ارزش های کار و رضایت شغلی پزشکان خانواده
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|6192||2013||8 صفحه PDF||سفارش دهید||محاسبه نشده|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Journal of Vocational Behavior, Volume 82, Issue 3, June 2013, Pages 248–255
Theory and prior research suggest linkages between work values and job satisfaction. The present study examined such linkages in a group of workers in a professional occupation. Family physicians (134 women, 206 men, 88% Caucasian) responded to context-specific measures of work values and job satisfaction. ANOVA results indicated a work values hierarchy of Autonomy, Service, Lifestyle, Scholarly Pursuits, Management, and Prestige in decreasing order of importance. Canonical correlation analysis yielded a significant function with three work values collectively predicting job satisfaction: Lifestyle (negatively) and Service and Scholarly Pursuits (positively) in decreasing order of magnitude. The study findings may be useful to medical students in the specialty choice process, to medical school faculty advising such students, and to currently practicing physicians contemplating career specialty change. Future research may examine work values and job satisfaction differences across employment and geographic settings, give increased attention to cultural variables, and include intervention studies and longitudinal designs.
Values figure significantly in work motivation and job satisfaction (Dawis and Lofquist, 1984 and Lent, 2008). Yet, they have received much less attention in this regard compared to vocational interests, abilities, and personality traits (Dawis, 2001, Robinson and Betz, 2008 and Rottinghaus et al., 2009). To redress this gap in the literature, we examined relationships between work values and job satisfaction among physicians in one specialty area, as recommended by prior research (Duffy & Richard, 2006). Fairly significant amounts of research have investigated either physician job satisfaction or work values in medicine (e.g., Duffy and Richard, 2006, Gibson and Borges, 2009, Henry et al., 1992 and Schubot et al., 1996). Very few studies have attempted to understand possible links between these variables. In particular, there has been little focus on professionals within a particular area of medicine, preferring to sample physicians across specialties. Such an approach may mask important differences between them. Given that family medicine ranks among the most recruited medical specialties (Merritt, Hawkins, & Associates, 2006) and is a key provider of primary care, we selected it as the focus of the present study. The United States ranks the lowest among industrialized nations in providing primary care medical services (Phillips & Starfield, 2004). Fueling the problem, medical students express a decreasing interest in primary care (Bland and Isaacs, 2002 and Colwill, 1992). Despite recent increases in the numbers of medical students entering primary care specialties like family medicine (National Residency Match Program, 2011), estimates still project a substantial shortage in the numbers of primary care physicians by 2025 (Association of American Medical Colleges, 2008, Dill and Salsberg, 2008 and Newton and Grayson, 2003). Given the current national focus on increasing accessibility to healthcare and reducing healthcare costs, many medical schools seek to increase their numbers of students who enter primary care specialties like family medicine (Dorsey et al., 2011, Petterson et al., 2011 and Senf et al., 2004). Medical students often cite concerns about low income and low prestige associated with the specialty as factors that influenced their decision to not enter family medicine (Senf et al., 2004). Even students who do pursue careers as family physicians voice concerns about low financial compensation and “lack of respect and value for similar tasks to those performed by other specialists” (Scott, Wright, Brenneis, Brett-MacLean, & McCaffrey, 2007, p. 1957). Yet, family physicians provide more than 90% of the healthcare people need during their lives (Hing, Cherry, & Woodwell, 2005), and an estimated one-third of the nation consults with a family physician each year (Green et al., 2004). A substantial amount of research has examined values in an attempt to understand and facilitate medical career development and specialty choice. For example, Abbott (1983) found that family-practice residents scored higher on humanistic values than did residents in other specialties. Other studies have examined the influence of values on the specialty-choice process in terms of the importance of research and teaching (Hojat, Gonnella, & Erdmann, 1995), desired level of prestige and income (Bland et al., 1995 and DeWitt et al., 1998), importance of a biopsychosocial versus bioscientific orientation (Bland et al., 1995, DeWitt et al., 1998 and Senf et al., 2004), and issues of role strain and role support (DeWitt et al., 1998 and Kassler et al., 