A survey to assess job satisfaction among junior doctors in Greece

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ORIGINAL ARTICLE
A survey to assess job satisfaction among junior doctors in
Greece
K. Roditis 1,2, E. Samara 2,3, K. Louis 2,4
1Vascular Surgery Department, “Korgialeneio-Benakeio” General Hospital of the Hellenic Red
Cross, Athens, Greece, 2Junior Doctors’ Network-Hellas (JDN-Hellas), Athens, Greece,
3Anesthesiology Department, Tzaneio General Hospital, Piraeus, Greece and 4Third Department
of Obstetrics-Gynecology, “Attikon” University Hospital, Medical School, National and
Kapodistrian University of Athens, Greece
ABSTRACT
Introduction: Junior doctors have to learn how to deal with long shifts, lack of sleep, study hours,
increased responsibilities, hard competition, and also a personal and social life. This amount of
pressure leads to both physical and mental illness. The present study seeks to unveil how Greek
junior doctors perceive their residency, focusing on job satisfaction.
Methods: A 36-question survey based on the Job Satisfaction Survey (JSS) translated into the
Greek language, was placed online and promoted to junior doctors. Pay, Promotion, Supervision,
Fringe Benefits, Contingent Rewards, Operating Procedures, Coworkers, Nature of Work, and
Communication facets were studied.
Results: 113 junior doctors replied, 52 (46%) males and 61 (54%) females with a mean age of 33,4
years. They appear dissatisfied within their working environment (JSS score=100,4). This applies
more to females (97,1) than males (104,3). They only feel satisfied with the nature of their work
(16,5) with females more satisfied (16,7) than males (16,3). Pay facet presented the worst results,
independent of sex. Greek junior doctors consider themselves working in far worse environment
than that of their American colleagues (JSS score=135,8 compared to 100,4 in Greece).
Conclusion: The serious problems Greek junior doctors face are depicted with truly disappointing
figures, with bureaucracy being the major problem leading to less work efficiency. More
healthcare investments and fairer salaries must be implemented, especially in times of economic
crisis, as good health is paramount for a stable society and public health is the result of the work of
the country’s hard-working junior doctors.
Keywords: job satisfaction, junior physician, medical residency, burnout, work satisfaction

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K. Roditis, E. Samara, K. Louis. A survey to assess job satisfaction among junior doctors in
Greece. Scientific Chronicles 2019; 24(1): 72-96
eoi: http://eoi.citefactor.org/10.11212/exronika/2019.1.7
INTRODUCTION
Stress at the workplace is often
difficult to define. It is not clear whether it is
a feeling felt by the worker, if it is a
characteristic of the working environment, or
if it is experienced as a result of both [1,2].
More often it is considered as a broader
concept, associated with situations that cause
it, as well as with the consequences it might
have, when present [1,3]. According to the
European Agency for Health and Safety at
Work (EU-OSHA, 2000), work-related stress
occurs when there is an imbalance between
the expectations a worker must fulfill and the
resources available for him to work. The
American National Institute for Occupational
Safety and Health (NIOSH, 1999), argues that
work-related stress is the harmful physical or
psychological response of the worker, when
job requirements do not match the capability,
available resources, the needs or the personal
expectations of the worker and can lead to
health problems, even serious trauma [1]. A
similar approach is made by the World
Health Organisation in its definition for
workplace stress as “the response people may
have when presented with work demands
and pressures that are not matched to their
knowledge and abilities and which challenge
their ability to cope”. WHO further states that
stress occurs in a wide range of work
circumstances but is often made worse when
employees feel they have little support from
supervisors and colleagues, as well as little
control over work processes [4].
Doctors face complex situations and
high level of responsibility. This is something
inherent to the profession [5,6]. Stress
associated with medical profession has been
documented for the last 30 years. According
to Cooper [7], dentists and doctors are
considered as high stress occupations,
together with pilots, police, miners and social
workers. Factors which make the doctors’
profession so stressful include their
responsibility for “people” rather than
“objects” [8], and the fact that their actions or
omissions have a profound impact on human
life [9,10]. Doctors’ competence is under
continual evaluation by both patients and
colleagues. Their mistakes are highly visible
with potentially devastating results for
patients as well as the doctors themselves
[11].
Doctors often confront emotionally
challenging and traumatic situations
including patients' suffering, injury and
death. This can cause stress especially if
doctors are not trained to face these complex
environments and to deal with challenging

