Physician job satisfaction, job dissatisfaction, and physician turnover

The logistic models for the 5 physician groups were repeated with the more parsimonious forward stepwise variable selection approach to test the robustness of the model findings and as a functional colinearity check.³⁰ With only 1 exception of the 100 satisfaction-departure associations tested across the 5 physician groups, the findings were identical to those of the full logistic models. We reported only the full logistic models.

The statistical significance level was set at .01, to partially adjust for this study’s numerous comparisons.

Results

Unweighted characterizations of the 1939 eligible respondent physicians found that 70% were male and 72% non-Hispanic white, with a median age of 46 years (range, 27-88 years). Most were married (84%) and had children (85%). There were 459 family physicians (24%), 375 general internists (19%), 494 general pediatricians (25%), and 611 pediatric and medical subspecialists (32%). Eighteen percent worked in solo practices, 36% worked in small groups, and the rest worked in larger groups. Most (57%) owned their practices. Physicians had worked in their current practices for a median duration of 9 years when surveyed (range, 0-58 years).

Satisfaction scores

As a whole, the generalist and specialist physicians reported midrange satisfaction levels in the 10 areas of work assessed Table 1). For 2 work facets-administrative responsibilities and having adequate personal time-the average satisfaction scores for both groups indicated overall dissatisfaction. Physicians indicated greatest satisfaction with their intrinsic rewards from patient care, specifically their personal connection with and gratitude from patients.

The mean satisfaction scores of generalists and specialists were comparable for 7 of the 10 aspects of practice. In the remaining 3 areas, the generalist-specialist differences in satisfaction were small. Satisfaction scores varied more often with age, with physicians 55 years and older more satisfied than younger physicians in 8 of the 10 areas queried.

Anticipated job turnover

In total, 27.1% of physicians foresaw leaving their practices within the next 2 years: 13.8% believed leaving was likely or definite and 13.3% believed they had a moderate chance of leaving. Generalist and specialist physicians perceived similar chances of leaving (26.7% vs 30.0%, respectively; P = .31), with and without adjusting for age and sex. In contrast, physicians of various age groups anticipated different likelihoods of leaving Figure 1), with a 29% rate for the youngest group, a nadir of 22% to 23% for physicians aged 45 to 54 years, and again higher rates for older physicians, reaching 63% for those 70 years and older (P < .001).

Those who anticipated leaving their jobs within 2 years frequently also anticipated leaving the practice of clinical medicine entirely within 5 years, including 84% of leavers older than 54 years, 50% of leavers 45 to 54 years, and even 33% of leavers younger than 45 years.

Satisfaction with work and anticipated job turnover

Overall observations. In analyses that controlled for satisfaction with other facets of work and for several physician characteristics, we found that physicians’ regard for only some aspects of work was associated with their anticipated departure from their jobs (Table 2 and Table 3). Further, we found that physicians who were relatively dissatisfied with a variety of aspects of their work more often foresaw leaving their jobs than those with median satisfaction levels. In contrast, intentions to leave were generally just as likely for those of high and median satisfaction levels.Figure 2 shows the typical relationship between satisfaction and anticipated departure. In this example, as in most instances, the transition from lower to higher likelihood of anticipated departure occurs only when physicians’ feelings drop below neutral into dissatisfied levels.

Generalists and specialists. Among generalists and compared with those of average satisfaction (the omitted group in the statistical models), leaving one’s job was anticipated more often by those less satisfied with their pay (OR, 3.65; P < .0001), with their relationships with their communities (OR, 2.26; P < .0001), and with their relationships with the nonphysician staff in their offices (OR, 1.59; P < .01) Table 2). Only for 1 area of work, patient care issues (eg, feeling overwhelmed with patients’ demands and feeling that time constraints prevented good relationships with patients), were generalists in the highest satisfaction quartile less likely to anticipate leaving their practices than generalists with midrange satisfaction scores (OR, 0.60; P < .01).

For specialists, those reporting lowest satisfaction with their pay (OR, 3.24; P = .01) and community relationships (OR, 3.89; P < .01) anticipated leaving more often than those with midrange scores Table 2). For no aspects of work were the most satisfied specialists less likely to anticipate leaving than specialists of average satisfaction.