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1.  The impact of change in a doctor's job position: a five-year cohort study of job satisfaction among Norwegian doctors 
Background
Job satisfaction among physicians may be of importance to their individual careers and their work with patients. We lack prospective studies on whether a change in a doctor's job position influences their job satisfaction over a five-year period if we control for other workload factors.
Methods
A longitudinal national cohort of all physicians who graduated in Norway in 1993 and 1994 was surveyed by postal questionnaire in 2003 (T1) and 2008 (T2). Outcomes were measured with a 10-item job satisfaction scale. Predictor variables in a multiple regression model were: change in job position, reduction in work-home interface stress, reduction in work hours, age, and gender.
Results
A total of 59% of subjects (306/522) responded at both time points. The mean value of job satisfaction in the total sample increased from 51.6 (SD = 9.0) at T1 to 53.4 (SD = 8.2) at T2 (paired t test, t = 3.8, p < 0.001). The major groups or positions at T1 were senior house officers (45%), chief specialists in hospitals (23%), and general practitioners (17%), and the latter showed the highest levels of job satisfaction. Physicians who changed position during the period (n = 176) experienced an increase in job satisfaction from 49.5 (SD = 8.4) in 2003 to 52.9 (SD = 7.5) in 2008 (paired t test, t = 5.2, p < 0.001). Job satisfaction remained unchanged for physicians who stayed in the same position. There was also an increase in satisfaction among those who changed from positions other than senior house officer at T1 (p < 0.01). The significant adjusted predictor variables in the multiple regression model were the change in position from senior house officer at T1 to any other position (β = 2.83, p < 0.001), any change in job position (from any position except SHO at T1) (β = 4.18, p < 0.01) and reduction in work-home interface stress (β = 1.04, p < 0.001).
Conclusions
The physicians experienced an increase in job satisfaction over a five-year period, which was predicted by a change in job position and a reduction in work-home stress. This study has implications with respect to career advice for young doctors.
doi:10.1186/1472-6963-12-41
PMCID: PMC3342917  PMID: 22340521
2.  Resilience among doctors who work in challenging areas: a qualitative study 
The British Journal of General Practice  2011;61(588):e404-e410.
Background
Although physician burnout has received considerable attention, there is little research of doctors who thrive while working in challenging conditions.
Aim
To describe attitudes to work and job satisfaction among Australian primary care practitioners who have worked for more than 5 years in areas of social disadvantage.
Method
Semi-structured interviews were conducted with 15 primary health care practitioners working in Aboriginal health, prisons, drug and alcohol medicine, or youth and refugee health. The interviews explored attitudes towards work and professional satisfaction, and strategies to promote resilience.
Results
All doctors were motivated by the belief that helping a disadvantaged population is the ‘right thing’ to do. They were sustained by a deep appreciation and respect for the population they served, an intellectual engagement with the work itself, and the ability to control their own working hours (often by working part-time in the field of interest). In their clinical work, they recognised and celebrated small gains and were not overwhelmed by the larger context of social disadvantage.
Conclusion
If organisations want to increase the numbers of medical staff or increase the work commitment of staff in areas of social disadvantage, they should consider supporting doctors to work part-time, allowing experienced doctors to mentor them to model these patient-appreciative approaches, and reinforcing, for novice doctors, the personal and intellectual pleasures of working in these fields.
doi:10.3399/bjgp11X583182
PMCID: PMC3123503  PMID: 21722448
burnout, professional; practitioner satisfaction; primary care; resilience, psychological; social disadvantage; vulnerable populations; work satisfaction
3.  What do doctors really think about the relevance and impact of GP appraisal 3 years on? A survey of Scottish GPs 
Background
The aim of appraisal is to provide an opportunity for individuals to reflect on their work to facilitate learning and development. Appraisal for GPs has been a contractual requirement since 2004 in Scotland, and is seen as an integral part of revalidation.
Aim
To investigate the outcomes of GP appraisal in terms of whether it has prompted change in medical practice, education and learning, career development, attitudes to health and probity, how GPs organise their work, and their perception of the overall value of the process.
Design of study
A cross-sectional postal questionnaire.
Setting
GP performers in Scotland who had undertaken appraisal.
Method
The questionnaire was based on the seven principles outlined in Good Medical Practice, a literature review, and previous local research. The survey was conducted on a strictly anonymous basis with a random, representative sample of GPs.
Results
Fifty-three per cent (671/1278) responded. Forty-seven per cent (308/661) thought that appraisal had altered their educational activity, 33% (217/660) reported undertaking further education or training as a result of appraisal, and 13% (89/660) felt that appraisal had influenced their career development. Opinion was evenly split on the overall value of appraisal.