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situations like death. In fact, a high
proportion of doctors suffer from stress and
burnout, especially in training positions [5,6].
Burnout is more common among physicians
than among other workers and physicians in
specialties at the front line of care access seem
to be at greatest risk [12]. Olkinuora [13]
concluded that doctors who worked in
hospitals experienced higher levels of
professional burnout than those working in
other settings (e.g. private practice, research
institutions).
Residency is a special period in a
doctor’s life, as they suddenly have to
combine being a learner and a healthcare
provider at the same time. A junior doctor,
after a long period of student status, has to
undertake new roles and major
responsibilities, such as being responsible for
clinical and ethical decisions, following a
vague job description and tolerating sleepless
on-call nights [14] and is, therefore, exposed
in many stressful factors in their working
environment. These stressors could be
exacerbated by the pressure placed on
doctors to appear calm and controlled but at
the same time remain emotionally involved
and concerned with their patients’ problems
[15-17]. Stress can be derived by a temporal,
particular situation or constant lack of
guidance and feedback by supervisors [18].
Inadequate support from senior staff is
described by many junior hospital doctors
(JHDs) as an extra stress factor towards them
on a daily basis, as it is a common experience
when senior physicians often tend to dismiss
a stressful situation by just saying: “I went
through it in my time; why shouldn’t you?”
[19]. It is harder to deal with stressful
situations if the system is rigid and not
humanized. In “hierarchical systems” still
commonly found in medicine, doctors in
training may feel powerless to ask for senior
input or confront behaviors of harassment
and belittling attitudes. Besides, in some
countries tutors do not have enough time to
provide adequate supervision and feedback
as they have too much other work. High
levels of responsibility without supervision
causes stress and can increase risk to patient
safety [5,6]. In 2002, Mc Manus [20]
researched emotional factors to increase or
decrease occupational stress among young
doctors. Ochsmann [18] used a questionnaire
to correlate stress among junior doctors with
adequate feedback from the supervisors and
colleagues.
Junior doctors also have to learn how
to deal with long shifts, lack of sleep, study
hours, increased responsibilities, hard
competition, and also a personal and social
life. All this amount of pressure can lead to
both physical and mental illness.
Maladaptive coping behaviors, such as high
levels of alcohol consumption, smoking,
substance abuse and even suicide may be
manifested by JHDs as a result of high levels
of stress [21-24]. Sleep deprivation and
workload can lead to both professional and
personal dysfunctions, such as errors,
misjudgement, job dissatisfaction or quitting,
depression, anxiety, divorce and isolation
and even suicide ideation. Inability to sleep
properly, related to demanding work
schedules has also been linked to poorer
work performance in JHDs [25]. Moreover,

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adverse changes in mood and cognitive
performance of House Officers after night
duty, have been reported by Orton and
Gruzelier [26]. Similarly, recent research
illustrated that a sample of British JHDs
experienced substantial increases in certain
stress symptoms (e.g. anxiety and insomnia)
and were more likely to make errors in a
medical context, eight weeks after beginning
as junior house officers [27]. Depression can
affect up to 30% of junior doctors, mainly
during the first year of residency. There is a
direct link between depression and working
hours. It occurs more often in female doctors,
as does suicide. As shown in a meta-analysis
by Schernhammer and Colditz [28], the
aggregate suicide rate ratio for male
physicians, compared to the general
population, was 1.41, and for female
physicians the ratio was 2.27. A Mayo Clinic
study published in 2011 showed that as many
as one in 16 surgeons reported having
suicidal thoughts in the previous year but
few sought help from a mental health
clinician. Of 7905 surgeons who responded to
an anonymous survey with questions about
suicidal ideation and the use of mental health
resources, 501 reported thoughts of suicide
and of them 301 were reluctant to seek help
from a psychiatrist or psychologist because
they believed it might affect their medical
license [29,30].
It should also be noted that job
insecurity (British Medical Association, 1992),
the very real fear of unemployment, along
with the vague job descriptions and the lack
of general facilities, are also common sources
of stress reported by JHDs [14]. The whole
problem seems to start at medical school but
exact causes are still unknown. During their
medical studies, competitiveness, the quest
for perfection, too much autonomy coupled
with responsibility, and the fear of showing
vulnerability have all been cited as triggers
for mental ill health [30,31].
Starting from entering medical school,
and furthermore during their training,
doctors tend to believe that they should not
get sick, and even if they do, they should
continue working. Thus, there is a great
percentage of self-treating, and they rarely
seek a fellow specialist for help. The same
“rule” applies for mental distress as well.
Doctors hesitate to ask for help, as they are
afraid of lack of confidentiality, being
stigmatized among colleagues and being
considered incompetent as professionals [32].
It is said that the medical profession often
attracts highly driven individuals with a
strong sense of duty. Physicians need to
complete long and intense educational
requirements and are subject to high
expectations from patients and the public.
But these expectations can contribute to
prioritizing the care of others over care of self
and feelings of guilt and selfishness for
managing their own well-being if they
become unwell [5,6]. A systematic review in
2008, revealed that junior doctors do not seek
help as they are concerned about
confidentiality and embarrassed in case of
exposure, but also that physicians fail to treat
colleagues as patients [33].
In Greece, residency lasts from four to
seven years. It is paid, and considered to be a
full time and exclusive occupation. However,

