It is also associated with aspects of health care such as quality of care and physician work efficiency. There is a general trend in declining job satisfaction among healthcare workers in many countries; although no studies were found in the literature on job satisfaction among doctors in Kazakhstan. The aim of the study is to estimate the prevalence and determine factors of working conditions related to job satisfaction among doctors working in public hospitals in Astana city of Kazakhstan METHODS. These risk factors need to be further investigated to address the issue of job satisfaction among physicians.
Job satisfaction is associated with aspects of healthcare such as quality of care, healthcare costs and physicians' work efficiency (Wada et al, 2009). The overall job satisfaction of doctors and the associated factors therefore remain unknown to us. The aim of the study is to estimate the prevalence and determine factors of working conditions associated with job satisfaction among doctors working in public hospitals in the city of Astana, Kazakhstan.
A cross-sectional study aimed at investigating the prevalence and determining factors of working conditions associated with job satisfaction among doctors working in public hospitals in the city of Astana, Kazakhstan.
RESULTS
Univariate Analysis: Socio-Demographic and Occupational Characteristics
81.73% of doctors felt a good personal connection with their patients and 73.08% noticed that gratitude shown by patients keeps them working. Slightly more than half (56.73%) of respondents thought that their relationships with patients are more adversarial than they used to be. Almost two-thirds of the participants were overwhelmed by the needs of patients, and exactly the same percentage of doctors (68.27%) thought that time pressure prevented them from developing good relationships with patients.
Relationships with other doctors.79.81% of the respondents found medical colleagues to be a good source of professional stimulation. One-third (29.81%) of physicians mentioned that their physician colleagues do not value their unique perspectives in practice, while 79.81% considered physician colleagues an important source of personal support. For about half (58.65%) of the respondents, non-physician colleagues were an important source of personal support.
About two-thirds (75.96%) of the participants stated that non-physician colleagues support their professional judgment and. 91.35% of respondents considered their salary unfair and 84.56% of respondents disagreed with the statement that they are well compensated compared to doctors in other specialties considering the workload. For 83.65% of participants paperwork was a burden and for about two-thirds (63.46%) the role of managing the business aspects of their practice was also a burden.
Resources. “Medical providers are available when I need them” - 62.50% of physicians responded positively to this question. 54.81% of respondents had sufficient exam space to see patients, but less than half (48.08%) had sufficient support staff. 79.81% of respondents said that the workload is always too high for them and 83.65% felt that the time pressure is high.
Bivariate Analysis
Lack of personal time, the need to be called by the hospital during holidays, and the need to go to the hospital on days off were not associated with job satisfaction (p-values were 0.564, respectively). Agreeing with the statement that the gratitude patients show keeps them at work (85.19%) was statistically significantly associated with job satisfaction (p-value=0.004). However, having a good relationship with patients, worrying about a lawsuit due to possible medical errors, and having more hostile relationships with patients than before were not statistically significantly associated with job satisfaction.
Overload with patient needs and lack of time to develop good relationships with patients were also not statistically significantly related to job satisfaction (p-values were 0.227 and 0.227, respectively). Relationships with other physicians. Only having physician colleagues as an important source of personal support (88.89%) was statistically significantly associated with job satisfaction (p-value 0.017), other risk factors - having physician colleagues as a good source professional stimulation (87.04%), that they have good relations with doctors (96.3%) and that their colleagues appreciate them for their unique perspectives in practice (74.07%), they do not (p-values or 0.368). Having non-physician colleagues as an important source of personal support (74.07) was statistically significantly associated with job satisfaction (p-value 0.001).
Income. Disagreeing that their overall pay is fair was statistically significantly associated with job satisfaction (p-value 0.032). Furthermore, agreeing that they are compensated compared to doctors in other specialties was statistically significantly associated with job satisfaction (p-value 0.007) taking into account their workload (22.22%). Agreeing that physicians' role in managing the business aspects of the practice is a burden for them (53.7%) and that paperwork is also a burden (74.07) were statistically significantly associated with job satisfaction ( p-value 0.032 and 0.006 respectively).
