1 1 SUBMITTED 22 MAR 22 1 REVISION REQ. 9 JUN 22; REVISION RECD. 3 JUL 22 2 ACCEPTED 3 AUG 22 3 ONLINE-FIRST: AUGUST 2022 4 DOI: https://doi.org/ 10.18295/squmj.8.2022.050 5 6 Determinants of Physicians’ Job Satisfaction 7 A national multi-centre study from the Sultanate of Oman 8 Ikram A. Burney,1 *Sulaiman D. Al Sabei,2 Omar Al-Rawajfah,2,3 Leodoro J. 9 Labrague,2 Raeda AbuAlrub4 10 11 1The Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Oman; 12 2College of Nursing, Sultan Qaboos University, Muscat, Oman; 3College of Nursing, Al Albayt 13 University, Mafraq, Jordan; 4Faculty of Nursing, Jordan University of Science and Technology, 14 Irbid, Jordan 15 *Corresponding Author’s e-mail: alsabei@squ.edu.om 16 17 Abstract 18 Objectives: Physician satisfaction with their job can lead to a better quality of care, fewer 19 chances of making errors, and better patient outcomes. The purpose of the study was to examine 20 physician satisfaction; and to assess job satisfaction across several factors, such as quality of 21 care, ease of practice, relationship with leadership, and inter-professional collaboration. Method: 22 A descriptive cross-sectional design was used. Data were collected between July 2019 and 23 January 2020. Participants provided demographic information and completed surveys related to 24 physician satisfaction (13-item Likert type items on a scale from 1 to 5), and inter-professional 25 collaboration (15-item, 4-point Likert scale, ranging from 1 for “strongly disagree” to 4 for 26 “strongly agree”). Multiple linear regressions were used to determine the relationship between 27 overall job satisfaction and demographic features and inter-professional collaboration. Results: 28 Out of 396 physicians who were contacted, 354 responded (response rate = 89.4%). The median 29 age was 40 years, and there were 208 male and 124 female physicians. The vast majority 30 mailto:alsabei@squ.edu.om 2 2 (238/354 = 62%) were expatriates. Seventy percent had a post-graduate degree. The vast 31 majority (308 = 87%) worked in government hospitals. Results showed that 15 (5%) of the 32 physicians were not satisfied with their job (<3.00), 179 (40%) expressed a moderate level of 33 satisfaction (3.00 – 3.75), and 129 (55%) were highly satisfied (>3.76). There was no difference 34 in mean job satisfaction score among different groups of study participants, except for gender, 35 and the working grade (p < 0.05). The overall job satisfaction rates were higher for the quality of 36 care (M = 3.93, SD = 0.61), and for ease of practice (M = 3.89, SD = 0.55) and lower for the 37 relationship with leadership (M = 3.67, SD = 0.86). Having a clinical postgraduate degree 38 together with a PhD, a senior level of responsibility and good inter-professional relationship 39 were associated with higher job satisfaction rates (p = 0.003 and 0.007, respectively). 40 Conclusion: Overall, the job satisfaction rate was high. There was no difference among different 41 groups of study participants, except for the working grade. Having a clinical postgraduate 42 degree, a senior level of responsibility, and good inter-professional relationship were associated 43 with higher job satisfaction rates. The overall job satisfaction rates were higher for the quality of 44 care, and for ease of practice, and lower for relationship with the leadership. Relationship with 45 the leadership is a modifiable factor and efforts at enhancing the physician-leadership 46 relationship may lead to even higher satisfaction rates. 47 Keywords: Interprofessional relations; Job Satisfaction; Leadership; Oman; Physician; Quality of 48 health care 49 50 Advances in Knowledge 51  This is the first multi-center study to report job satisfaction of physicians from the 52 Sultanate of Oman. 53  Working in an environment that facilitates interprofessional collaboration has a positive 54 impact on physicians’ job satisfaction. 55 56 Application to Patient Care 57  The current study findings inform policy-makers of modifiable work-related factors that 58 can enhance physicians' satisfaction. 59  Health care providers' job satisfaction is positively correlated with the quality of care they 60 provide. 