Conclusion
Appraisal can have a significant impact on all aspects of a GP's professional life, and those who value the process report continuing benefit in how they manage their education and professional development. However, many perceive limited or no benefit. The renewed emphasis on appraisal requires examination of these findings and discussion of how appraisal can become more relevant.
doi:10.3399/bjgp08X264036
PMCID: PMC2233956  PMID: 18307850
appraisal; continuing education; general practitioners; professional education; revalidation
4.  The role of regulation in influencing income-generating activities among public sector doctors in Peru 
Objective
To examine in Peru the nature of dual practice (doctors holding two jobs at once – usually public sector doctors with private practices), the factors that influence individuals' decisions to undertake dual practice, the conditions faced when doing so and the potential role of regulatory intervention in this area.
Methods
The study entailed qualitative interviews with a sample of twenty medical practitioners based in metropolitan Lima, representing a cross-section of those primarily employed in either the private or public sectors and engaged in clinical practice or policy making. The interviews focused on:
1. individuals' experience with dual practice;
2. the general underlying pressures that influence the nature and extent of such activities; and
3. attitudes toward, and the influence of, regulation on such activities.
Results
Dual practice is an activity that is widespread and well-accepted, and the prime personal motivation is financial. However, there are also a number of important broad macroeconomic influences on dual practice particularly the oversupply of medical services, the deregulated nature of this market, and the economic crisis throughout the country, which combine to create major hardships for those attempting to make a living through medical practice. There is some support among doctors for tighter regulation.
Conclusion
Research findings suggest appropriate policy responses to dual practice involve tighter controls on the supply of medical practitioners; alleviation of financial pressures brought by macro-economic conditions; and closer regulation of such activities to ensure some degree of collective action over quality and the maintenance of professional reputations. Further research into this issue in rural areas is needed to ascertain the geographical generalizability of these policy responses.
doi:10.1186/1478-4491-5-5
PMCID: PMC1819388  PMID: 17324290
5.  Rural Clinician Scarcity and Job Preferences of Doctors and Nurses in India: A Discrete Choice Experiment 
PLoS ONE  2013;8(12):e82984.
The scarcity of rural doctors has undermined the ability of health systems in low and middle-income countries like India to provide quality services to rural populations. This study examines job preferences of doctors and nurses to inform what works in terms of rural recruitment strategies. Job acceptance of different strategies was compared to identify policy options for increasing the availability of clinical providers in rural areas. In 2010 a Discrete Choice Experiment was conducted in India. The study sample included final year medical and nursing students, and in-service doctors and nurses serving at Primary Health Centers. Eight job attributes were identified and a D-efficient fractional factorial design was used to construct pairs of job choices. Respondent acceptance of job choices was analyzed using multi-level logistic regression. Location mattered; jobs in areas offering urban amenities had a high likelihood of being accepted. Higher salary had small effect on doctor, but large effect on nurse, acceptance of rural jobs. At five times current salary levels, 13% (31%) of medical students (doctors) were willing to accept rural jobs. At half this level, 61% (52%) of nursing students (nurses) accepted a rural job. The strategy of reserving seats for specialist training in exchange for rural service had a large effect on job acceptance among doctors, nurses and nursing students. For doctors and nurses, properly staffed and equipped health facilities, and housing had small effects on job acceptance. Rural upbringing was not associated with rural job acceptance. Incentivizing doctors for rural service is expensive. A broader strategy of substantial salary increases with improved living, working environment, and education incentives is necessary. For both doctors and nurses, the usual strategies of moderate salary increases, good facility infrastructure, and housing will not be effective. Non-physician clinicians like nurse-practitioners offer an affordable alternative for delivering rural health care.
doi:10.1371/journal.pone.0082984
PMCID: PMC3869745  PMID: 24376621
6.  Attitudes toward depression among Japanese non-psychiatric medical doctors: a cross-sectional study 
BMC Research Notes  2012;5:441.
Background
Under-recognition of depression is common in many countries. Education of medical staff, focusing on their attitudes towards depression, may be necessary to change their behavior and enhance recognition of depression. Several studies have previously reported on attitudes toward depression among general physicians. However, little is known about attitudes of non-psychiatric doctors in Japan. In the present study, we surveyed non-psychiatric doctors’ attitude toward depression.
Methods
The inclusion criteria of participants in the present study were as follows: 1) Japanese non-psychiatric doctors and 2) attendees in educational opportunities regarding depression care. We conveniently approached two populations: 1) a workshop to depression care for non-psychiatric doctors and 2) a general physician-psychiatrist (G-P) network group. We contacted 367 subjects. Attitudes toward depression were measured using the Depression Attitude Questionnaire (DAQ), a 20-item self-report questionnaire developed for general physicians. We report scores of each DAQ item and factors derived from exploratory factor analysis.
Results
We received responses from 230 subjects, and we used DAQ data from 187 non-psychiatric doctors who met the inclusion criteria. All non-psychiatric doctors (n = 187) disagreed with "I feel comfortable in dealing with depressed patients' needs," while 60 % (n = 112) agreed with "Working with depressed patients is heavy going." Factor analysis indicated these items comprised a factor termed "Depression should be treated by psychiatrists" - to which 54 % of doctors (n = 101) agreed. Meanwhile, 67 % of doctors (n = 126) thought that nurses could be useful in depressed patient support. The three factors derived from the Japanese DAQ differed from models previously derived from British GP samples. The attitude of Japanese non-psychiatric doctors concerning whether depression should be treated by psychiatrists was markedly different to that of British GPs.
