OBJECTIVES: We studied how physicians’ relative satisfaction and/or dissatisfaction with 10 distinct aspects of their work protected against or promoted their plans for leaving their jobs.
STUDY DESIGN: We used a cross-sectional mail survey.
POPULATION: We used questionnaire data from 1939 practicing generalists and specialists across the United States.
OUTCOMES MEASURED: Using logistic regression analysis, we assessed whether physicians in the top and bottom quartiles of satisfaction for each of 10 aspects of their work and communities were more or less likely to anticipate leaving their jobs within 2 years, compared with physicians in mid-satisfaction quartiles. Separate analyses were compiled for generalists vs specialists, and physicians by age groups (27-44 years, 45-54 years, and 55 years and older).
RESULTS: Generalists and specialists had generally comparable levels of satisfaction, whereas physicians in the oldest age group indicated greater satisfaction than younger physicians in 8 of the 10 work areas. One quarter (27%) of physicians anticipated a moderate-to-definite likelihood of leaving their practices within 2 years. The percentage that anticipated leaving varied with physicians’ age, starting at 29% of those 34 years or younger, steadily decreasing with age until a nadir of 22% of those from 45 to 49 years, then reversing direction to steadily increase thereafter. Across the 5 groups (ie, the 2 specialty clusters and 3 age groups), there were only 14 instances in which physicians in the lowest satisfaction quartiles were more likely to anticipate leaving than those of average satisfaction. In only 2 cases were physicians in the highest satisfaction quartiles less likely to anticipate leaving. Relative dissatisfaction with pay and with relationships with communities was associated with plans for leaving in nearly all physician groups. For specific specialty and age groups, anticipated departure also correlated with relative dissatisfaction with other selected areas of work.
CONCLUSIONS: To promote retention, these data suggest that physicians and their employers should avoid physician dissatisfaction in particular; building particularly high levels of satisfaction generally is not helpful for this end. Avoiding relative dissatisfaction with pay and with community relationships appears broadly important.
Until recently, the satisfaction of physicians was studied only among those working in special settings, such as in rural and urban underserved areas. In these settings, a less than satisfying work environment sometimes leads physicians to leave their jobs, with subsequent costs for needy communities.1,2 Now, with US physicians often employed by others, physicians’ autonomy constrained, medicine managed as a business, and incomes falling for some specialties, the satisfaction of rank and file physicians in all locations and specialties can no longer be assumed.3-5 Indeed, unhappiness is increasing among physicians, with growing numbers considering job changes, nonclinical work, and early retirement.6-8 Some physicians regret ever pursuing a medical career.8-10
Dissatisfaction among physicians is a concern even if medical work still pays handsomely and medical schools still have an abundance of applicants. Physicians’ satisfaction relates to their job effectiveness, including the quality of care they render, their patients’ compliance with recommended care, patients’ satisfaction with care, and patients’ health outcomes.6,9,11-15 The most obvious consequence of a dissatisfying job, however, is that physicians will quit to work elsewhere, disrupting patient-physician continuity and creating organizational instability and replacement costs, estimated at nearly $250,000 per physician lost.16-18 A job change also brings personal and financial costs to physicians and their families.
Although common experience and prior studies show that physicians’ job satisfaction generally influences whether they leave their jobs, little more is known about how satisfaction relates to job changes for physicians. From studies of other professions, we know that satisfaction is a multidimensional concept in which individuals can be satisfied with some aspects of work while dissatisfied with others.16,19 Further, we know that workers’ satisfaction with only some aspects of work correlates with turnover.16,20 For example, in 1 recent study rural generalist physicians who were satisfied with their local communities remained longer in their jobs, whereas their satisfaction with most other aspects of work, including with autonomy and doctor-patient relationships, was unrelated to their retention.2 The effects of workers’ satisfaction and dissatisfaction may also require separate assessment, because greater dissatisfaction with a given aspect of work may lead a worker to leave a job, but increasingly higher levels of satisfaction with the same issue may not lead to ever-increasing chances of retention, or vice versa.15,21
The goal of this study was to better understand the relationship between physicians’ satisfaction with various aspects of their work and whether or not they have thoughts or plans to leave their jobs. We assessed whether anticipated job departure related to satisfaction at both the upper and lower ends of its range; that is, whether particularly high satisfaction levels relative to other physicians protected against job change plans and significant relative dissatisfaction promoted such plans. We also assessed how the satisfaction/job-change relationship varied for physician groups with differing needs and values, specifically for generalists compared with specialists, and for younger, midcareer, and older physicians.