61 3 3 62 Introduction 63 Job satisfaction is defined as ‘a pleasurable or positive emotional state, resulting from the 64 appraisal of one’s job or job experiences’.1 Interaction between work experience and 65 organizational environment determine satisfaction with the job. Physician satisfaction with their 66 job can lead to better patient outcomes and satisfied patients which can lead to better outcomes 67 and fewer litigations.2 Furthermore, satisfied physicians are known to provide a better quality of 68 care, are more conscientious with their attitude towards prescribing treatment, and have less 69 chances of making errors.3,4 On the other hand, a lack of job satisfaction is related to higher 70 attrition rates, work-related stress, burnout, and work-family conflict.3,5-7 71 72 Several personal, workplace-specific and other modifiable factors contribute to physician 73 satisfaction, and these can be measured using different scales. For example, Domagala et al. used 74 a 17-item questionnaire to measure the level of physicians' satisfaction working in Polish 75 hospitals in four domains; personal, professional, performance, and inherent factors.8 Warr-76 Cook-Wall scale is a 10-item scale consisting of one item for overall job satisfaction and 9 other 77 items for different aspects of satisfaction, such as variety in job, opportunity to use abilities, 78 freedom of working method.9 Factors which have been well studied include professional 79 autonomy, doctor-patient relationship, academic involvement, and work-life balance.5,10,11 Other 80 factors include quality of care, ease of practice, relationship with leadership and management, 81 and inter-professional relationship.8 A systematic review from 12 European countries consisting 82 of 24 studies on more than 20,000 physicians identified several scales and classified the factors 83 into three groups: personal, intrinsic, and contextual.12 The majority of contextual or 84 professional-related factors are modifiable, such as, the quality of care, the ease of practice, the 85 opportunity for professional development, inter-professional collaboration, and relationship with 86 the leadership. Healthcare organizations can study these factors to modify the work environment, 87 in turn facilitating and improving physician satisfaction. 88 89 Oman is one of the rapidly developing Arab countries, located in southeast of the Arabian 90 peninsula, with a population of around 5 million, of which 60% are Omani nationals, and their 91 treatment expenses are fully covered by the government.13 As a result of effective planning, the 92 4 4 health care system in Oman has seen significant advances in the last 4 decades,.14 Oman spends 93 3.8% of its Gross Domestic Product (GDP) on health and is placed at number 60 on the human 94 development index (HDI), with an average life expectancy of 77.9 years at birth.15 The World 95 Health Organization (WHO) ranked Oman’s healthcare system as number 8 among all the 96 member states based on population health indicators, such as, the overall level of population 97 health, health inequalities within the population, responsiveness of the health system, and the 98 distribution of responsiveness and health system’s financial resources within the population.16 99 Harvard University and other joint commissioned organizations appreciated Oman’s healthcare 100 achievements and consider it as a model for other countries.17 There are more than 6,500 101 physicians, including 2400 specialists and consultants in Oman, with a density of 2.0 physicians 102 per 1,000 population. However, there are only a few reports assessing physician satisfaction with 103 their job in Oman.18,19 Almost all these studies assessed various determinants of physician 104 satisfaction in the capital area, Muscat, and the last study was published more than 10 years 105 back. Over the last few years, healthcare system in Oman has expanded, and it is important to 106 study the factors and determinants of physician satisfaction, especially the modifiable factors. 107 108 The aims of the current study were twofold: To examine physician job satisfaction rate; and to 109 assess job satisfaction across several factors including demographic features, quality of care, ease 110 of practice, relationship with leadership, and inter-professional collaboration. 111 112 Methods 113 Study design 114 A descriptive study using a cross-sectional design, and a convenience-sampling method was 115 carried out. 116 117 Participants 118 Registered Omani and non-Omani physicians were eligible to participate in the study. The 119 sample represented all geographical areas of Oman including 11 governorates. The sample was 120 proportional to the healthcare facility (Ministry of Health (MoH), non-MoH and private 121 hospitals). The study approval was obtained from the Medical Research Ethics Committee of the 122 MoH, the relevant participating hospitals not related to MoH, and the selected private hospitals. 123 5 5 Data were collected between July 2019 and January 2020. Informed consent was obtained from 124 study participants. The participants were assured of anonymity and confidentiality. 125 The purpose and significance of the study was discussed with hospital administrators. 