Conclusions
Japanese non-psychiatric doctors believe that depression care is beyond the scope of their duties. It is suggested that educational programs or guidelines for depression care developed in other countries such as the UK are not directly adaptable for Japanese non-psychiatric doctors. Developing a focused educational program that motivates non-psychiatric doctors to play a role in depression care is necessary to enhance recognition and treatment of depression in Japan.
doi:10.1186/1756-0500-5-441
PMCID: PMC3434090  PMID: 22894761
7.  The effect of perceived person-job fit on employee attitudes towards change in trauma centers 
Health care management review  2013;38(2):115-124.
Background
Employee attitudes towards change are critical for health care organizations implementing new procedures and practices. When employees are more positive about the change they are likely to behave in ways that support the change, whereas when employees are negative about the change they will resist the changes.
Purpose
This study examines how perceived person-job (demands–abilities) fit influences attitudes towards change following an externally-mandated change. Specifically, we propose that perceived person-job fit moderates the negative relationship between individual job impact and attitudes towards change.
Methodology
We examined this issue in a sample of Level I trauma centers facing a regulatory mandate to develop an alcohol screening and brief intervention (SBI) program. A survey of 200 providers within 20 trauma centers assessed perceived person-job fit, individual job impact, and attitudes towards change approximately one year after the mandate was enacted.
Results
Providers who perceived a better fit between their abilities and the new job demands were more positive about the change. Further, the impact of the alcohol SBI program on attitudes towards change was mitigated by perceived fit, where the relationship between job impact and change attitudes was more negative for providers who perceived a worse fit as compared to those who perceived a better fit.
Practical Implications
Successful implementation of changes to work processes and procedures requires provider support of the change. Management can enhance this support by improving perceived person-job fit through ongoing training sessions that enhance providers’ abilities to implement the new procedures.
doi:10.1097/HMR.0b013e318249aa60
PMCID: PMC3370148  PMID: 22310485
Person-job fit; attitudes toward change; organizational change; trauma centers
8.  Organizational Climate Partially Mediates the Effect of Culture on Work Attitudes and Staff Turnover in Mental Health Services 
Staff turnover in mental health service organizations is an ongoing problem with implications for staff morale, productivity, organizational effectiveness, and implementation of innovation. Recent studies in public sector services have examined the impact of organizational culture and climate on work attitudes (i.e., job satisfaction and organizational commitment) and, ultimately, staff turnover. However, mediational models of the impact of culture and climate on work attitudes have not been examined. The present study examined full and partial mediation models of the effects of culture and climate on work attitudes and the subsequent impact of work attitudes on staff turnover. Multilevel structural equation models supported a partial mediation model in which organizational culture had both direct influence on work attitudes and indirect influence through organizational climate. Work attitudes significantly predicted one-year staff turnover rates. These findings support the contention that both culture and climate impact work attitudes and subsequent staff turnover.
doi:10.1007/s10488-006-0039-1
PMCID: PMC1564125  PMID: 16544205
organizational culture; climate; work attitudes; turnover; mental health
9.  Is being a doctor still fun? 
Western Journal of Medicine  1993;159(6):665-669.
Over the past two decades, a decline in physician job and career satisfaction has been reported. This study was developed to determine the current state of physician satisfaction and to define factors correlated with overall satisfaction. We mailed a survey to 406 physicians in Solano County, California. Responses were anonymous, and data were analyzed by several methods. Of the 406 physicians, 251 (62%) responded. Most respondents were satisfied with their jobs (80%). The vast majority felt good about their ability to help their patients (92%), enjoyed the relationships they had with patients (93%) and colleagues (86%), and found their work intellectually satisfying (89%). Nearly two thirds (63%) of respondents thought their job was "fun." This ability to derive great pleasure from work showed the strongest correlation with overall satisfaction. Overall satisfaction did not differ between primary care and non-primary care physicians or between physicians in a large health maintenance organization and those in mostly solo and small-group fee-for-service practices. Despite substantial challenges to physician morale and autonomy, most responding physicians in our study continued to enjoy overall job satisfaction, and a solid majority thought that their work was fun.
PMCID: PMC1022452  PMID: 8128674
10.  A preliminary study to measure and develop job satisfaction scale for medical teachers 
Industrial Psychiatry Journal  2011;20(2):91-96.
Background:
Job satisfaction of medical teachers has an impact on quality of medical education and patient care. In this background, the study was planned to develop scale and measure job satisfaction status of medical teachers.
Materials and Methods:
To generate items pertaining to the scale of job satisfaction, closed-ended and open-ended questionnaires were administered to medical professionals. The job satisfaction questionnaire was developed and rated on Likert type of rating scale. Both quantitative and qualitative methods were used to ascertain job satisfaction among 245 health science faculty of an autonomous educational institution. Factor loading was calculated and final items with strong factor loading were selected. Data were statistically evaluated.