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residents are rarely organized enough to
achieve changes in their working
environment. There is no official agency to
report problems at work, educational gaps or
violation of working hours, which is often,
despite the law. Despite the growing
empirical evidence on the levels of stress of
the medical professionals, to date only a few
systematic studies have been conducted in
Greece to investigate the levels of stress and
burnout experienced by Greek junior doctors.
Case reports and circumstantial evidence
from the Ministry of Health of Greece and the
Greek Open University have briefly
presented the difficult working conditions in
five main hospitals of Athens and in all
public hospitals of Greece related to
equipment, hygiene, levels of noise,
outpatients clinics, shortage of nursing staff
and the overall provision of facilities to
patients. A more thorough study conducted
in a sample of 355 male and female JHDs
from the greater Athens area in 2003, using
an extended version of the occupational
stress indicator (OSI) questionnaire revealed
that JHDs presented significantly higher
levels of sources of pressure than the
normative population and other comparative
occupational samples. It also showed that the
most significant predictors of low levels of
job satisfaction of the sample were: demands
of the profession, great volume of work and
lack of power and influence [14]. In general,
residents are generally not satisfied with the
educational environment of the Greek
hospitals chosen for their specialty training,
and the expectations that they had when
entering the entered medical school are not
covered to the extent that they would like
[34].
However, no study so far has focused
specifically on determining how satisfied
residents feel in their working environment
or how several aspects of their daily practice
affect their perception of their residency both
as an educational and working experience.
The present study seeks to unveil the
present situation of how Greek junior doctors
perceive their residency with a special focus
on job satisfaction.
MATERIALS AND METHODS
Survey structure
A 36-question survey based on the Job
Satisfaction Survey (JSS) developed by Paul
E. Spector in 1985 and properly translated
into the Greek language, was created and
placed online (Table 1) [35]. The JSS is a 36-
item, nine-facet scale to assess employee
attitudes about the job and aspects of the job.
Each facet is assessed with four items, and a
total score is computed from all items. A
summated rating scale format is used, with
six choices per item ranging from "strongly
disagree" to "strongly agree". Items are
written in both directions, so about half must
be reverse scored. The nine facets are: Pay,
Promotion, Supervision, Fringe Benefits,
Contingent Rewards (performance-based
rewards), Operating Procedures (required
rules and procedures), Coworkers, Nature of
Work, and Communication (Table 2).
Although the JSS was originally developed

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Table 1. The questionnaire used in the present survey (in English).
JOB SATISFACTION SURVEY QUESTIONNAIRE
Paul E. Spector, Department of Psychology, Universit y of South Florida.
Copyright Paul E. Spector 1994, All rights reserved.
Disagree
very much
Disagree
moderately
Disagree
slightly
Agree
slightly
Agree
moderately
Agree
very
much
PLEASE CIRCLE THE ONE NUMBER FOR EACH QUEST ION THAT
COMES CLOSEST TO REFLECTING YOUR OPINION AB OUT IT.
1
I feel I am being paid a fair amo unt for the work I do.
1
2
3
4
5
6
2
There is really too little chance for promotion on my job.
1
2
3
4
5
6
3
My supervisor is quite competent in doing his/her job.
1
2
3
4
5
6
4
I am not satisfied with the benefits I receive.
1
2
3
4
5
6
5
When I do a good job, I receive the recognition for it that I should
receive.
1
2
3
4
5
6
6
Many of our rules and procedures make doing a good job difficult.
1
2
3
4
5
6
7
I like the people I work with.
1
2
3
4
5
6
8
I sometimes feel my job is meaningless.
1
2
3
4
5
6
9
Communications seem good within this organization.
1
2
3
4
5
6
10
Raises are too few and far between.
1
2
3
4
5
6
11
Those who do well on the job stand a f air chance of being
promoted.
1
2
3
4
5
6
12
My supervisor is unfair to me.
1
2
3
4
5
6
13
The benefits we receive are as good as most other organizatio ns
offer.
1
2
3
4
5
6
14
I do not feel that the work I do is appreciated.
1
2
3
4
5
6
15
My efforts to do a good job are seldom blocked by red tape.
1
2
3
4
5
6
16
I find I have to work har der at my job because of the incompetence
of people I work with.
1
2
3
4
5
6
17
I like doing the things I do at work.
1
2
3
4
5
6
18
The goals of this organization are not clear to me.
1
2
3
4
5
6
19
I feel unappreciated by the organization when I think about what
they pay me.
1
2
3
4
5
6
20
People get ahead as fast here as they do in other places.
1
2
3
4
5
6
21
My supervisor shows too little interest in the feelings of
subordinates.
1
2
3
4
5
6
22
The benefit package we have is equitable.
1
2
3
4
5
6
23
There are few rewards for those who work here.
1
2
3
4
5
6
24
I have too much to do at work.
1
2
3
4
5
6
25
I enjoy my coworkers.
1
2
3
4
5
6
26
I often feel that I do not know what is going on with the
organization.
1
2
3
4
5
6
27
I feel a sense of pride in doing my job.
1
2
3
4
5
6
28
I feel satisfied with my chances for salary increases.
1
2
3
4
5
6
29
There are benefits we do not have which we should have.
1
2
3
4
5
6
30
I like my supervisor.
1
2
3
4
5
6
31
I have too much paperwork.
1
2
3
4
5
6
32
I don't feel my efforts are rewarded the way they should be.
1
2
3
4
5
6
33
I am satisfied with my chances for promotion.
1
2
3
4
5
6
34
There is too much bickering and fighting at work.
1
2
3
4
5
6
35
My job is enjoyable.
1
2
3
4
5
6
36
Work assignments are not fully explained.
1
2
3
4
5
6