1991). Many studies indicate that “controllable lifestyle” factors significantly influence medical specialty choice (e.g., Dorsey et al., 2003 and Gelfand et al., 2002). However, as Dawis (1991) explained, “asking people which values served as the bases for their choices is not the same as discovering which values differentiate among occupational groups” (p. 851). Constraining research on values and specialty choice is heavily reliant on medical student and resident data (Borges, Gibson, & Karnani, 2005). We addressed this problem by sampling practicing physicians. Against this backdrop, physician job satisfaction research indicates mixed results. Two studies (Duffy and Richard, 2006 and Gibson and Borges, 2009) found moderately high overall job satisfaction among physicians across specialties, consistent with prior findings (Arnetz, 2001). Other researchers have found substantial career dissatisfaction among physicians (Sibbald, Bojke, & Gravelle, 2003), with one study reporting that nearly one in five physicians feels dissatisfied with their career (Leigh, Kravitz, Schembri, Samuels, & Mobley, 2002). This raises important public health concerns because dissatisfied physicians provide lower standards of care (Leigh et al., 2002 and Levinsky, 1993) and receive lower ratings of overall quality of care (Kassirer, 1998).
نتیجه گیری انگلیسی
The current study offers a step toward better understanding work values and their relationships to job satisfaction. Our findings indicate a values hierarchy among family physicians consistent with prior research and that physician work values predict job satisfaction to varying degrees. Family physicians in the current study endorsed a work values hierarchy in decreasing order of importance of Autonomy, Service, Lifestyle, Scholarly Pursuits, Management, and Prestige. These findings support prior research indicating that family physicians value self-direction in their work (Eliason et al., 2000 and Eliason and Schubot, 1995) and that medical students interested in primary care tend to downplay income and prestige (Bland et al., 1995, Hojat et al., 1995, Kassler et al., 1991 and Wright et al., 2004). The high rating of Service supports valuing patient relationships, indigent care (Hojat et al., 1995), and caregiving without reward (Eliason and Schubot, 1995, Eliason et al., 2000, Senf et al., 2004 and Ducker, 1994). Our finding of a relatively strong endorsement of Lifestyle indicates that family physicians value a predictable and stable work schedule. It also supports prior findings that medical students more interested in primary care than in subspecialty care want to avoid role strain, limit their work hours, and share job obligations with others (Ducker, 1994 and Kassler et al., 1991). Some prior evidence suggests that medical students who choose family medicine are significantly more likely to value lifestyle over income than are students who choose internal medicine subspecialties, orthopedics, general surgery, and obstetrics–gynecology (Newton, Grayson, & Thompson, 2005). Previous research also supports our findings of family physicians placing less importance on Scholarly Pursuits and Management. For example, medical students interested in primary care have reported relatively little interest in academic medicine (Bland et al., 1995, Kassler et al., 1991 and Senf et al., 2005), and primary care physicians tend to express less interest than subspecialists in clinical and laboratory research activities (Kassebaum & Szenas, 1994). Consistent with prior findings (Eliason et al., 2000 and Hojat et al., 1995), we found that family physicians rated Prestige the lowest among their work values. We also found that women family physicians value Lifestyle more so than do men, and that they value Management and Scholarly Pursuits less so than do men. Prior research among medical students supports these findings by indicating that women compared to men report less of a biomedical orientation and academic interest and more desire to avoid role strain (Murdoch et al., 2001). The current finding also adds support for women's greater involvement in life tasks such as child-care and balancing work and family roles. Our finding of a negative relationship between Autonomy and job satisfaction supports previous research findings that family physicians who highly endorse self-direction feel less satisfied with their practices (Eliason et al., 2000). To deal with this incongruence, Eliason et al. (2000) proposed that “physicians who are able to accept many of the limitations placed on them by outside forces and work within existing frameworks will likely be more satisfied” (p. 231). This possibility finds support from research indicating that “both positive attitudes toward managed care and reform-mindedness” make independent and statistically significant contributions to predicting career satisfaction among family physicians (Shearer & Toedt, 2001, p.753). Perhaps job satisfaction in family medicine relates