126 Consenting participants were contacted by one of the research officers and invited to participate 127 voluntarily. The data was collected via a self-filling questionnaire. A survey packet containing a 128 letter explaining the purpose of study and its significance, and the instruments were handed to 129 the physicians, together with a return envelope. Participants were asked to drop the completed 130 surveys in a locked box in their unit. 131 132 Instruments 133 Date were collected using three paper-based self-reported surveys to collect information related 134 to participant’s demographics, satisfaction, and their perception of interprofessional 135 collaboration. 136 137 Demographic information. Information was collected using a demographic sheet developed by 138 the authors. The validity of the instrument was assessed by three investigators from both 139 academia and the clinical setting. Information about participants’ age, gender, educational level, 140 nationality, years of work experience, marital status, place of work, and position was obtained. 141 142 Job satisfaction. The Physician Satisfaction Survey, developed by Wolosin et al. 21 was used to 143 assess physician’s satisfaction. The survey consists of 13 Likert-type items, on a scale from 1 to 144 5. The scale is divided into three subscales, with adequate degree of reliability: quality of patient 145 care; ease of practice; and relationship with leadership. The construct validity of the survey is 146 well established and the tool demonstrated acceptable level of reliability. (Cronbach α = 0.76 to 147 0.92 for the three scales).21 148 149 Inter-professional Collaboration is defined as the ability of every health care provider to effectively 150 complement each other roles, share the responsibility and work collaboratively to make decisions about 151 patients’ care. The Assessment for Collaborative Environment tool, developed by Tilden et al.,22 152 was used to measure physician’s perceptions of the quality of inter-professional collaboration. 153 The tool consists of 15 items rated on a four-point Likert scale, ranging from 1 for “strongly 154 6 6 disagree” to 4 for “strongly agree”. The validity and reliability has been well-established.22,23 155 The range of possible total scores is 15 (lowest possible score) to 60 (highest possible score). 156 The higher the score; the higher is the perception of interprofessional collaboration. The 157 reliability has been well-established (Cronbach’s alpha of 0.80). The tool demonstrated 158 acceptable convergent validity (r = 0.81).22 159 160 Sample size 161 Using the standardized formula for calculating sample size from the defined population, the 162 estimated sample size was calculated to be 396 physicians with a 95% CI and a p-value of 0.05.20 163 164 Statistical methods 165 The Statistical Package for Social Sciences software (SPSS) version 22 was used for analysis. 166 Participant’s background variables were analyzed using descriptive statistics. Overall job 167 satisfaction was assessed by looking at the mean scores across all domains. Reliability was 168 assessed using Cronbach α. Job satisfaction was plotted as, ‘low’ (score ≤ 3, ‘moderate’ (score 169 3.01 – 3.76), or ‘high’ (score ≥ 3.76) level of satisfaction using bar charts. The relationship between 170 job satisfaction and interprofessional collaboration was assessed using multiple linear regression. 171 The regression model was adjusted for participants’ demographic data including age, gender, 172 educational level, nationality, years of work experience, marital status, and place of work. The 173 four assumptions of linear regression including normality, linearity, homoscedasticity, and 174 independence, were assessed and found to be satisfactory. 175 176 Results 177 Over the study period, a total of 396 physicians were contacted, and 354 responded (response rate 178 89.4%). Characteristics of study participants are shown in table 1. The median age of study 179 participants was 40 years; the vast majority of participants were between the ages 30 and 40 years. 180 There were more males than female physicians. The majority of physicians were non-Omani, 181 married, had 1-3 children, had a postgraduate clinical degree, and worked as full-time physicians. 182 A significant number of physicians had more than 5 years of overall work experience, and 183 experience in the place of work at the time of interview. The vast majority of participants were 184 working as specialist or senior house officer. 