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Facet
Description
Item numbers
Pay
Pay and remuneration
1, 10, 19, 28
Promotion
Promotion opportunities
2, 11, 20, 33
Supervision
Immediate supervisor
3, 12, 21, 30
Fringe Benefits
Monetary and nonmonetary fringe
benefits
4, 13, 22, 29
Contingent Rewards
Appreciation, recognition, and rewards
for good work
5, 14, 23, 32
Operating
Procedures
Operating policies and procedures
6, 15, 24, 31
Coworkers
People you work with
7, 16, 25, 34
Nature of Work
Job tasks themselves
8, 17, 27, 35
Communication
Communication within the organization
9, 18, 26, 36
Total
Total of all facets
1-36
Table 2. The nine facets of the JSS scale and item (question) distribution according to them
for use in human service organisations, it is
applicable to all organisations.
After creating the survey, the link to
fill it in was provided to Greek junior doctors,
defined as medical graduates up to 15 years
after their graduation. This was done by
promoting the survey through various
channels, including the e-mailing list of
communication of the Junior Doctors
Network - Hellas (JDN-Hellas) hosted by
Google Groups, the e-mailing list of the
Alumni of the Hellenic Medical Students'
International Committee (HelMSIC) hosted
by Yahoo! Groups
(https://groups.google.com/forum/#!forum
/helmsic-alumni), the official page of JDN-
Hellas on Facebook
(https://www.facebook.com/Junior-
Doctors-Network-JDN-Hellas-
851331098227489) and the official Twitter
account (http://www.twitter.com/jdnhellas)
of JDN-Hellas, as well as by word of mouth.
The time provided for participation
was limited from 13 May 2014 to 31
December 2017. Participants were asked to
participate anonymously in the survey,

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Characteristic
Prevalence (%)
Gender
Male
Female
52 (46)
61 (54)
Age Range according
to gender
Male, 20-24 years
Female, 20-24 years
Male, 25-29 years
Female, 25-29 years
Male, 30-34 years
Female, 30-34 years
Male, 34-39 years
Female, 34-39 years
Male, 40-44 years
Female, 40-44 years
2 (1,8)
7 (6,2)
4 (3,5)
18 (15,9)
14 (12,4)
15 (13,3)
23 (20,4)
11 (9,7)
9 (8)
10 (8,9)
Medical specialty
Anesthesiology
General/Family Medicine
General Surgery
Internal Medicine
Neurosurgery
Obstetrics/Gynecology
Pediatrics
Urology
Vascular Surgery
15 (13,3)
15 (13,3)
34 (30,1)
5 (4,4)
5 (4,4)
15 (13,3)
5 (4,4)
10 (8,9)
5 (4,4)
Job status
Resident
Young specialist
101 (89,4)
12 (10,6)
Table 3. Demographics of survey participants.

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providing basic demographic information
(Table 3), namely their sex and age range,
their medical specialty and their job status
(resident or young specialist).
Data analysis
Microsoft Excel® was used for data
collection and statistical analysis of the
responses given.
The JSS assesses job satisfaction on a
continuum from low (dissatisfied) to high
(satisfied). There are no specific cut scores
that determine whether an individual is
satisfied or dissatisfied, in other words, one
cannot confidently conclude that there is a
particular score that is the dividing line
between satisfaction and dissatisfaction.
Where there is a need to draw conclusions
about satisfaction versus dissatisfaction for
samples or individuals, two approaches can
be used: The normative approach would
compare the target person/sample to the
norms for the sample. There are norms
published in the literature for several
different groups. One can reference the
norms and describe given
individuals/samples as being more satisfied,
dissatisfied, or about the same as the norms.
The absolute approach picks cut scores to
represent dissatisfaction versus satisfaction.
Given the JSS uses 6-point agree-disagree
response choices, one can assume that
agreement with positively worded items and
disagreement with negatively worded items
would represent satisfaction, whereas
disagreement with positive-worded items,
and agreement with negative-worded items
represents dissatisfaction. For the 4-item sub-
scales, as well as the 36-item total score, this
means that scores with a mean item response
(after reverse scoring the negatively-worded
items) of 4 or more represents satisfaction,
whereas mean responses of 3 or less
represents dissatisfaction. Mean scores
between 3 and 4 are ambivalent. Translated
into the summed scores, for the 4-item sub-
scales with a range from 4 to 24, scores of 4 to
12 are dissatisfied, 16 to 24 are satisfied, and
between 12 and 16 are ambivalent. For the 36-
item total where possible scores range from
36 to 216, the ranges are 36 to 108 for
dissatisfaction, 144 to 216 for satisfaction, and
between 108 and 144 for ambivalent [35].
Statistics
JSS Scores mentioned below are means
± 1 standard deviation (SD). A standard
Student’s t-test was used to compare JSS facet
scores among male and female respondents,
among residents and young specialists, as
well as results from different countries.
Kruskal-Wallis H test was used to compare
means among different age ranges and
among different medical specialties.
Statistical significance was identified for p-
values <0.05.

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RESULTS
Survey-derived “raw” results
In total, 113 junior doctors participated
in the survey with both sexes almost equally
represented in the sample. Mean age was 33,4
years. By using the above-mentioned
absolute approach, we determined agreement
or disagreement percentages for each
individual item (question) of the
questionnaire used. These direct survey-
derived “raw” results are shown in Table 4.
#
Question
Agree
(%)
Disagree
(%)
1
I feel I am being paid a fair amount for the work I do.
17
83
2
There is really too little chance for promotion on my job.
57
43
3
My supervisor is quite competent in doing his/her job.
38
62
4
I am not satisfied with the benefits I receive.
75
25
5
When I do a good job, I receive the recognition for it that I should receive.
40
60
6
Many of our rules and procedures make doing a good job difficult.
88
12
7
I like the people I work with.
78
22
8
I sometimes feel my job is meaningless.
44
56
9
Communications seem good within this organization.
57
43
10
Raises are too few and far between.
96
4
11
Those who do well on the job stand a fair chance of being promoted.
21
79
12
My supervisor is unfair to me.
33
67
13
The benefits we receive are as good as most other organizations offer.
23
77
14
I do not feel that the work I do is appreciated.
66
34
15
My efforts to do a good job are seldom blocked by red tape.
18
82
16
I find I have to work harder at my job because of the incompetence of
65
35
17
I like doing the things I do at work.
81
19
18
The goals of this organization are not clear to me.
64
36
19
I feel unappreciated by the organization when I think about what they pay
85
15
20
People get ahead as fast here as they do in other places.
19
81
21
My supervisor shows too little interest in the feelings of subordinates.
73
27