to perceived clinical autonomy but is also impacted by the degree to which an individual is able and willing to work within the inevitable constraints of the healthcare system. Future research may help to better understand the intricacies of this balance. The positive link that we found between Service and job satisfaction supports characterizing medicine as a helping profession. It also bolsters research demonstrating that assisting others and providing direct patient care promote physician job satisfaction (e.g., DeVoe et al., 2002, Eliason and Schubot, 1995 and Eliason et al., 2000). Likewise, research indicates that physician job satisfaction correlates positively with altruism, commitment to the needs of society, and humanistic values like empathy, integrity, and trustworthiness (Stoddard, Hargraves, Reed, & Vratil, 2001). We found that family physicians who strongly endorsed the work value of Prestige tended to report lower levels of job satisfaction. If Prestige is understood to incorporate elements such as financial compensation, a high degree of social influence, and receiving admiration from others, this finding is both contradicted and supported by previous research. For example, income was not found to be a source of satisfaction for rural physicians (Pastor, Huset, & Lee, 1989) nor was it relevant to levels of satisfaction among primary care physicians (Williams et al., 2002). Conversely, family physicians who reported earning an annual income under $100,000 were more likely to report feeling dissatisfied with their work (DeVoe et al., 2002). Eliason and Schubot (1995) found that ‘social power,’ defined as the desire for social status and control over people did not contribute to physician job satisfaction. The negative relationship between prestige and job satisfaction that we found may be attributable to the fact that family medicine typically ranks among the less prestigious medical specialties. Physicians who choose and develop careers in family medicine likely do so for reasons other than factors like income, power, and status. Family physicians who placed a higher importance on Lifestyle in the current study tended to have lower job satisfaction. This is interesting when considered with our study's finding that Lifestyle was a highly-rated work value among family physicians. Additionally, this finding seems at odds with previous research showing that medical students do not consider family medicine to be one of the specialties more conducive to maintaining a predictable and manageable work schedule (e.g., Newton et al., 2005). Regarding work values and overall job satisfaction, canonical correlation analysis found a pattern consisting of (a) positive correlations among the three types of satisfaction and the work values of Service and Scholarly Pursuits, and (b) negative correlations between these variables and the work value of Lifestyle. This is evidence of a strong link between family physician job satisfaction, helping others, and contributing to the field of medicine at the expense of personal comfort or work-life balance. We labeled this finding, “Altruism,” thereby recognizing family physicians' tendency to contribute to the welfare of society (through clinical and/or scholarly efforts) with diminished regard for their own desires or personal convenience. This self-sacrificing commitment to humanity and philanthropy bolsters our findings about the family physicians work values–job satisfaction link described above. The results of the canonical correlation further emphasize the negative relationship between Lifestyle and job satisfaction. Our findings present somewhat of a paradox in this regard. That is because the results indicate that family physicians highly value Lifestyle, yet, it is negatively correlated with the synthetic variable of satisfaction. Grayson, Newton, Patrick, and Smith (2011) found that medical students in an honorary society are increasingly seeking residencies in more lifestyle friendly specialties. This finding may partially explain the decrease in the numbers of students entering family medicine. That is, family physicians appear to value lifestyle, however, they work in a specialty with unpredictable work hours, limited personal time, and little control over lifestyle, which contribute to negative job satisfaction. Therefore, with medical students increasingly valuing lifestyle, they may look for more lifestyle-friendly specialties. The canonical correlation also indicated that Scholarly Pursuits was a secondary contributor to the synthetic variable of satisfaction. Academic responsibilities have been reported as very satisfying for many physicians (Eliason et al., 2000 and Lepnurm et al., 2006), and physicians in medical school settings have reported significantly higher levels of career satisfaction as compared to physicians in other settings (Stoddard et al., 2001). However, it is often difficult for family physicians to maintain their clinical duties and do research and teaching (Arnetz, 2001 and Linn et al., 1985). Studies also suggest that satisfaction decreases among family physicians when academic duties are added to increasing administrative and clinical responsibilities (Lepnurm et al., 2006). 