Results:
Average job satisfaction score was 53.97 on a scale of 1–100. The Cronbach's alpha reliability coefficient was 0.918 for entire set of items. There was statistically significant difference in job satisfaction level across different age groups (P 0.0358) showing a U-shaped pattern and fresh entrants versus reemployed faculty (P 0.0188), former showing lower satisfaction. Opportunity for self-development was biggest satisfier, followed by work, opportunity for promotion, and job security. Factors contributing toward job dissatisfaction were poor utilization of skills, poor promotional prospects, inadequate pay and allowances, work conditions, and work atmosphere.
Conclusion:
Tertiary care teaching hospitals in autonomous educational institutions need to build infrastructure and create opportunities for their medical professional. Job satisfaction of young entrants needs to be raised further by improving their work environment. This will pave the way for effective delivery of health care.
doi:10.4103/0972-6748.102484
PMCID: PMC3530295  PMID: 23271862
Health science; job satisfaction; medical; teachers
11.  Career shift phenomenon among doctors in tacloban city, philippines: lessons for retention of health workers in developing countries 
Background
At the height of the global demand for nurses in the 1990s, a phenomenon of grave concern arose. A significant number of medical doctors in the Philippines shifted careers in order to seek work as nurses overseas. The obvious implications of such a trend require inquiry as to the reasons for it; hence, this cross-sectional study. The data in the study compared factors such as personal circumstances, job satisfaction/dissatisfaction, perceived benefits versus costs of the alternative job, and the role of social networks/linkages among doctors classified as career shifters and non-shifters.
Methodology
A combined qualitative and quantitative method was utilized in the study. Data gathered came from sixty medical doctors practicing in three major hospitals in Tacloban City, Philippines, and from a special nursing school also located in the same city. Respondents were chosen through a non-probability sampling, specifically through a chain referral sampling owing to the controversial nature of the research. A set of pre-set criteria was used to qualify doctors as shifters and non-shifters. Cross-tabulation was carried out to highlight the differences between the two groups. Finally, the Wilcoxon-Mann-Whitney test was utilized to assess if these differences were significant.
Results
Among the different factors investigated, results of the study indicated that the level of job satisfaction or dissatisfaction and certain socio-demographic factors such as age, length of medical practice, and having children to support, were significantly different among shifters and non-shifters at p ≤ 0.05. This suggested that such factors had a bearing on the intention to shift to a nursing career among physicians.
Conclusion
Taken in the context of the medical profession, it was the level of job satisfaction/dissatisfaction that was the immediate antecedent in the intention to shift careers among medical doctors. Personal factors, specifically age, support of children, and the length of medical practice gained explanatory power when they were linked to job satisfaction or dissatisfaction. On the other hand, factors such as perceived benefits and costs of the alternative job and the impact of social networks did not differ between shifters and non-shifters. It would then indicate that efforts to address the issue of physician retention need to go beyond economic incentives and deal with other sources of satisfaction or dissatisfaction among practicing physicians. Since this was an exploratory study in a particular locale in central Philippines, similar studies in other parts of the country need to be done to gain better understanding of this phenomenon at a national level.
doi:10.1186/1447-056X-10-13
PMCID: PMC3204289  PMID: 21977902
Career-shift; doctors; nurses; immigration/emigration/migration; retention; health workers; job satisfaction/dissatisfaction
12.  Job Security at Isfahan University of Medical Sciences: Implications on Employees and Types of Contracts 
Materia Socio-Medica  2013;25(1):64-67.
Introduction:
Medical universities are of those organizations that serve many individuals. As a result, the employees who work at medical universities should have adequate job qualifications and requisite conditions for work. Job security is one of these needed conditions. The current study aims to determine the main components of job security among the employees of Isfahan University of Medical Sciences (IUMS).
Method and materials:
The study had a cross-sectional design. The sample included 300 employees which were selected from the faculties of IUMS. The sample was recruited using quota sampling. First, demographic and Job security questionnaires were completed by each employee. Then, data was analyzed by descriptive methods and ANOVA in SPSS16.
Results:
The study results showed that there was no significant difference among five subscales of Job security questionnaire and as a result, job security among the employees of IUMS but there was a significant difference in job security among male and female employees and a significant difference in job security based on type of job contract.
Discussion:
Lower rate of job security among female employees with temporary job contracts has professional and psychological implication for both females and IUMS which should be considered in designing professional programs of IUMS.
doi:10.5455/msm.2013.25.64-67
PMCID: PMC3655786  PMID: 23687464
Job security; Employees; Isfahan University of Medical Sciences.
13.  Leadership, Job Satisfaction and Organizational Commitment in Healthcare Sector: Proposing and Testing a Model 
Materia Socio-Medica  2013;25(2):121-126.
Conflict of interest: none declared.
Introduction
Employees’ job satisfaction and commitment depends upon the leadership style of managers. This study clarifies further the relationships between leadership behaviors of managers and two employees’ work-related attitudes-job satisfaction and organizational at public hospitals in Iran. A better understanding of these issues and their relationships can pinpoint better strategies for recruiting, promotion, and training of future hospital managers and employees, particularly in Iran but perhaps in other societies as well.
