Surgery resident working conditions and job satisfaction.
ABSTRACT Medical students demonstrate decreased interest in surgical residencies and resident attrition after entry into programs has been reported at 14% to 20%. This study surveyed surgery residents regarding working conditions and how those conditions influenced their job satisfaction.
A new survey was developed to measure residents' working conditions. Questions generated from literature review were expanded and validated through focus groups at 2 academic medical centers. The resulting survey was administered on general/vascular surgery services at 52 hospitals along with a job-satisfaction scale. Questions were grouped into composite measures using factor analysis. Correlations were calculated between working conditions and job satisfaction at the individual and the hospital level.
In 844 returned surveys, resident job satisfaction did not correlate with age, sex, or postgraduate year. Perceived quality of patient care was the strongest (R = .51) of 68 items that did correlate (P < .01). Duty hours correlated less strongly (R = -.17). At the aggregate hospital level, effective ancillary staff/services (R = .77), empathetic nurses (R = .69), and attending teaching, appreciation and openness to suggestions (R = .49) correlated positively; scutwork (R = -.63) and erroneous paging (R = -.37) correlated negatively.
Our data confirm prior studies indicating that the teaching skills of the attending and the duty hours influence resident satisfaction. More important than these factors, however, were the effectiveness of systems and staff that facilitate the residents' job-care of the patient. Resident satisfaction and student recruitment efforts could be enhanced by the Program and Hospital Director's correction of deficiencies in these areas.
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ABSTRACT: Job satisfaction has become an increasingly important topic of focus for the medical profession over the last 20 years. This report details the application of factor analysis to validate a widely used 10-item job satisfaction scale that has not previously been validated in a medical practitioner population. The study drew on data from 9,900 participants enrolled in the first wave of a longitudinal survey of Australian doctors. The instrument was found to possess a dominant single factor explaining 75% of the variance and internal reliability was high (r = .86), enabling the determination of a composite job satisfaction score. Australian doctors experienced high levels of job satisfaction overall, but this varied with doctor subpopulation, age, geographic location, and hours worked per week. The validation of this brief scale in a large cohort of Australian doctors provides opportunities for undertaking further exploratory and comparative job satisfaction research in medical practitioner populations.Evaluation & the Health Professions 03/2011; 35(1):47-76. DOI:10.1177/0163278710397339 · 1.67 Impact Factor
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ABSTRACT: Although the Accreditation Council for Graduate Medical Education (ACGME) limits the work hours of residents, concerns about fatigue persist. A new Institute of Medicine (IOM) report recommends, among other changes, improved adherence to the 2003 ACGME limits, naps during extended shifts, a 16-hour limit for shifts without naps, and reduced workloads. We used published data to estimate labor costs associated with transferring excess work from residents to substitute providers, and we examined the effects of our assumptions in sensitivity analyses. Next, using a probability model to represent labor costs as well as mortality and costs associated with preventable adverse events, we determined the net costs to major teaching hospitals and cost-effectiveness across a range of hypothetical changes in the rate of preventable adverse events. Annual labor costs from implementing the IOM recommendations were estimated to be $1.6 billion (in 2006 U.S. dollars) across all ACGME-accredited programs ($1.1 billion to $2.5 billion in sensitivity analyses). From a 10% decrease to a 10% increase in preventable adverse events, net costs per admission ranged from $99 to $183 for major teaching hospitals and from $17 to $266 for society. With 2.5% to 11.3% decreases in preventable adverse events, costs to society per averted death ranged from $3.4 million to $0. Implementing the four IOM recommendations would be costly, and their effectiveness is unknown. If highly effective, they could prevent patient harm at reduced or no cost from the societal perspective. However, net costs to teaching hospitals would remain high.New England Journal of Medicine 06/2009; 360(21):2202-15. DOI:10.1056/NEJMsa0810251 · 54.42 Impact Factor
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ABSTRACT: Although teamwork is widely promoted by the Institute of Medicine, the American Academy of Family Physicians, and the Future of Family Medicine project, the health care literature does not provide clear direction on how to create or maintain high-functioning teams in ambulatory residency education. In 2004, we reorganized the clinical operation of our family medicine residency clinic into teams, each consisting of faculty, residents, and nursing and administrative staff. We hypothesized that operating within teams would have a positive effect on employees' job satisfaction and perceptions of our clinic's organizational and learning environments. We administered a confidential survey to faculty, residents, and staff annually over 5 years (2002-2006). Using questionnaire data from 2002-2003 as a baseline and data from 2004-2006 as a post-intervention measurement, we performed Mann-Whitney tests to assess the effect of the implementation of teams on employees' ratings of job satisfaction, individual autonomy, organizational commitment, goal attainment, physical characteristics and personnel arrangements within the clinic, learning opportunities for residents, teaching behaviors of faculty, roles of staff, and learning organization characteristics. After the implementation of teams, there was an improvement in ratings of learning opportunities and quality of teaching, job satisfaction, employee autonomy, staff roles, and staff attitudes toward residents. Implementing a team approach in a residency clinic can improve measures of physician and staff satisfaction and organizational function.Family medicine 07/2009; 41(6):434-9. · 0.85 Impact Factor