therefore, its application can help amend past mistakes in health service provision and improve care for the hospitalised COVID-19 patients or other patients suffering from similar conditions. This study can contribute to the national decision-making regarding hospital care, open up further avenues in the health policy and system research, and eventually improve the quality of care provided to Bangladeshi patients seeking hospital services. Moreover, findings yielded by this study can be incorporated into doctors’ medical education and in-service training.

Application of X-ray examinations in General practice for the diagnosis of lung damage in patients suspected of COVID-19 infection

General practitioners who have access to diagnostic investigations from primary health care and clear referral guidelines to follow can utilize these resources as efficiently as hospital physicians and doctors from secondary health care [1-3]. More complex imaging methodologies such as magnetic resonance imaging (MRI) and X-ray computed tomography (CT) cannot be used in Bulgarian General Practice yet and they are subject to restrictions by the National Health Insurance Fund. The most readily available imaging method that general physicians can apply in the diagnosis of COVID-19 patients is convectional chest radiography. This is a first-line test for detecting lung pathology and it is helpful for evaluation of patients with a high pre-test probability of overt COVID-19 pneumonia, clinical follow up, and for the evaluation of potential complications [4].

The relationship between emotional intelligence, transformational leadership, and performance: a test of the mediating role of job satisfaction

PurposeThis paper examines the effect of job satisfaction on job performance among physicians in Iraq's public hospitals. It also determines the mediating role of job satisfaction on the relationship between emotional intelligence and job performance. It further unveils the mediating role of job satisfaction on the nexus between transformational leadership and job performance. As physicians form the bulk of health-care professionals, their performance at work is crucial in determining patient satisfaction regarding care quality.Design/methodology/approachA quantitative approach with structural equation modelling via partial least squares (PLS-SEM) and bootstrapping estimation was used to test the hypotheses developed. A total of 157 responses were utilized in the data analysis.FindingsEvidence from the study indicates that job satisfaction has a positive relationship with job performance. The study also provides evidence that job satisfaction plays a positive mediating role in the relationship between emotional intelligence and job performance. Similarly, job satisfaction has a positive mediating effect on the nexus between transformational leadership and job performance among physicians in Iraq's public hospitals.Originality/valueTo the best of the authors' knowledge, this is the first study to investigate the relationship between physician job satisfaction and job performance in Iraqi public hospitals. Studies using Eastern samples are scarce, so the findings of this study will add to the body of knowledge from a cross-cultural standpoint.

Developing and sustaining advanced practice provider services: A decade of lessons learned.

Developing and sustaining advanced practice provider services: A decade of lessons learned.

Multisystem involvement in COVID-19: what have we learnt?

The COVID-19 illness trajectory involves persistent cardio-renal inflammation, activation of the haemostatic pathway and lung involvement. Results of a study carried out by the authors' team demonstrate a link between post-COVID-19 syndrome (people who have long COVID) and multisystem disease, which partly explains the lingering impairments in patient-reported health-related quality of life, physical function and psychological wellbeing after COVID-19. This article discusses what hospital physicians need to be aware of when considering the likelihood of myocarditis in patients with post-COVID-19 syndrome and the implications in the longer term.

Besonderheiten geriatrischer Rehabilitation: Zielgruppe, Angebote, Zugang

Geriatric rehabilitation is an interdisciplinary offer of rehabilitation services for elderly persons who often have several impairments and, in some cases, an already existing need for nursing care. It aims at maintaining their self-determined participation in everyday life to the greatest possible extent as well as at avoiding or reducing their needs for nursing care. Characteristic features of geriatric patients are high vulnerability due to an age-related reduction of reserves and often multiple chronic diseases. This is why the geriatric assessment and the multi-professional geriatric team present a correspondingly broad base.As a result of the vulnerability of geriatric patients, early rehabilitation that already starts during acute treatment in hospital is of great importance for their rehabilitative care. Of total German geriatric-rehabilitative care 75 % is inpatient- and 8 % day-care in hospital. These kinds of care are largely provided nationwide. Unfortunately, they often cannot make use of the entire rehabilitation potential of geriatric patients. Independent geriatric rehabilitation facilities, however, are not available in all federal states yet and mainly focus on inpatients. They account for 17 % of geriatric-rehabilitative care - for more than 95 % in connection with a previous hospitalization. Up to now, there has not been an adequate focus on the utilization of out-patient and mobile geriatric rehabilitation as well as on the use of geriatric rehabilitation in case of a slowly progressing deterioration of activities and participation without any acute event. Especially, mobile rehabilitation that is directly performed at the patient's home constitutes a particularly suitable rehabilitation setting mainly for persons who will still need nursery care despite reaching their rehabilitation targets. But this kind of rehabilitation care is still little known.The article provides decision-making aids to physicians in hospitals and doctor's offices as well as information on how to gain access to geriatric-rehabilitative care services, including new regulations to facilitate this access, which are planned for 01 July 2022.