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22
The benefit package we have is equitable.
11
89
23
There are few rewards for those who work here.
82
18
24
I have too much to do at work.
89
11
25
I enjoy my coworkers.
70
30
26
I often feel that I do not know what is going on with the organization.
62
38
27
I feel a sense of pride in doing my job.
79
21
28
I feel satisfied with my chances for salary increases.
9
91
29
There are benefits we do not have which we should have.
97
3
30
I like my supervisor.
67
33
31
I have too much paperwork.
85
15
32
I don't feel my efforts are rewarded the way they should be.
85
15
33
I am satisfied with my chances for promotion.
16
84
34
There is too much bickering and fighting at work.
60
40
35
My job is enjoyable.
69
31
36
Work assignments are not fully explained.
76
24
Table 4. Survey derived “raw” results showing participants’ agreement or disagreement for each survey
item (question).
Job Satisfaction Scale
By using the absolute approach again, we calculated the JSS score and level of satisfaction -
“satisfied”, “ambivalent” and “dissatisfied” for each sub-scale/facet (Figure 1) as well as the
overall JSS score and level of satisfaction (100,4 - “dissatisfied”).
Figure 1. Bar graph showing Job Satisfaction
Scale (JSS) scores and level of satisfaction
observed for each sub-scale/facet.

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JSS scores showed statistically significant differences according to gender, only for the
Promotion and Supervision facets (Figure 2).
Figure 2. Box-plot graph showing comparison of Job Satisfaction Scale (JSS) scores for each sub-scale/facet
between genders (males and females). The bold flat bars within each column represent medians. Statistical
significance is marked with asterisks (p=0.023) and double asterisks (p=0.034).
No difference was found between males and females for Overall Satisfaction (Figure 3).
Figure 3. Box-plot graph showing comparison of Total Job Satisfaction Scale (JSS) scores for overall
satisfaction between genders (males and females). The bold flat bars within each column represent
medians. Absence of statistical significance is marked with NS.

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All facets and Overall Satisfaction showed no statistically significant differences (p>0.05)
in JSS scores among different age ranges (Figures 4 and 5), job status and medical specialties.
Greek junior doctors present extremely dissatisfied with their payment, the fringe benefits in their
working environment, the operating procedures in their workplace, as well as their chances for
promotion. Satisfaction only comes from the nature of their work, with women, expressing
themselves as more satisfied than men, although without statistical significance (p=0.665).
Figure 4. Box-plot graph showing
comparison of Job Satisfaction
Scale (JSS) scores for each sub-
scale/facet between age groups.
The bold flat bars within each
column represent medians.
Absence of statistical significance
is marked with NS.
Figure 5. Box-plot graph showing comparison of Total Job Satisfaction Scale (JSS) scores for overall
satisfaction between age groups. The bold flat bars within each column represent medians. Absence of
statistical significance is marked with NS.

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Comparison with other countries
Given the fact that JSS scores from the health sector in USA have already been published
and can be found in the literature [36], we compared our results with the American results.
Comparison for each satisfaction facet as well as overall satisfaction is shown in Figures 6 and 7.
Figure 6. Bar graph showing comparison of Job Satisfaction Scale (JSS) scores for each sub-scale/facet
between different countries (Greece and USA). Statistical significance is marked with asterisks (p<0.0001).
Figure 7. Bar graph showing comparison of Total Job
Satisfaction Scale (JSS) scores for overall satisfaction
between different countries (Greece and USA).
Statistical significance is marked with asterisks
(p<0.0001).

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DISCUSSION
Modern work environment is
characterized by new forms of employment,
such as part-time work, the establishment of
non-permanent staff, e-commerce or e-work,
all those forms have been created alongside
traditional forms of work. At the same time,
the global economic crisis of the last decade
has increased unemployment rates, wages are
decreasing while cost of living is rising. In
addition, the continuous development of
technology intensifies workers' anxiety, since
on the one hand machines in many cases tend
to replace human hands and on the other
hand modern employers are constantly
looking for workers with adaptability and
advanced technological skills. This has
introduced an intense competition in the
labor market, thus increased insecurity felt by
workers, mental and physical illness and
intense levels of anxiety which they develop
to meet the above-mentioned requirements
[37].
Medical practice has always been a
difficult task in Greece, even after the country
entered the European Union (EU) in 1981,
when European legislation was incorporated
into national legislation. Greek JHDs bare
most of the daily volume of medical services
the country offers its citizens. They are truly
among the hospital doctors who suffer
mostly from the adverse working conditions
in the hospitals where they spend more hours
than doctors of any other rank [38].
Furthermore, the shortage of nursing staff
and especially of specialized nurses
aggravates the whole problem for JHDs and
creates additional workload [39]. For a short
time, this difficult situation of daily medical
practice seemed to change for the better, after
the country implemented all relevant
European directives like the European
Working Time Directive (EWTD), which
although at first excluded residents from its
protection [40], it included them at a later
point [41], now setting certain working time
limits for all physicians, including junior
trainees. Greek law now directs that junior
doctors have to work for 58 hours/week,
while a day off from work after a 24-hour
shift is considered obligatory and the
overtime compensation framework has also
improved. According to Law 2071/92 No. 60,
responsibility for the training of JHDs lies not
only with the supervisors and consultants of
clinics but also with the scientific committees
of hospitals. However, in many cases, these
committees are not able to design a complete
training program for JHDs since their
members have little communication with
JHDs and are unaware of their real
difficulties and needs [14].
The economic crisis that has struck
Greece since 2010 has led to an
unprecedented social crisis, and the Greek
State has proven incompetent to oversee the
implementation of certain legislation.
Furthermore, the lack of technical support
mechanisms and organizational failure in
most public hospitals, as well as the fact that,
junior doctors have fled from the country in
big numbers seeking to start their medical
careers in a foreign country with a better
healthcare system and higher chances of
professional promotion and development
and better salaries, has devastated the