Methods
This cross-sectional study was conducted using self-administered questionnaires distributed among 814 hospital employees and managers through a stratified random sampling.
Results and discussion
The dominant leadership style of hospital managers was participative style. Hospital employees were moderately satisfied with their jobs and committed to their organization. Salaries, benefits, promotion, contingent rewards, interpersonal relationships and working conditions were the best predictors of job satisfaction among hospitals employees. Leadership, job satisfaction and commitment were closely interrelated. The leadership behavior of managers explained 28% and 20% of the variations in job satisfaction and organizational commitment respectively.
Conclusion
This study clarifies the causal relations of job satisfaction and commitment, and highlights the crucial role of leadership in employees’ job satisfaction and commitment. Nevertheless, participative management is not always a good leadership style. Managers should select the best leadership style according to the organizational culture and employees’ organizational maturity.
doi:10.5455/msm.2013.25.121-126
PMCID: PMC3769150  PMID: 24082837
Leadership; Job satisfaction; Organizational commitment; Hospital
14.  Explaining global job satisfaction by facets of job satisfaction: the Japanese civil servants study 
Objectives
Management of job satisfaction is of growing importance in terms of the maintenance of employees’ health. This study aimed to evaluate which and to what extent facets of job satisfaction contributed to global job satisfaction.
Methods
The participants were 4286 employees aged 18–69 years working in local government in Japan. A questionnaire survey was conducted in 1998–1999. Seven facets of job satisfaction were evaluated. Multiple logistic regression analysis was performed to evaluate which facets of job satisfaction contributed to global job satisfaction.
Results
For all employees, all of the facets of job satisfaction significantly contributed to global job satisfaction. Among the facets of job satisfaction, ‘being satisfied with interests and skills involved in work’ and ‘how abilities were used’ contributed more strongly to global satisfaction than ‘being satisfied with how the section is running’, ‘co-workers’, ‘work prospects’, ‘physical working conditions’ and ‘payment’. The differing associations of facets of job satisfaction with global job satisfaction did not change substantially in stratified analysis by occupation, with one exception that only three facets of job satisfaction contributed to global job satisfaction in administrative workers.
Conclusion
Job satisfaction related to the intrinsic aspects of the job (i.e., ‘interests and skills involved in work’ and ‘how abilities were used’) contributed more to global job satisfaction than the other aspects of job satisfaction. Longitudinal research in employees with various occupations may be needed to confirm the results of this study.
doi:10.1007/s12199-010-0173-y
PMCID: PMC3047668  PMID: 21432229
Job satisfaction; Occupation; Working environments; The JACS study; Japan
15.  Online Access to Doctors' Notes: Patient Concerns About Privacy 
Background
Offering patients online access to medical records, including doctors’ visit notes, holds considerable potential to improve care. However, patients may worry about loss of privacy when accessing personal health information through Internet-based patient portals. The OpenNotes study provided patients at three US health care institutions with online access to their primary care doctors’ notes and then collected survey data about their experiences, including their concerns about privacy before and after participation in the intervention.
Objective
To identify patients’ attitudes toward privacy when given electronic access to their medical records, including visit notes.
Methods
The design used a nested cohort study of patients surveyed at baseline and after a 1-year period during which they were invited to read their visit notes through secure patient portals. Participants consisted of 3874 primary care patients from Beth Israel Deaconess Medical Center (Boston, MA), Geisinger Health System (Danville, PA), and Harborview Medical Center (Seattle, WA) who completed surveys before and after the OpenNotes intervention. The measures were patient-reported levels of concern regarding privacy associated with online access to visit notes.
Results
32.91% of patients (1275/3874 respondents) reported concerns about privacy at baseline versus 36.63% (1419/3874 respondents) post-intervention. Baseline concerns were associated with non-white race/ethnicity and lower confidence in communicating with doctors, but were not associated with choosing to read notes or desire for continued online access post-intervention (nearly all patients with notes available chose to read them and wanted continued access). While the level of concern among most participants did not change during the intervention, 15.54% (602/3874 respondents, excluding participants who responded “don’t know”) reported more concern post-intervention, and 12.73% (493/3874 respondents, excluding participants who responded “don’t know”) reported less concern.
Conclusions
When considering online access to visit notes, approximately one-third of patients had concerns about privacy at baseline and post-intervention. These perceptions did not deter participants from accessing their notes, suggesting that the benefits of online access to medical records may outweigh patients’ perceived risks to privacy.
doi:10.2196/jmir.2670
PMCID: PMC3785972  PMID: 24072335
electronic medical records; patient access to records; patient portals; privacy; consumer health informatics; personal health records
16.  ATTITUDE, PRACTICE AND NEEDS FOR CONTINUING MEDICAL EDUCATION AMONG PRIMARY HEALTH CARE DOCTORS IN ASIR REGION 
Objectives:
Assess the attitude and practice of Primary Health Care (PHC) physicians in Aseer region, their educational needs and recommendations to establish a continuing medical education program (CMEP) to address these needs.