5.1. Limitations Using snowball sampling via the internet relied on participants' self-selection and recruitment of colleagues thereby limiting the study design. The present findings may represent a specific subset of family physicians grouped by some unknown variable prompting them to participate. Additionally, the current sample may be skewed with regard to professional satisfaction because motivation to participate could have been influenced by strong positive or negative reactions to the survey, creating a self-selection bias. Although participants provided adequate variability on many demographic variables, the sample constituted a homogeneous group with regard to age and race. Participants mostly represented older, Caucasian adults. Use of self-report data and a cross-sectional correlational design also limited the research. 5.2. Practice and future research implications Results of the current study may be useful for currently practicing family physicians, for employers concerned with improving physician retention and job satisfaction, and for medical students contemplating specialty choices. Dissatisfaction generally arises from unmet expectations (Pincus, 1995). Examining personal expectations and work values in comparison to what is offered within one's current vocational context may promote identifying possible sources of discontent. Employers and managers may, in turn, be better able to develop interventions and facilitate changes in the employment setting to address these issues. For medical students considering careers in family practice, they may compare their own work values to the benchmark values hierarchy found in the present study. Doing so may help them generate an impression of the work culture they would likely encounter should they pursue a career in family medicine. Using the present data may promote more realistic career specialty discussions between medical students and advisors. Future studies could consider examining differences among family physicians based on geographic location and employment setting. Even within one specialty, differences in values and levels of job satisfaction will likely emerge for physicians in varying positions. Physician satisfaction may be significantly influenced by local phenomena masked by summative data, thereby hindering the usefulness of the findings (Landon et al., 2003, Mechanic, 2003 and Senf et al., 2004). Future studies may also examine how individual values sets interact with varying cultural orientations and vocational contexts. Because career commitment depends more on values than on any other factor, such as interests, abilities, and personality, values may be a more valid and reliable predictor of job satisfaction (Rounds, 1990). However, from a person–environment fit perspective, perceived fit between individual values and those reinforced or supported by their work tasks correlates strongly (.56) with job satisfaction (Kristof-Brown, Zimmerman, & Johnson, 2005). This suggests that person–job values congruence predicts job satisfaction more so than do individual work values alone (Dawis, 2005). Future studies would therefore do well to take more integrative approaches to studying job satisfaction that use work values as one of multiple predictor variables. While some research has examined changes in physician satisfaction over time (Buchbinder et al., 2001 and Reed et al., 2004), some scholars have commented that work values stability and change remain relatively unexplored (Dawis, 1991). In particular, we know little about what factors shape values importance and how circumstances or experiences may change level of importance over time. Recent meta-analytic work by Jin and Rounds (2012) has done much to correct this problem. Their review of 22 longitudinal studies supported work values as a stable individual differences variable. They also identified factors such as age and its typical concomitants of family, career, and material concerns that shift individual values from less ideological to more pragmatic over time. Intervention studies of work values and job satisfaction would be useful for managers and policymakers who may wish to know if and how it is possible to alter factors to influence physician satisfaction (Landon et al., 2003). Future research may also use the PVIPS and the PWS with specialties other than family medicine to provide comparison data on work values and job satisfaction across and between groups of specialists. Doing so could increase the information available to assist medical students in the specialty selection process. In sum, the relationship between work values and job satisfaction appears reciprocal, fluid, and likely involves other components and interactions yet to be uncovered.