Program Accreditation, Innovation, or Both? – The Interdependencies in Specialized Cancer Care

Objective To understand (a) the determinants of hospitals’ decisions to seek program accreditation and pursue innovation activities in specialized cancer care, (b) whether accreditation and innovation activities help hospitals reach their strategic goals, and (c) how program accreditation and innovation activities influence one another. Data Sources Semi-structured, in-depth interviews with hospital physicians and quality managers (n=25). Study Design Comparative case study of hospitals that provide specialized cancer care in Germany (n=19). Data Collection/ Extraction methods Inductive grounded theory approach and coding of interview transcripts across multiple waves to develop a conceptual model of the relationship between program accreditation and innovation activities, including determinants of both measures at the environmental and organizational levels. Principal Findings The hospitals in our sample engaged in program accreditation and innovation activities in order to achieve quality and financial goals. However, the strategic focus varied across different hospital types. For smaller hospitals, such accreditation was a necessary condition to be able to compete in competitive market environments. Regardless of competition, smaller hospitals benefitted from a positive effect of accreditation on incremental process and product innovation. For larger hospitals, obtaining accreditation was a necessary condition to acquire additional funding, but the influence on innovation activities was limited because these were generally already being pursued with high intensity. Conclusions Seeking program accreditation and pursuing innovation activities are not contradictory strategies for hospitals. Ideally, both can be aligned in such a way that the quality and financial performance outcomes achieved are superior to those that would be possible were only one of these strategies to be pursued or to predominate. Hospital decision-makers must align both activities while taking account of costs and benefits. Policy makers can support access to high quality care by setting incentives for hospitals to acquire accreditation.

The whole experience of public hospital physicians from several specialties with biopharmaceutical effectiveness, safety, adverse drug reactions and interchangeability: A qualitative study

BackgroundAlthough there is increasing support for biosimilar medicines by the Iraqi Ministry of Health (MOH), there is scarce information about whether physicians accept these medicines and support movement toward replacing reference medicines with their biosimilar counterparts. ObjectivesThe study objectives were to 1) explore in-depth the perceptions of Iraqi physicians working in public hospitals about the difference in effectiveness and safety between biosimilar medicines and their reference biological counterparts, 2) evaluate physicians' barriers to prescribing biosimilar medicines, 3) assess the adherence of physicians to the new pharmacovigilance regulations on reporting biopharmaceutical adverse drug reactions (ADRs) and 4) identify any barriers facing physicians to reporting biopharmaceutical- ADRs. MethodsThis qualitative study included face-to-face and virtual semi-structured interviews involving physicians from different disciplines who had experience with biological or biosimilar medicines. The interviews were conducted between November 6, 2020, and February 7, 2021. Thematic analyses were used to analyze qualitative data generated from the interviews. ResultsThe study sample included 36 physicians (6 women and 30 men) from seven different specialties at ten governmental hospitals mainly in Baghdad, and one physician was from Mosul, Iraq. Because most physicians had insufficient experience with biosimilar medications and were not sure about their effectiveness, the majority were hesitant to prescribe them. Most physicians preferred to prescribe reference biological medicines initially. However, the initial prescribing and switching between a reference and counterpart biosimilar relies on its availability. They chose biosimilar medications that have been approved by the U.S. FDA or EMA. Most physicians were unaware about the new pharmacovigilance regulations to report adverse biopharmaceutical reactions. The physicians tended to underreport biopharmaceutical ADRs and believed that inadequate physician-pharmacist collaboration negatively impacts preventing and reporting ADRs. ConclusionsMedicine procurement in healthcare settings should focus on sustainably securing high-quality biopharmaceuticals rather than looking only at costs to enhance physician experience and patient clinical outcomes. Promoting documentation, monitoring, and physician-pharmacist collaboration is pivotal to prevent, monitor, and treat biopharmaceutical ADRs.