Methods:
This study was carried out during the first half of 1999 in Aseer region, Saudi Arabia. A self-administered questionnaire was distributed to all PHC physicians in Aseer region. The questionnaire explored socio-demographic characteristics, scientific background, the attitude towards CME, the current method for medical updating, the barriers to CME, and the topics requested for a future CMEP.
Results:
There were a total of 383 PHC physicians in Aseer region, 86% of whom responded to this questionnaire. Of these 76.1% were Arabs, 91.2% were married, 26.3% had post-graduate qualifications and 68.6% had had no experience in the PHC field prior to arriving in Saudi Arabia. Most respondents showed a positive attitude toward CME. Nearly two-thirds (64.4%) had adequate time for CME, 86.7% allocated time for CME, and 64.4% were ready to participate as tutors in CMEP. Suggestions were given by 49.6% for establishing a CMEP in the region. The most popular methods practiced for CME were reading medical journals (79.8%) and medical textbooks (53.8%), and attending training courses (39.6%). The medical subjects that were identified as needed were emergency medicine (24.5%), pediatrics (20.8%), internal medicine (20%), and obstetrics/ gynecology (18.7%). However, 75.2% also indicated that computer literacy was a practice requirement, 57.7 and 54.1% thought designing diabetes and hypertension management programs were vital, and 41.7% said learning how to design a PHCC action plan was essential.
Conclusion:
PHC physicians in Aseer region had a positive attitude towards selective CMEP. They needed CMEP but felt its content should be in line with their practice needs.
PMCID: PMC3439742  PMID: 23008649
Attitude assessment; practice needs; CME; primary care physicians; Aseer region
17.  Job satisfaction survey among health centers staff 
Background:
Due to the importance of health care organizations with significant responsibility for prevention and care, assessment of job satisfaction among health care staff is essential. Quality of health services will be decreased provided they are not satisfied.
Materials and Methods:
This study was a cross-sectional analysis of health care staff in Khomeinishahr (centers, buildings, and networks) If they had at least 6 months work experience, they could enter the study. Data included a two-part questionnaire with a standardized questionnaire, demographic variables, and Smith job descriptive index, which is a questionnaire with six domains. Reliability was obtained for each domain and its validity was reported 0.93.
Findings:
The results showed an overall satisfaction score averages 43.55 ± 12.8 (from 100). Job satisfaction score was not significantly different between the sexes. However, within the current attitude toward job satisfaction, men scores was better than women (P = 0.001). Highest score in job satisfaction was related to relationships with colleagues and lowest score was related to the income, benefits, and job promotion. The more the years of work, the less the job satisfaction was. The attitude toward the current job had a direct relationship with income (P = 0.01). There was a significant inverse relationship between educational level and job satisfaction in domains promotion, income, and benefits (P = 0.01). The staff with higher education levels was less satisfied with income and job promotion qualification.
Conclusion:
Managers should focus on job qualification to increase job satisfaction and improve the quality of work.
doi:10.4103/2277-9531.131911
PMCID: PMC4089140
Health care providers; health services administration; job satisfaction
18.  Exposure to Psychological Aggression at Work and Job Performance: The Mediating Role of Job Attitudes and Personal Health 
Work and stress  2011;25(1):23-40.
Despite the growing literature on workplace aggression and the importance of employee performance at work, few studies have examined the relation between workplace aggression and job performance. The purpose of this study was to investigate the relations between psychological aggression at work and two forms of job performance (task performance and contextual performance) and potential mediators of these relations. Based on Conservation of Resources theory and prior research, a model was developed and tested in which overall job attitudes (i.e., job satisfaction and organizational commitment) and overall personal health (i.e., physical and psychological health) fully mediate the relations between exposure to psychological aggression at work and both task performance and contextual performance. Data were obtained from a national probability sample of US workers (N = 2376) and the model was tested using structural equation modelling. The results supported the hypothesized model, demonstrating that exposure to psychological aggression at work negatively predicted both task performance and contextual performance, and that these relations were explained by decrements in job attitudes and health associated with exposure to psychological aggression at work.
doi:10.1080/02678373.2011.563133
PMCID: PMC3105890  PMID: 21643471
Psychological aggression; Workplace; Bullying; Work-related stress; Job attitudes; Employee health; Job performance; Contextual performance
19.  Satisfaction of physician assistants and other nonphysician providers in a managed care setting. 
Public Health Reports  1995;110(6):714-719.