185 7 7 186 The mean satisfaction rate was 3.85 ± 0.55 on the job satisfaction scale. Overall, 5% of the 187 physicians were not satisfied with their job (mean satisfaction score <3.00), 40 % had moderate 188 level of satisfaction (mean satisfaction score, 3.00-3.75), and 55% were highly satisfied with their 189 job (mean satisfaction score >3.76). There was no difference in mean job satisfaction score among 190 different groups of study participants, except for gender, and the working grade. The means score 191 amongst the 208 male physicians was 3.76 ± 0.54 compared to 124 female physicians (3.90 ± 0.52; 192 p-value 0.026 using ANOVA). Figure 1 shows job satisfaction rates according to the working 193 grade. Almost equal number of senior house officers, specialists and senior specialists expressed 194 ‘moderate’ or ‘high’ level of satisfaction, whereas, the vast majority of consultants and senior 195 consultants had a ‘high’ level of satisfaction with their job. 196 197 Mean satisfactions scores across the three domains and the 13 items are shown in table 2. The 198 overall job satisfaction rate was 3.82 ± 0.55; for quality of care the rate was 3.93 ± 0.61; for ease 199 of practice 3.89 ± 0.55, and for relationship with leadership, the score was 3.67 ± 0.55. Overall 200 satisfaction score, as well as across the 3 domains showed a high level of internal consistency. 201 Please see the table for Cronbach α levels. 202 203 Whereas, the vast majority of physicians were ‘moderately’ or ‘highly’ satisfied with ease of 204 practice, and quality of care, 14.5% expressed a low level of satisfaction with their relationship 205 with leadership [Figure 2]. Table 3 shows the results of physician’s perceptions of the quality of 206 inter-professional collaboration. The overall mean satisfaction rate was 3.045 ± 0.39, and the 207 results showed a high degree of internal consistency (Cronbach’s α = 0.89). The results were 208 consistent across the various items of the scale. The relationship between demographic variables 209 and physician’s perception of inter-professional collaboration and overall job satisfaction was 210 assessed using linear regression. Overall, the results indicate that physicians were satisfied or 211 highly-satisfied with different dimensions of their job, especially, if they had a clinical 212 postgraduate degree together with a PhD (p = 0.003), were on a senior level of responsibility (p = 213 0.007), and had good inter-professional relationship (p <0.001) [Table 4]. 214 215 Discussion 216 8 8 This study describes the level and determinants of job satisfaction of physicians from various 217 parts from the Sultanate of Oman. Out of the 354 physicians who responded, 95% were satisfied 218 with their job. The majority of satisfied physicians were women, and senior consultants. 219 Satisfaction was observed in different modifiable domains of patient care, was higher in quality 220 of care and ease of practice, but was marginally lower in relationship with the leadership. 221 Physicians were also perceived to be satisfied with inter-professional collaboration. Majority of 222 satisfied physicians had a postgraduate clinical degree, and had been working for more than five 223 years in the current job, and were working at a rank of consultant or above. 224 225 A validated, 13-item Physician Satisfaction Survey measuring physician satisfaction across the 226 three domains of professional practice was employed.21 The domains included quality of patient 227 care, ease of practice, and relationship with leadership. The scale has a high degree of internal 228 consistency, and our results are not only reliable, but match the internal consistency mark 229 reported in the literature. Although the vast majority of physicians were satisfied or highly 230 satisfied, with the quality of care and the ease of practice, relationship with leadership was 231 identified as an area of opportunity for further improvement. The important determinates which 232 could potentially enhance satisfaction were confidence of the leadership in the staff, and 233 responsiveness of the hospital administration to the ideas and needs of the medical staff 234 members. 235 236 In the highly complex working environment, health organizations depend on collaborative work 237 within teams and across different teams. Teamwork not only provides specialist care, but also 238 enhances quality of care. Team member satisfaction is one of the important determinants of job 239 satisfaction. In fact, team climate has been shown to be a better predictor of team satisfaction 240 than team leadership.24 The results demonstrate that the majority of physicians had the 241 perception of being satisfied with the quality of inter-professional collaboration. Our results are 242 consistent with the results of studies from an academic hospital in Brazil, family physicians in 243 Canada, and primary care physicians in Germany, where an important determinant of overall job 244 satisfaction was having a good inter-professional relationship.9,25-26 245 In terms of degree of satisfaction