All risk factors from this item were statistically significantly related to job satisfaction: availability of medical providers (72.22%), enough space for examinations (68.52%) and enough support staff (59.26%); p-values of 0.018, respectively. Desire to recommend medicine to others as a profession (25.93%) was statistically significantly associated with job satisfaction (p-value 0.002). Absolutely all work factors from this item were not statistically significantly related to job satisfaction - excessive workload, time constraints, work interrupted by other tasks (p-values or 0.055).
Multivariate Logistic Regression Analysis
After stratifying by gender, it was determined that career satisfaction was associated with job satisfaction among male (p-value 0.002) physicians and was not associated with job satisfaction among female physicians (p-value 0.244). The adjusted odds of job satisfaction among those who agreed with the statement that nonphysician colleagues in their practice are a significant source of personal support are about 288% higher than those who disagreed (OR 3.88 ; CI p=0.004). The odds of being satisfied with the job among those who agreed that they had sufficient examination room space to see patients are about 2.79 times higher than those who disagreed, when other covariates are constant (OR 2, 79; CI p=0.027).
The odds of being satisfied with the job among those who agreed with the statement that they would recommend medicine to others as a career are about 451% higher than those who disagreed, adjusted for other variables (OR 5.51; CI p=0.041).
DISCUSSION
Multivariate logistic regression analysis of the adjusted association between risk factors and job satisfaction found that gratitude expressed by patients was a significant risk factor for job satisfaction among physicians. Research shows that the doctor-patient relationship has a significant impact on job satisfaction and is consistent with our findings (Lu Y, 2016). Having enough room in the examination room for patient examinations and the desire to recommend medicine as a career to others were identified as other job satisfaction factors.
Research conducted in Japan shows that hospital resources were related to job satisfaction; and Career satisfaction was associated with job satisfaction among male physicians and was weakly associated with job satisfaction among female physicians (Wada et al, 2009). Another study found that only the age category over 40 years compared to the age category 20-29 years was statistically significantly associated with job satisfaction. The association between years of practice experience and job satisfaction was statistically significant only for physicians who had more than ten years of experience, compared to those who had worked less than four years.
First, study findings allowed us to get a broad picture about associated factors of doctors' job satisfaction working in public hospitals in Astana. Second, this study can help us to develop and implement policies in the field of health care delivery and labor management by increasing job satisfaction. Third, to the best of our knowledge, this study was the first to investigate the prevalence and associated factors with job satisfaction among physicians working in public hospitals in Astana.
In addition, in our study we did not only use descriptive statistics, but we used bivariate analysis and multivariate logistic regression analysis to find a less biased association between job satisfaction and independent risk factors. However, it is worth noting that another group of factors is important in predicting job satisfaction. Doctors who are satisfied with their work are defined as those who chose the answer "very satisfied" or "satisfied" for the statement "write a statement here".
CONCLUSION
However, it may be possible that satisfied physicians were in fact not homogeneous in answering specific questions; it would have been better to consider separately those who chose “satisfied” and “very satisfied”. Likewise, the same uncertainty arises from defining physicians dissatisfied with their work as those who responded to the same statement “dissatisfied,” “neither,” or “very dissatisfied.” It is recommended to perform the sensitivity analysis to examine the relationship between each risk factor and an individual response to the statement.
Some translated questions were found ambiguous for respondents, such as questions about medical providers, room space to see patients, and paperwork. In Kazakhstan, medical providers are those who supply hospitals with medical equipment, perhaps abroad they are meant as a completely different professional. Another reasonable question was about room space to see patients: whether it was rooms in admission department or in the clinical department or even doctor's room.
The statement "paperwork is a burden to me" was not completely clear to the respondents. We recommend that in further investigations you avoid such ambiguous concepts and use terms that are understandable to the local population.
RECOMMENDATIONS
Williams ES, Skinner AC. Physician job satisfaction outcomes: A narrative review, implications, and directions for future research. Pathman DE, Konrad TR, Williams ES, Scheckler WE, Linzer M, Douglas J; Career Satidfaction Study Group.Satisfaction, dissatisfaction and turnover of doctors at work. Physicians' perceptions of institutional and managerial factors influencing their job satisfaction in one academic medical center.
فرح ديبا, در & رابية أرشد أثمان, در & ماهوش أختار, در & تسكين زهرة, در & حفصة رسول, در.