The Rise and Potential of Physician Unions

This Viewpoint discusses the potential increase in physician unions as a way to deal with conflicts between large hospital systems and physicians, as well as how such unions may be able to provide individual employment benefits but have limited impact on higher governance concerns.

Analysis of patients’ demand for professional conduct by residents in public hospitals based on expectations

Objective: This study aims to reveal patients’ demand for professional conduct by physicians in public hospitals in terms of 22 elements in five dimensions, namely, the principles of life value, integrity fairness and justice, rationality, and honesty, based on the theory of social expectations and from the perspective of patients. Methods: More than 1500 patients were selected from 34 public hospitals in Shandong Province, China to participate in a questionnaire survey. A Chi-square test, logistic regression analysis, and other methods were used to analyze the survey data, such as satisfaction with residents’ medical services and demand for professional conduct. Results: About 79.5% of the patients expressed that the medical services provided by residents in public hospitals were above the “average” level. There was statistical significance for age, educational level, occupation, and satisfaction with inpatient services (P &lt; 0.05). In the ranking of moral elements, four elements related to honesty, three elements related to rationality, two elements related to kindness (righteousness), and one element related to life value ranked in the top 10 elements, all with average scores above 4.70. Conclusion: The social evaluation mechanism for professional conduct by residents in public hospitals should be strengthened, and the standardized training system for the professional conduct of residents in public hospitals should be improved.

Hospital physicians´ working hour characteristics and sleep quality: a cross-sectional analysis of realized working hour and survey data

BackgroundHospital physicians’ work includes on-call duties to provide 24/7 health care. Previous studies using self-reported survey data have associated long working hours and on-call work with sleep difficulties. To reduce recall bias, we complemented survey data with payroll-based objective data to study whether hospital physicians’ realized working hours are associated with sleep.MethodsThe study was nested within the Finnish Public Sector study. We used survey data on 728 hospital physicians (mean age 43.4 years, 62% females) from 2015 linked to realized daily working hour data from 3 months preceding the survey. The associations of working hour characteristics with sleep quantity and quality were studied with multinomial logistic regression analysis adjusted for demographics, overall stressfulness of life situation, control over scheduling of shifts, and hospital district.ResultsOne fourth (26%) of the participants reported short (≤6.5 h) average sleep duration. Frequent night work (> 6 shifts/91 days) was associated with short sleep (OR 1.87 95%CI 1.23–2.83) compared to no night work. Approximately one third (32%) of the physicians reported insufficient sleep. Physicians with long weekly working hours (> 48 hours) had higher odds for insufficient sleep (OR 1.78 95%CI 1.15–2.76) than physicians with short weekly working hours (< 40 hours). Insufficient sleep was also associated with frequent on-call duties (> 12 shifts/3 months OR 2.00 95%CI 1.08–3.72), frequent night work (OR 1.60 95%CI 1.09–2.37), and frequent short shift intervals (≤11 hours; > 12 times/3 months OR 1.65 95%CI 1.01–2.69) compared to not having these working hour characteristics. Nearly half of the physicians (48%) reported at least one sleep difficulty at least two times a week and frequent night work increased odds for difficulties in initiating sleep (OR 2.43 95%CI 1.04–5.69). Otherwise sleep difficulties were not associated with the studied working hour characteristics.ConclusionWe used realized working hour data to strengthen the evidence on on-call work and sleep quality and our results advice to limit the frequency of night work, on-call shifts, short shift intervals and long weekly working hours to promote hospital physicians’ sufficient sleep.

Realized working hours and sleep among hospital physicians

Realized working hours and sleep among hospital physicians

Prevalence and Factors Associated with Palliative Care Utilization among Hospitalized Patients with Esophageal Cancer in the United States.