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country’s public healthcare structure and has
led junior doctors - who are considered to be
its backbone - to poverty.
The main problems that junior doctors
face in Greece are described in the present
study with disappointing figures. According
to the results, professional burnout seems to
be quite prominent in JHDs working in Greek
public hospitals. Physician professional
burnout is an under-recognized and under-
reported problem. Characterized by a state of
mental exhaustion, depersonalization, and a
decreased sense of personal accomplishment,
burnout may affect more than 60% of family
practice providers and at least 30% of
gastroenterologists. Some studies have
shown that younger physicians, physicians
performing high-risk procedures, and
physicians experiencing work-life conflicts
are at greatest risk. If unrecognized, the costs
to the physician and to the health care system
can be enormous because physician burnout
is associated with increased rates of
depression, alcohol and drug abuse, divorce,
suicide, medical errors, difficult relationships
with coworkers, and patient dissatisfaction,
as well as physician attrition [42-44]. As
already presented by other investigators,
burnout in medical specialists and residents
is linked to different characteristics of their
working environment including perceived
job demands in terms of time pressure,
mental effort and emotional labor. Burnout
measured using the Maslach Burnout
Inventory [45] presented in the form of
emotional exhaustion and depersonalization,
with different factors predicting each form of
burnout when referring to specialists and to
residents, respectively [46]. Several strategies
have been proposed to combat burnout.
There seems to be a consensus in determining
five key principles: a) Learn to balance
personal and professional goals, b) Shape
your career and identify stressors, c) Nurture
wellness strategies, d) Become engaged
and/or re-engage and e) Build resilience [42].
A recent meta-analysis evaluated controlled
interventions to reduce physician burnout
both on the organizational level (such as
rescheduling shifts, reducing workload,
structural changes, or meetings to enhance
teamwork) as well as on the
physician/individual level (such as
mindfulness, stress reduction, education
targeting communication skills, exercise, or
some combination). The majority of the
studies evaluated physician-directed
interventions. Interventions overall were
associated with small but significant
reductions in burnout. The treatment effects
of organization-directed interventions were
significantly larger than the effects of
physician-directed interventions. These
findings underscore the argument that
“burnout is rooted in the organization
coherence of the health care system” and that
the scope of the overall burnout problem is
unlikely to be addressed completely on an
individual physician level [42,47].
High workload presents as a common
nuisance for Greek JHDs. Total working time
reaches up to 100 hours/week and day(s) off
from work after 24-hour shifts are completely
off the table, in contrast with existing
legislation. This particular stressor represents
the most widely quoted stressful situation for

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JHDs, having been defined in the literature as
the “pre-residency syndrome” or the “house
officer syndrome” [14,48]. Furthermore,
consequences of medical errors and high
workload were reported as sources of stress
in a more recent study with a general sample
of Greek hospital doctors [14,49].
Problematic working environment and
poor working conditions are other pressing
issues, especially the common presence of
disorganization combined with poor working
conditions.
Junior doctors in Greece consider
bureaucracy as a major factor causing loss of
working hours thus leading to less
productivity and efficiency. Inadequately
defined roles are considerably stressful for
Greek JHDs. For years, JHDs attempted to
determine and legislate a clear job
description. The existing informal job
description is frequently the cause of
conflicts, not only between doctors from
different ranks, but also between doctors and
the nursing staff. Overall, the lack of a clear
job description has a negative impact on the
scientific orientation of JHDs, most of whom
spend a lot of time in jobs irrelevant to their
job description.
Another common belief is that senior
attending physicians do not appreciate their
work even after them trying really hard and
they rather seem untouched by the problems
they face in their daily practice of medicine.
Many trainees think that their supervisors
often prove incompetent both scientifically
and educationally and appear doubtful about
their teaching ability. Relationships with
superiors are considered a “sensitive” area
for JHDs. Lack of acknowledgement and
praise from superiors have been mentioned
in the literature to be among the top three
stressful situations for young doctors.
Moreover, several JHDs of both genders have
reported that receiving feedback from
supervisors is particularly important for them
giving them strength to continue their work
more effectively [14]. It has been found that
personality characteristics of JHDs’
supervisors affect their decision regarding the
selection of a specialty [50]. Quite often,
junior doctors have to deal with serious
behavioral issues at work, including constant
bickering and fighting with their supervisors,
but also among themselves. Several JHDs
have admitted that, not infrequently, they
had to come into conflict with their
colleagues in order to participate in certain
medical procedures (e.g. a difficult diagnosis
or a surgery). This situation has consequences
for the relationships between JHDs which,
particularly in certain specialties, which are
usually considered as quite competitive [14]
and usually leads, according to them, to less
motivated work and emotional distress.
Junior doctors also believe that
disorganization within their working
environment causes a lack of benefits they
could enjoy. All issues mentioned above
conclude that chances for promotion and
professional development of junior doctors in
Greece seem rather unlikely.
Last but not least, unjust payments
and very low salaries of junior doctors and
trainees also pose as a threat, mainly because
this does not seem to be the case in other