with the job, the current study findings showed that physicians 246 working in Oman reported higher levels of satisfaction compared with physicians working at 247 9 9 Saudi Arabia, Iraq, and Pakistan. The study from a tertiary hospital in Saudi Arabia reported that 248 as many as 30% of the 344 participants were dissatisfied with their job, mainly either due to the 249 nature of job (intensive care physicians), or low income.27 Another study from Saudi from a 250 tertiary medical center demonstrated more than 30% of the 217 respondents to be dissatisfied 251 with their job, mainly because of low income, health coverage and the overall benefit package.26 252 A study on 237 family physicians from two different areas of Saudi Arabia revealed an overall 253 job satisfaction rate of 62%. Factors significantly associated with professional dissatisfaction 254 included the physicians having an opinion that they were not respected by community members 255 and their own perception of being inferior to other specialties.28 A study from Pakistan 256 conducted on hospital doctors revealed that only 35% had well-above-average or outstanding job 257 satisfaction. Factors associated with lack of satisfaction with job included younger age, lower 258 income, fewer number of years in service, and a lack of postgraduate qualification. 29 Another 259 study from Pakistan assessed job satisfaction using 35 questions about sources of work-related 260 stress and satisfaction, and concluded that overall satisfaction rate was low at 2.69±0.37. Job 261 dissatisfaction was more amongst government sector doctors; whereas, increasing age, duration 262 of current posting and work experience positively correlated with satisfaction level.30 263 264 There are at least two other studies from Oman assessing job satisfaction of physicians. Al 265 Shafaee18 used qualitative and quantitative tools to assess job satisfaction amongst physicians 266 working in the capital area, Muscat governorate, and explored several organizational and job-267 related factors which influence satisfaction rate. Amongst the 371 physicians, the job satisfaction 268 rate was 68.4%. Physicians were satisfied with their professional status and teamwork, however, 269 they were less satisfied with administration, pay and workload. Al Touby19 reported job 270 satisfaction amongst 50 physicians working in two tertiary care hospitals in the capital area, and 271 identified younger age and fewer years of experience to be inversely related with job satisfaction. 272 The current study was different in several respects. The survey included physicians from all 273 geographical areas of Oman, used a validated job satisfaction tool with high degree of internal 274 validity, assessed modifiable factors in relation to job satisfaction, and reported an overall 275 satisfaction rate of 95%. The results should be reassuring for the health managers, as the level of 276 job satisfaction amongst physicians in the Sultanate of Oman is higher compared to many centers 277 in the region. Furthermore, as the health care system in Oman continues to evolve and improve,14 278 10 10 it should be satisfying to note that that the average job satisfaction rate has increased 279 considerably compared to the two earlier studies18, 19. While there are ongoing efforts and 280 initiatives to assess and improve satisfaction of healthcare professionals14, this study provides 281 areas and avenues for specific targets for improvement, including the modifiable factors, such as, 282 relationship with leadership. 283 284 Study Limitations 285 There are several limitations of the study. Physician’s income was not assessed in relationship 286 with job satisfaction. This has been shown to be inversely related to job satisfaction in several 287 studies. However, over the last few years, the salary structure for physicians in the government 288 sector in Oman has been revised and unified, and is dependent on the grade. Grade of work was 289 assessed, and inherent in the grade is the salary. Secondly, very few physicians working in 290 private hospitals were invited to participate, or agreed to be surveyed. However, it may be of 291 interest to note that healthcare in private sector is only beginning to emerge in Oman, and at the 292 moment, the vast majority of hospitals are government-managed facilities. The proportion of 293 physicians surveyed in this study reflect the overall proportion of private hospitals in healthcare 294 sector. Thirdly, a higher level of job satisfactions was observed amongst female doctors. This 295 was an important observation from this study, however, reasons were not explored further and 296 remain speculative. It may be argued that in a cross-sectional study design, only an association 297 can be described and not causality. Longitudinal studies are needed to establish causal 298 relationship between dependent and independent variables. In addition, this study used a self-299 reported method, which may be associated with a response bias. To minimize the possibility of 300 this bias, all data were collected anonymously, without collecting any identification information. 