Surgery resident working conditions and job satisfaction
Department of Surgery, University of Kentucky, Lexington, KY 40536-0298, USA. Surgery
(Impact Factor: 3.38).
08/2008; 144(2):332-338.e5. DOI: 10.1016/j.surg.2008.03.038
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.
Available from: europepmc.org
- "Our results also showed that the number of teaching physicians and that of inpatients had a positive effect on hospital choices. Previous studies also indicated that the quality of training environments, such as teaching skills of attending physicians and opportunities to learn clinical skills, was a significant factor that affected resident’s choice of specialty and training location, and job satisfaction [25,27,44,45]. Although the number of teaching physicians does not necessarily guarantee the quality of teaching, busy attending physicians were reported to decrease residents’ satisfaction with the quality of attending teaching in the US national survey of surgical residents . "
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Previous studies have investigated factors that are influential on the choice of training hospitals among residency physicians, but the effect of salary was not conclusive. In this study, we aimed to examine whether a higher salary attracted more residents to non-university hospitals participating in the Japanese Residency Matching Programme.
Data on 475 hospitals/programmes between 2006 and 2009 were available for analysis. We first conducted an ordinary least squares regression analysis on the ratio of the number of applicants to the residency programme quota as an index of resident’s choice, for comparison with previous studies. We further performed panel data analysis to better control for unobserved heterogeneity across hospitals, which could be confounded by the amount of salary. We also performed stratified analysis by the population size of the hospital location.
In ordinary least squares regression, salary showed a positive, but not significant association, with the ratio of the number of applicants to the programme quota, while the results of a fixed effect model exhibited a positive and significant effect of salary (ε= 0.4995, P = 0.015) on the ratio. Analysis stratified by city size showed that the elasticity of salary was comparable (ε= 1.9089, P = 0.016 in large cities versus ε= 1.9185, P = 0.008 in small cities), while that of the number of teaching physicians was larger in large cities (ε= 1.9857, P = 0.009) compared with that in small cities (ε= 1.6253, P = 0.033). The number of teaching physicians had a significant and negative effect modification on salary, implying an antagonistic effect between these two attributes (ε= −1.5223, P = 0.038).
Our results indicate that the amount of salary influences the choice of training hospitals among medical graduates who choose non-university settings. Use of a monetary reward in a residency programme could be a feasible tactic for hospitals to attract residents.
Available from: ehp.sagepub.com
- "In developing a composite score for job satisfaction in Australian doctors, important information about the similarities and differences of job satisfaction in Australian medical clinicians can be determined. Job satisfaction outcomes from the MABEL survey accord with results reported in much of the recent international research literature, indicating that medical practitioners experience high levels of job satisfaction overall (Aasland et al., 2010; Davenport et al., 2008; Kumar, Fischer, Robinson, Hatcher, & Bhagat, 2007; Lindfors et al., 2007; Linzer et al., 2009; McNearney et al., 2008; Rosta et al., 2010), despite earlier concerns about plummeting satisfaction in medicine (Edwards, Kornacki, & Silversin , 2002; McGlone & Chenoweth, 2001; Weinstein & Wolfe, 2007). "
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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.
Available from: ualberta.ca
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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.
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