Health maintenance organizations have employed physician assistants, nurse practitioners, and other nonphysician providers for decades, yet there is little information on how satisfied these providers are with this form of practice. This paper examines how physician assistants evaluate their experience practicing in a large group model health maintenance organization and compares their attitudes and satisfaction levels with those of other nonphysician providers-nurse practitioners, optometrists, mental health therapists, and chemical dependency counselors. The data source is a 1992 survey of 5,000 nonphysician employees of a health maintenance organization. The survey instrument was a self-administrated questionnaire that included both structured and open-ended questions. The response rate averaged 88 percent for physician assistants and the other non-physician providers. Physician assistants expressed the most satisfaction with the amount of responsibility, support from coworkers, job security, working hours, supervision, and task variety. They were less satisfied with workload, control over the pace of work, and opportunities for advancement. Most physician assistants were also satisfied with pay and fringe benefits. Compared with other nonphysician providers, chemical dependency counselors expressed the highest levels of satisfaction across the various dimensions of work and optometrists the lowest. Nurse practitioners, chemical dependency counselors, and mental health professionals also tended to be satisfied with most aspects of practice in this setting. In a number of instances, they were more satisfied than the physician assistants. The findings are consistent with other studies that found health maintenance organizations to be favorable practice settings for physician assistants. The limits of physician assistant involvement and their role satisfaction and efficient use in HMOs are more likely to relate to physician attitudes and acceptance than to lack of support by coworkers and other attributes of the work environment.
PMCID: PMC1381814  PMID: 8570825
20.  Relationship between Organizational Culture, Leadership Behavior and Job Satisfaction 
Background
Organizational culture refers to the beliefs and values that have existed in an organization for a long time, and to the beliefs of the staff and the foreseen value of their work that will influence their attitudes and behavior. Administrators usually adjust their leadership behavior to accomplish the mission of the organization, and this could influence the employees' job satisfaction. It is therefore essential to understand the relationship between organizational culture, leadership behavior and job satisfaction of employees.
Methods
A cross-sectional study was undertaken that focused on hospital nurses in Taiwan. Data was collected using a structured questionnaire; 300 questionnaires were distributed and 200 valid questionnaires were returned. To test the reliability of the data, they were analyzed by Cronbach's α and confirmatory factors. Correlation analysis was used on the relationships between organizational cultures, leadership behavior and job satisfaction.
Results
Organizational cultures were significantly (positively) correlated with leadership behavior and job satisfaction, and leadership behavior was significantly (positively) correlated with job satisfaction.
Conclusions
The culture within an organization is very important, playing a large role in whether it is a happy and healthy environment in which to work. In communicating and promoting the organizational ethos to employees, their acknowledgement and acceptance of it can influence their work behavior and attitudes. When the interaction between the leadership and employees is good, the latter will make a greater contribution to team communication and collaboration, and will also be encouraged to accomplish the mission and objectives assigned by the organization, thereby enhancing job satisfaction.
doi:10.1186/1472-6963-11-98
PMCID: PMC3123547  PMID: 21569537
21.  Doctor Patient Communication—A Vital Yet Neglected Entity in Indian Medical Education System 
The Indian Journal of Surgery  2011;73(3):184-186.
Doctor patient communication is the most important and an integral part of any treatment regimen. Properly carried out it has been shown to have a therapeutic effect equivalent to drugs. Despite being so important part of treatment it is more than often taken and carried out casually. Apart from apathy towards this practice, its omission in the medical study curriculum is an important factor. This study was carried in amongst the surgical residents of surgical departments of various medical colleges to assess the attitude of surgical residents towards patient doctor communication. A questionnaire was forwarded by mail and email and the response was assessed: The responses of the surgical residents from various residents from different medical colleges were similar. Most of the residents prefer inclusion of communication skill in medical education curriculum
doi:10.1007/s12262-010-0208-z
PMCID: PMC3087063  PMID: 22654327
Doctor patient communication
22.  Factors Influencing the Job Satisfaction of Health System Employees in Tabriz, Iran 
Health Promotion Perspectives  2012;2(2):190-196.
Background: Employees can be counseled on how they feel about their job. If any particular dimension of their job is causing them dissatisfaction, they can be assisted to appropriately change it. In this study, we investigated the factors affecting job satisfaction from the perspective of employees working in the health system and thereby a quantitative measure of job satisfaction.
Methods: Using eight focus group discussions (n=70), factors affecting job satisfaction of the employees were discussed. The factors identified from literature review were categorized in four groups: structural and managerial, social, work in it-self, environmental and welfare factors.
Results: The findings confirmed the significance of structural and managerial, social, work in it-self, environmental and welfare factors in the level of job satisfaction. In addition, a new factor related to individual characteristics such as employee personal characteristics and development was identified.
Conclusion: In order to improve the quality and productivity of work, besides, structural and managerial, social, work in it-self, environmental and welfare factors, policy makers should be taken into account individual characteristics of the employee as a factor affecting job satisfaction.
doi:10.5681/hpp.2012.022
PMCID: PMC3963645  PMID: 24688933
Job satisfaction; Health system employee; Qualitative study
23.  Cost-consciousness among Swiss doctors: a cross-sectional survey 
Background
Knowing what influences physicians attitudes toward health care costs is an important matter, because most health care expenditures are the results of doctors' decisions. Many decisions regarding medical tests and treatments are influenced by factors other than the expected benefit to the patient, including the doctor's demographic characteristics and concerns about cost and income.