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professional sectors, often considered as
“inferior” or “of less value” and
acknowledgement by society. Even if the
economic crisis is to blame, salary levels in
other EU countries and the USA seem rather
unreachable. This problem is closely in
interaction with the inadequate training of
junior doctors as their salaries do not
correspond to their increased educational
needs. It is worth pointing out that the
earnings of Greek hospital doctors have
remained almost frozen for over a decade.
When the Greek National Health System was
founded 30 years ago, a specific rate of
payments for hospital doctors was laid down,
but this has been ignored for many years and
great cuts have been implemented during the
recent economic crisis. It has been admitted
that doctors’ salaries cannot cover expenses
of continuous professional development
(participation in medical conferences,
subscription to professional journals, etc.).
This has caused consequences for the self-
respect of doctors since they often rely on
pharmaceutical companies for these expenses
[14,38].
When researchers compare overall job
satisfaction among JHDs from different
countries, there are many methodological
limitations and obstacles. So far, and to our
knowledge, there has not been any
comparative study performed specifically on
job satisfaction among JHDs from different
countries. Only the results of the
international cross-sectional quantitative
ORCAB (Improving quality and safety in the
hospital: The link between organizational
culture, burnout, and quality of care) project
are worth to mention. It explored the
associations between burnout and fast food
consumption, exercise, alcohol consumption
and painkiller use in a multinational sample
of 2623 doctors, nurses and residents from
Greece, Portugal, Bulgaria, Romania, Turkey,
Croatia and the Former Yugoslav Republic of
Macedonia, adopting a cross-national
approach. The study concluded that burnout
and risk health behaviors among health
professionals are important both in the
context of health professionals’ health and
well-being and as factors contributing to
medical errors and inadequate patient safety.
Organizational interventions should
incorporate early identification of such
behaviors together with programs promoting
health and aimed at the reduction of burnout
and work-related stress [51]. The comparison
made between total JSS scores in Greece, as
presented in our study, and in the USA, as
published some years ago [36], seems
alarmingly in favor of our American
colleagues.
In conclusion, most of the above-
mentioned problems and difficulties seem to
be caused by continuous limited funding and
rudimentary organizational reforms
conducted by the Greek State. Useful
legislation is already in place, but it must be
righteously applied and all stakeholders
involved must ensure its smooth
implementation.
As far as Greek JHDs are concerned, a
number of organizational changes can be
suggested in order to reduce levels of stress
and facilitate their hospital duties. An
updated code of ethics, according to