Objective: Due to poor 5-year survival and high symptom burden, esophageal cancer (EC) patients benefit markedly from palliative care utilization. However, there is scant literature exploring factors associated with receipt of palliative care in this population. The prevalence of palliative care consultations among hospitalized EC patients was assessed. Furthermore, we examined the factors associated with palliative care utilization among hospitalized patients with EC. Methods: Retrospective analyses were conducted using the National Inpatient Sample data collected between 2016 and 2018. Descriptive analyses were used to explore the overall prevalence of palliative care utilization. Univariate and multivariable regression models were used to examine factors associated with palliative care utilization among hospitalized EC patients. Results: The overall prevalence of palliative care utilization was 15.97%. Non-Hispanic Blacks had 1.16 times (95% CI: 1.00-1.34) higher odds of palliative care utilization compared to non-Hispanic Whites. Compared to patients on Medicare, those on Medicaid (AOR: 1.21; 95% CI: 1.02-1.45), private (AOR: 1.19; 95% CI: 1.06-1.35) and other insurance types (AOR: 1.68; 95% CI: 1.39-2.02) were more likely to utilize palliative care. Relative to patients hospitalized in the Northeast, those in Midwest (AOR: 1.34; 95% CI: 1.17-1.53), south (AOR: 1.28; 95% CI: 1.12-1.45), and west (AOR: 1.41; 95% CI: 1.22-1.61) were more likely to receive palliative care. Patients admitted to urban teaching hospitals (AOR: 1.28; 95% CI: 1.07-1.52) had higher odds of having palliative care consultations when compared to their counterparts in rural hospitals. Also, patients who were either discharged to a facility/with home health (OR: 5.39; 95% CI: 4.76-6.10) or died during hospitalization (OR: 26.93; 95% CI: 23.31-31.11) had higher odds of utilizing palliative care when compared to those with a routine discharge. Other factors identified were median household income quartiles, admission type, chemotherapy receipt, and the number of comorbidities. Conclusions: Our findings highlight the need to further analyze and address factors that may hinder palliative care utilization among hospitalized EC patients to decrease disparities and improve their quality of life. Hospital physicians and health systems need to be more proactive about palliative care consultations to maximize the benefits to these sick cancer patients.

Incidence of giant cell arteritis in six districts of Paris, France (2015–2017)

This prospective population-based study estimated the incidence of giant cell arteritis (GCA) in northeastern Paris. GCA cases diagnosed between 2015 and 2017 were obtained from local hospital and community-based physicians and the national health insurance system database. Criteria for inclusion were living in the study area at that time and fulfilling the 1990 American College of Rheumatology classification criteria and/or its expanded version. Cranial and large-vessel GCA cases were defined by the presence or absence of cranial signs and/or symptoms, respectively. Annual incidence was calculated by dividing the number of incident cases by the size of the study population ≥ 50years old. Completeness of case ascertainment was assessed by a three-source capture-recapture analysis. Among the 62 included cases, 42 (68%) were women, mean (± SD) age 77.3 ± 9.1years. The annual incidence ofGCA in northeastern Parisand completeness of case ascertainment were estimated at 7.6 (95% CI 5.9-9.8) per 100,000 inhabitants ≥ 50years old and 66% (95% CI 52-92%), respectively. Incidence increased with age, peaked at age 80-89years, and was almost twice as high in women versus men. Large-vessel GCA cases, mean (± SD) age 68.6 ± 11.5years, accounted for 8% of all GCA cases.In this study,GCA epidemiology was mainly driven by cases with cranial GCA signs or symptoms and incidence results were consistentwith recent European and past French studies.