Methods
Doctors (n = 1184) in Geneva, Switzerland, answered questions about their cost-consciousness, practice patterns (medical specialty, public.vs. private sector, number of patients per week, time spent with a new patient), work satisfaction, and stress from uncertainty. General linear models were used to identify independent risk factors of higher cost-consciousness.
Results
Most doctors agreed that trying to contain costs was their responsibility ("agree" or "totally agree": 90%) and that they should take a more prominent role in limiting the use of unnecessary tests (92%); most disagreed that doctors are too busy to worry about costs (69%) and that the cost of health care is only important if the patient has to pay for it out-of-pocket (88%). In multivariate analyses, cost-consciousness was higher among doctors in the public sector, those who saw fewer patients per week, who were most tolerant of uncertainty, and who were most satisfied with their work.
Conclusion
Thus even in a setting with very high health care expenditures, doctors' stated cost-consciousness appeared to be generally high, even though it was not uniformly distributed among them.
doi:10.1186/1472-6963-5-72
PMCID: PMC1308814  PMID: 16281977
24.  Perceptions of doctors to adverse drug reaction reporting in a teaching hospital in Lagos, Nigeria 
Background
Spontaneous adverse drug reaction (ADR) reporting is the cornerstone of pharmacovigilance. ADR reporting with Yellow Cards has tremendously improved pharmacovigilance of drugs in many developed countries and its use is advocated by the World Health Organization (WHO). This study was aimed at investigating the knowledge and attitude of doctors in a teaching hospital in Lagos, Nigeria on spontaneous ADR reporting and to suggest possible ways of improving this method of reporting.
Methods
A total of 120 doctors working at the Lagos State University Teaching Hospital (LASUTH), in Nigeria were evaluated with a questionnaire for their knowledge and attitudes to ADR reporting. The questionnaire sought the demographics of the doctors, their knowledge and attitudes to ADR reporting, the factors that they perceived may influence ADR reporting, and their levels of education and training on ADR reporting. Provision was also made for suggestions on the possible ways to improve ADR reporting.
Results
The response rate was 82.5%. A majority of the respondents (89, 89.9%) considered doctors as the most qualified health professionals to report ADRs. Forty (40.4%) of the respondents knew about the existence of National Pharmacovigilance Centre (NPC) in Nigeria. Thirty-two (32.3%) respondents were aware of the Yellow Card reporting scheme but only two had ever reported ADRs to the NPC. About half (48.5%) of the respondents felt that all serious ADRs could be identified after drug marketing. There was a significant difference between the proportion of respondents who felt that ADR reporting should be either compulsory or voluntary (χ2 = 38.9, P < 0.001). ADR reporting was encouraged if the reaction was serious (77, 77.8%) and unusual (70, 70.7%). Education and training was the most recognised means of improving ADR reporting.
Conclusion
The knowledge of ADRs and how to report them are inadequate among doctors working in a teaching hospital in Lagos, Nigeria. More awareness should be created on the Yellow Card reporting scheme. Continuous medical education, training and integration of ADR reporting into the clinical activities of the doctors would likely improve reporting.
doi:10.1186/1472-6904-9-14
PMCID: PMC2731723  PMID: 19671176
25.  Rural health workers and their work environment: the role of inter-personal factors on job satisfaction of nurses in rural Papua New Guinea 
Background
Job satisfaction is an important focal attitude towards work. Understanding factors that relate to job satisfaction allows interventions to be developed to enhance work performance. Most research on job satisfaction among nurses has been conducted in acute care settings in industrialized countries. Factors that relate to rural nurses are different. This study examined inter-personal, intra-personal and extra-personal factors that influence job satisfaction among rural primary care nurses in a Low and Middle Income country (LMIC), Papua New Guinea.
Methods
Data was collected using self administered questionnaire from rural nurses attending a training program from 15 of the 20 provinces. Results of a total of 344 nurses were available for analysis. A measure of overall job satisfaction and measures for facets of job satisfaction was developed in the study based on literature and a qualitative study. Multi-variate analysis was used to test prediction models.
Results
There was significant difference in the level of job satisfaction by age and years in the profession. Higher levels of overall job satisfaction and intrinsic satisfaction were seen in nurses employed by Church facilities compared to government facilities (P <0.01). Ownership of facility, work climate, supervisory support and community support predicted 35% (R2 =0.35) of the variation in job satisfaction. The factors contributing most were work climate (17%) and supervisory support (10%). None of these factors were predictive of an intention to leave.
Conclusions
This study provides empirical evidence that inter-personal relationships: work climate and supportive supervision are the most important influences of job satisfaction for rural nurses in a LMIC. These findings highlight that the provision of a conducive environment requires attention to human relations aspects. For PNG this is very important as this critical cadre provide the frontline of primary health care for more than 70% of the population of the country. Many LMIC are focusing on rural health, with most of the attention given to aspects of workforce numbers and distribution. Much less attention is given to improving the aspects of the working environment that enhances intrinsic satisfaction and work climate for rural health workers who are currently in place if they are to be satisfied in their job and productive.
doi:10.1186/1472-6963-12-156
PMCID: PMC3471005  PMID: 22691270

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