301 Furthermore, extra-ordinary circumstances, such as, COVID-19 pandemic may affect job 302 satisfaction levels, due to factors such as, risk perception, psychological stress and burnout, and 303 other factors, not studied here31, 32. However, data for the current study were acquired before the 304 onset of the pandemic. Finally, organizational factors, such as, human resource management, 305 details of ancillary facilities and leadership factors were not analyzed separately. The primary 306 aim of the study remained to assess job satisfaction across several factors, such as, quality of 307 care, ease of practice, relationship with leadership, and inter-professional collaboration in the 308 11 11 area / place or work. Therefore, the current study results and conclusions need to be interpreted 309 with caution, as the management and leadership details specific to the site were not studied. 310 311 Conclusion 312 In conclusion, satisfaction of physicians with their job from the Sultanate of Oman was high, and 313 the majority of physicians were highly satisfied. There was no difference in the level of 314 satisfaction among different groups of study participants, except for the working grade. Having a 315 clinical postgraduate degree, a senior level of responsibility, and the perception of a good inter-316 professional relationship were associated with higher job satisfaction rates. The overall job 317 satisfaction rates were higher for the quality of care, and for ease of practice, and lower for 318 relationship with the leadership. Relationship with the leadership is a modifiable factor and 319 healthcare policymakers should target interventional programs to improve satisfaction of junior 320 physicians. These results highlight areas of strength, as well as the area of opportunity, in which 321 efforts could be made to enhance job satisfaction. 322 323 Conflict of Interest 324 The authors declare no conflicts of interest. 325 326 Funding 327 This work was supported by The Research Council, Oman, (RC/RG-CON/FACN/18/01) and 328 Sultan Qaboos University (RF/COM/FACN/19/01). 329 330 Authors Contribution 331 IB prepared the article. SAS conducted the analysis, interpreted the data and provided critical 332 revisions for the article. OA-R contributed substantially to the conception and design of the 333 study. LJL and RA provided critical revisions for the article. All authors approved the final 334 version for submission. 335 336 Acknowledgements 337 The authors would like to acknowledge Sultan Qaboos University and The Research Council for 338 their support and thank all physicians who contributed to this study. 339 12 12 340 References 341 1. Locke EA. The nature and causes of job satisfaction. In: Dunnette MD, editor. Handbook 342 of industrial and organizational psychology. Chicago: Rand McNally; 1976. 1297–1343 343 p. 344 2. Kravitz RL. Physician job satisfaction as a public health issue. Isr J Health Policy Res. 345 2012;1:51. doi:10.1186/2045-4015-1-51. 346 3. Cooper CL, Rout U, Faragher B. Mental health, job satisfaction, and job stress among 347 general practitioners. BMJ. 1989; 298:366–370. 348 4. DeVoe J, Fryer GE, Hargraves JL, Phillips RL, Green LA. Does career dissatisfaction 349 affect the ability of family physicians to deliver high-quality patient care? J Fam Pract. 350 2002; 51:223–228. 351 5. Friedberg M, Chen P, Busum K Van. 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DOI: 10.1111/ijn.1307. 433 434 Table 1: Demographic Characteristics and Work Environment 435 Demographic features Working environment Age (years) Experience as a Physician (years) Less than 30 26 (7.4%) Less than 5 19 (5.3%) 30 – 40 123 (34.8%) 5-15 150 (42.4%) 41 – 50 80 (22.7%) 16 and more 149 (42.2%) 36 (10.2%) 51 – 66 N/R 49 (13.9%) 76 (21.4%) Experience in Current Working Place (years) Gender Less than 5 90 (25.4%) Male 208 (58.7%%) 5-15 164 (46.3%) Female N/R 124 (35%) 22 (6.6%) 16 and more 54 (15.2%) 46 (13%) Nationality Duration working with the team (years) Omani 91 (25.7%) 5 or less 150 (42.4%) Non-Omani N/R 238 (67.2%) 25 (7%) More than 5 181 (51.1%) 23 (6.5%) Marital Status Current Grade Single 34 (10%) Medical intern 15 (4.2%) Married 298 (89.2 Senior house officer 63 (17.7%) Divorced N/R 2 (.05%) 20 (5.6%) Specialist 139 (39.2%) Number of Children Senior specialist 41 (11.6%) None 48 (13.5%) Consultant 27 (7.6%) 1-3 182 (51.4%) Senior Consultant 23 (6.4%) 4 and more 40 (11.2%) 84 (23.7%) Others 24 (6.7%) 22 (6.1%) Highest Educational Level Specialty MD 99 (27.9%) Obstetrics & Gynecology 55 (17%) Post-graduate degree 199 (56.2%) General Medicine 44 (13.6%) Clinical + PhD 26 (7.3%) General Surgery 39 (12%) PhD 4 (<1%) 26 7%) Accident & Emergency 30 (9.2%) Employment Status ICU and Anesthesia 26 (8%) https://doi.org/10.1177/21501327211039714 16 16 Full time 335 (94.6%) Child Health 25 (7.7%) Part time 10 (2.8%) 9 (2.5%) Others 104 (32.2%) Place of Work Public hospitals 308 (87%) Private hospitals 46 (13%) Note. N/R: no response 436 **include internal medicine, cardiology, otorhinolaryngology, orthopedics, behavioral 437 medicine, radiology, urology, dermatology, ophthalmology, and oral health 438 439 440 Figure 1: Job Satisfaction Rate According to Responsibility 441 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% medical intern senior house officer specialist senior specialist consultanat senior consultant Low Moderate High 17 17 Table 2: Job satisfaction using the Physician Satisfaction Survey 442 Mean Cronbach alpha Quality of Care 3.932 ±0.61 .83 Quality of nursing staff 3.96 ±0.76 Staff’s concern and interest in your patient 3.95 ±0.79 Timeliness of follow-through on written orders 3.85 ±0.76 Staff’s reliability in recognizing and reporting changes in patients’ conditions 3.95 ±0.70 Ease of Practice 3.889 ±0.55 .75 Turnaround for lab results 3.92 ±0.70 Ease of scheduling inpatient test/therapy 4.01 ±0.69 Ease of admitting patients 3.97 ±0.77 Medical technology and equipment available in ICU/CCU 3.91 ±0.84 Overall rating of the Emergency Department 3.65 ±0.89 Relationship with Leadership 3.670 ±0.86 .89 Communication between yourself and the hospital administration 3.79 ±0.86 Responsiveness of the Hospital Administration to ideas and needs of medical staff members 3.57 ±0.99 Your confidence in the Hospital Administration to ideas and needs of medical staff members 3.65 ±0.96 Overall job satisfaction scale 3.846 ±0.55 .90 443 444 445 Figure 2: Job Satisfaction rate according to Physician Satisfaction Survey 446 0 50 100 150 200 250 Relationship with Leadership Ease of Practice Quality of Care Low Moderate High 18 18 Table 3: Inter-professional Collaboration 447 N Mean ± SD 1. Team members contribute to setting and evaluating goals for improving the practice. 346 3.29 ±0.59 2. The team has a culture of mutual continuous learning. 344 3.15 ±0.59 3. The team fosters a culture of continuously improving communication. 338 3.19 ±0.60 4. The team is well supported by the overall organization (e.g., practice improvement is encouraged; team training is supported). 342 3.06 ±0.67 5. Team members fail to appreciate each other’s values and diversity. 339 2.85 ±0.77 6. Team members appreciate each other’s roles and expertise. 346 3.11 ±0.62 7. Team members have the autonomy to implement their part of the plan once the patient’s needs and goals are clear. 343 3.13 ±0.56 8. The team is effective in assigning and implementing administrative tasks (e.g., leadership, record keeping, meeting facilitation, etc.) 348 3.08 ±0.63 9. Team members do not feel safe bringing up concerns about roles and responsibilities for discussion, proactive improvement, and prevention. 339 2.83 ±0.73 10. All voices on the team are heard and valued. 342 2.96 ±0.69 11. The team encourages trust by paying attention to important personal or professional connections (e.g., celebrating achievements, milestones, etc.). 347 3.09 ±0.54 19 19 12. Members of the team are active listeners and pay close attention to the contributions of others, including the patient and family. 345 3.17 ±0.57 13. The team engages in routine, frequent, meaningful evaluation to improve its performance. 344 3.05 ±0.58 14. Team members tend not to recognize their own limitations in knowledge and skills. 342 2.78 ±0.79 15. The team constructively manages disagreements among team members. 336 2.95 ±0.60 Note: Item numbers 5, 9, and 14 were reversed coded. 448 449 Table 4. Predictors of overall job satisfaction 450 Predictor Unstandardized β S.E Standardized β t p-value 95% CI Lower Upper Inter-professional collaboration .864 .071 .603 12.155 <0.001 .724 1.004 Education MD .100 .059 .086 1.716 .087 -.015 .216 Clinical + PhD .293 .097 .152 3.017 .003 .102 .484 PhD .406 .320 .065 1.271 .205 -.223 1.036 Grade as physician Medical intern -.034 .127 -.014 -.267 .789 -.284 .216 Medical officer -.103 .077 -.069 -1.336 .183 -.256 .049 Specialist -.136 .081 -.085 -1.672 .096 -.295 .024 Senior specialist -.094 .100 -.048 -.936 .350 -.291 .103 Consultant -.107 .126 -.045 -.844 .400 -.355 .142 Senior Consultant .297 .109 .138 2.720 .007 .082 .511 Note. r2= 0.453; Adjusted r2 = 0.404 451