The development and feasibility study of Multidisciplinary Timely Undertaken Advance Care Planning conversations at the outpatient clinic: the MUTUAL intervention

BackgroundPatients still receive non-beneficial treatments when nearing the end of life. Advance care planning (ACP) interventions have shown to positively influence compliance with end of life wishes. Hospital physicians seem to miss opportunities to engage in ACP, whereas patients visiting the outpatient clinic usually have one or more chronic conditions and are at risk for medical emergencies. So far, implemented ACP interventions have had limited impact. Structural implementation of ACP may be beneficial. We hypothesize that having ACP conversations more towards the end of life and involving the treating physician in the ACP conversation may help patient wishes and goals to become more concrete and more often documented, thus facilitating goal-concordant care.AimTo facilitate timely shared decision making and increase patient autonomy we aim to develop an ACP intervention at the outpatient clinic for frail patients and determine the feasibility of the intervention.MethodsThe United Kingdom’s Medical Research Council framework was used to structure the development of the ACP intervention. Key elements of the ACP intervention were determined by reviewing existing literature and an iterative process with stakeholders. The feasibility of the developed intervention was evaluated by a feasibility study of 20 ACP conversations at the geriatrics and pulmonology department of a non-academic hospital. Feasibility was assessed by analysing evaluation forms by patients, nurses and physicians and by evaluating with stakeholders. A general inductive approach was used for analysing comments. The developed intervention was described using the template for intervention description and replication (TIDieR).ResultsWe developed a multidisciplinary timely undertaken ACP intervention at the outpatient clinic. Key components of the developed intervention consist of 1) timely patient selection 2) preparation of patient and healthcare professional 3) a scripted ACP conversation in a multidisciplinary setting and 4) documentation. 94.7% of the patients, 60.0% of the nurses and 68.8% of the physicians agreed that the benefits of the ACP conversation outweighed the potential burdens.ConclusionThis study showed that the developed ACP intervention is feasible and considered valuable by patients and healthcare professionals.

Hypertension treatment in the oldest-old: focus group interviews with Swedish general practitioners

Objective This study explored the considerations and experiences of Swedish General Practitioners (GPs) of hypertension treatment in patients 80 years and above. Design Qualitative design with focus group interviews. Data were analysed by qualitative content analysis. Setting Primary health care centres (PHCCs), both rural and urban, in the Region of Västra Götaland, Sweden. Subjects GPs and GP trainees working at PHCCs in 2019 and 2020. Five focus group interviews with 24 physicians were performed. Main outcome measures Considerations and experiences of hypertension treatment in the oldest-old. Results Eighteen GPs and six GP trainees participated in the study. The latent content was formulated in a theme: ‘The physician’s decision-making in the treatment of hypertension in the oldest-old implies the inclusion of both medical and humanistic considerations.’ The manifest content constituted three main categories: ‘The patient characteristics’ included medical condition, behavioural factors and daily life. ‘The physician’s role’ described the GP as a professional and her/his experienced support. ‘The treatment decision’ considered these categories and involved risk-benefit balancing and communication. For the future, the participants proposed better guidelines for the oldest-old multimorbid patients, increased teamwork, continuous cooperation with nurses and better cooperation with hospital physicians. Conclusion Hypertension care for the oldest-old was experienced as complicated by GPs, due to the need of balancing medical and humanistic considerations. The GP’s clinical experience and the received support were of importance when making the treatment decision based on risk-benefit balancing and communication with the patient. Key points GPs experienced the task of caring for the oldest-old patients with hypertension as complicated. Patient factors like multimorbidity, polypharmacy, behavioural factors and the patient’s condition of daily life were identified. Clinical experience and the experienced support at the PHCC were discussed as important for the GPs’ treatment decision. Treatment decisions for the oldest-old patients with hypertension were based on risk-benefit balancing and communication with the patients.

Job satisfaction among nurses and physicians in an Army hospital: A content analysis

BackgroundLower job satisfaction is associated with increased turnover. Although factors that contribute to job satisfaction are well documented, less is known about job satisfaction among health care professionals in military hospitals. PurposeTo explore areas of most and least satisfaction with work among civilian and military nurses and physicians in an Army hospital. MethodsCivilian and military nurses and physicians (n = 285) completed two-open ended job satisfaction questions. We used content analysis to explore categories and themes. Data were sorted by professional identity (civilian, military) and professional role (nurse, physician). FindingsRegardless of professional identity or role, respondents experienced the most satisfaction with patient care and co-worker relationships. Military respondents experienced the least satisfaction with staffing inadequacies and work schedule conflicts. Civilians reported leadership attributes and co-worker conflicts contributed to the least satisfying aspects of work. DiscussionHospital leaders should implement relational work practices and develop policies that enhance job satisfaction.