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internationally respected standards of
medical ethics [14,52] can be planned in order
to respond to the real needs of health
professionals and patients. There is also a
need to determine the specific training
curriculum for JHDs in each medical
specialty. To date, there is no such unified
educational policy for each specialty in
Greece, although the present government is
planning a thorough reform, led by the
Central Health Council (KESY) that appears
promising, however it might prove
insufficient in the end, as JHDs and their
national representative bodies have been
completely excluded from any relevant
discussions and negotiations [14].
Additionally, the existence of systematic
training curricula would provide JHDs with
complete information about educational
targets and the practical skills and tasks
which they have to carry out in each specific
year of their training [53]. A nationwide plan
in this area could also include the possibility
for JHDs to participate in a rotation system in
different clinics or even hospitals, currently
almost impossible, which would enable them
to obtain more experience in a greater
spectrum of skills. Following this approach, a
balance between theoretical and practical
training could be achieved [14]. Finally, more
investment is needed by the Greek State and
the EU with an emphasis in better fund
management and fairer salaries, especially in
times of economic crisis, as good health is
paramount for a stable society and public
health is the result of the work of the
country’s hard-working junior doctors.
Furthermore, giving emphasis on increasing
the general mental health status and well-
being of junior doctors is paramount, since it
has a direct impact on the effective treatment
of patients.
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ΕΠΙΣΤΗΜΟΝΙΚΑ ΧΡΟΝΙΚΑ – www.exronika.com
ΤΟΜΟΣ 24ος – ΤΕΥΧΟΣ 1 - 2019
ΠΡΩΤΟΤΥΠΟ ΑΡΘΡΟ
Αξιολόγηση της εργασιακής ικανοποίησης των νέων ιατρών
στην Ελλάδα
Κ. Ροδίτης1,2, Ε. Σαμαρά2,3, Κ. Λούης2,4
1 Ειδικευόμενος Αγγειοχειρουργός, Αγγειοχειρουργικό Τμήμα, “Κοργιαλένειο-Μπενάκειο” Γενικό
Νοσοκομείο Ελληνικού Ερυθρού Σταυρού, Αθήνα, Ελλάδα, 2 Δίκτυο Νέων Ιατρών Ελλάδας,
Αθήνα, Ελλάδα, 3 Αναισθησιολόγος, Αναισθησιολογικό Τμήμα, Γενικό Νοσοκομείο Πειραιά
“Τζάνειο”, Πειραιάς, Ελλάδα, 4 Μαιευτήρας-Γυναικολόγος, 3ο Μαιευτικό-Γυναικολογικό
Τμήμα, “Αττικό” Πανεπιστημιακό Νοσοκομείο, Ιατρική Σχολή, Εθνικό Καποδιστριακό
Πανεπιστήμιο Αθηνών, Ελλάδα
ΠΕΡΙΛΗΨΗ
Εισαγωγή: Η υγεία και η ευεξία των ιατρών περιλαμβάνει εξίσου σημαντικούς βιολογικούς,
ψυχολογικούς και κοινωνικούς παράγοντες υγείας. Για την διατήρηση ιδανικής ευεξίας και
ικανοποίησης από την εργασία, οι ιατροί πρέπει να επιτυγχάνουν μια ισορροπία ανάμεσα στις
επαγγελματικές ιατρικές τους υποχρεώσεις και στην προσωπική τους ζωή. Έχουν δικαίωμα να
εργάζονται σε υγιείς χώρους εργασίας, απελευθερωμένους από κάθε μορφή βίας και
παρενόχλησης και με ασφαλείς συνθήκες εργασίας. Σκοπός της παρούσας εργασίας είναι η
αποτύπωση της εργασιακής ικανοποίησης των νέων ιατρών στην Ελλάδα.
Υλικό/Μέθοδος: Ένα ερωτηματολόγιο 36 ερωτήσεων, βασισμένο στην κλίμακα εργασιακής
ικανοποίησης Job Satisfaction Survey (JSS) που ανέπτυξε ο Paul E. Spector το 1985 στις ΗΠΑ
δημιουργήθηκε και τέθηκε προς συμπλήρωση στο Διαδίκτυο. Εννέα παράμετροι μελετήθηκαν:
Αμοιβές, Εξέλιξη, Επίβλεψη, Πρόσθετες Παροχές, Ενδεχόμενες Ανταμοιβές, Εργασιακή
Διαδικασία, Συνεργάτες, Φύση Εργασίας και Επικοινωνία.
Αποτελέσματα: Συμμετείχαν 113 νέοι ιατροί, 52 (46%) άνδρες και 61 (54%) γυναίκες, μέσης
ηλικίας 33,4 ετών. Το συνολικό JSS Score ήταν 100,4/216 (δυσαρεστημένοι) με τις γυναίκες
(97,1/216) να εκφράζουν περισσότερη δυσαρέσκεια από τους άνδρες (104,3/216). Ικανοποιημένοι
αισθάνονται μόνο με τη φύση της εργασίας τους (16,5/24) με τις γυναίκες περισσότερο
ικανοποιημένες (16,7/24) από τους άνδρες (16,3/24). Οι αμοιβές εμφανίζουν τη μικρότερη
ικανοποίηση, ανεξαρτήτως φύλου. Οι Έλληνες νέοι ιατροί θεωρούν εαυτούς εργαζόμενους σε
πολύ χειρότερο εργασιακό περιβάλλον σε σχέση με τους Αμερικανούς συναδέλφους τους
(συνολικό JSS Score στις ΗΠΑ=135,8/216 σε σχέση με 100,4/216 στην Ελλάδα).

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ΕΠΙΣΤΗΜΟΝΙΚΑ ΧΡΟΝΙΚΑ – www.exronika.com
ΤΟΜΟΣ 24ος – ΤΕΥΧΟΣ 1 - 2019
Συμπεράσματα: Τα σοβαρά προβλήματα που αντιμετωπίζουν οι νέοι Έλληνες ιατροί σήμερα στην
Ελλάδα περιγράφονται στην παρούσα έρευνα με ιδιαίτερα μελανά χρώματα. Πλήττονται από τη
γραφειοκρατία, που οδηγεί σε μικρότερη αποδοτικότητα, ενώ προβληματικές εμφανίζονται οι
σχέσεις τους με συναδέλφους και προϊσταμένους. Απαιτούνται περισσότερες επενδύσεις στον
τομέα της υγείας και δικαιότεροι μισθοί, ιδιαίτερα σε καιρούς οικονομικής κρίσης, καθώς η υγεία
είναι ζωτικής σημασίας για μια σταθερή κοινωνία και η δημόσια υγεία του πληθυσμού είναι υο
αποτέλεσμα των σκληρά εργαζομένων, νέων ιατρών της χώρας..
Λέξεις ευρετηρίου: εργασιακή ικανοποίηση, νέος ιατρός, ιατρική ειδικότητα,
εργασιακή εξουθένωση
Κ. Ροδίτης, Ε. Σαμαρά, Κ. Λούης. Αξιολόγηση της εργασιακής ικανοποίησης των νέων
ιατρών στην Ελλάδα. Επιστημονικά Χρονικά 2019; 24(1): 72-96
eoi: http://eoi.citefactor.org/10.11212/exronika/2019.1.7
Συγγραφέας επικοινωνίας: Konstantinos Roditis, E-mail: mailto:roditis.k@gmail.com