What motivates physicians throughout their careers in medicine?

What's up doc? Physicians' reflections on their sustainable employability throughout careers: a narrative inquiry

BACKGROUND

Physicians have complex and demanding jobs that may negatively affect their sustainable employability (SE) and quality of care. Despite its societal and occupational relevance, empirical research on physicians' SE is scarce. To further advance our understanding of physicians' SE, this study explores how physicians perceive their employment context to affect their SE, how physicians self-regulate with the intent to sustain their employability, and how self-regulations affect physicians' SE and their employment context.

METHODS

Twenty Dutch physicians from different specialisms were narratively interviewed between March and September 2021 by a researcher with a similar background (surgeon) to allow participants to speak in their own jargon. The interviews were analyzed collaboratively by the research team in accordance with theory-led thematic analysis.

RESULTS

According to the interviewees, group dynamics, whether positive or negative, and (mis)matches between personal professional standards and group norms on professionalism, affect their SE in the long run. Interviewees self-regulate with the intent to sustain their employability by (I) influencing work; (II) influencing themselves; and (III) influencing others. Interviewees also reflect on long-term, unintended, and dysfunctional consequences of their self-regulations.

CONCLUSIONS

We conclude that physicians' SE develops from the interplay between the employment context in which they function and their self-regulations intended to sustain employability. As self-regulations may unintentionally contribute to dysfunctional work practices in the employment context, there is a potential for a vicious cycle. Insights from this study can be used to understand and appraise how physicians self-regulate to face complex challenges at work and to prevent both dysfunctional work practices that incite self-regulation and dysfunctional consequences resulting from self-regulations.

Do I care for you more when you really need help? An experimental test of the effect of clinical urgency on compassion in health care

OBJECTIVES

To experimentally investigate whether more urgent patient presentations elicit greater compassion from health care professionals than less urgent, facilitating future research and thinking to address systemic barriers to compassion in health care.

DESIGN

This is a pre-registered online study with an experimental, within-subjects repeated-measure study design. Two clinical vignettes that systematically varied the urgency of patient presentation were utilized. Both vignettes depicted a patient with difficult behaviours typically associated with lower compassion.

METHODS

Health care professionals (doctors, nurses and allied health practitioners) recruited from all 20 District Health Boards across Aotearoa/New Zealand completed two vignettes in a counterbalanced order. Paired-sample t-tests were used to test the effect of the presentation urgency on indices of compassion.

RESULTS

A total of 939 participants completed the vignettes (20% doctors, 47%, nurses and 33% allied health professionals). As expected, participants reported greater care and motivation to help the more urgent patient. However, the more urgent patient was also perceived as less difficult, and exploratory analyses showed that perceived patient difficulty was associated with lower caring and motivation to help, particularly in the less urgent patient.

CONCLUSIONS

This is the first work to experimentally test the relationship between the urgency of patient presentation and compassion in health care. Although the association between urgency and difficulty is complex, our findings are consonant with evolutionary views in which urgent distress elicits greater compassion. A system-wide orientation towards efficiency and urgency may exacerbate this 'bias' which must be addressed to ensure more equitable compassion in health care.

Working in value-discrepant environments inhibits clinicians' ability to provide compassion and reduces well-being: A cross-sectional study

BACKGROUND

The practice of compassion in healthcare leads to better patient and clinician outcomes. However, compassion in healthcare is increasingly lacking, and the rates of professional burnout are high. Most research to date has focused on individual-level predictors of compassion and burnout. Little is known regarding how organizational factors might impact clinicians' ability to express compassion and well-being. The main study objective was to describe the association between personal and organizational value discrepancies and compassion ability, burnout, job satisfaction, absenteeism and consideration of early retirement among healthcare professionals.

METHODS

More than 1000 practising healthcare professionals (doctors, nurses and allied health professionals) were recruited in Aotearoa/New Zealand. The study was conducted via an online cross-sectional survey and was preregistered on AsPredicted (75407). The main outcome measures were compassionate ability and competence, burnout, job satisfaction and measures of absenteeism and consideration of early retirement.

RESULTS

Perceived discrepancies between personal and organizational values predicted lower compassion ability (B = -0.006, 95% CI [-0.01, -0.00], p < 0.001 and f ²  = 0.05) but not competence (p = 0.24), lower job satisfaction (B = -0.20, 95% CI [-0.23, -0.17], p < 0.001 and f ²  = 0.14), higher burnout (B = 0.02, 95% CI [0.01, 0.03], p < 0.001 and f ²  = 0.06), absenteeism (B = 0.004, 95% CI [0.00, 0.01], p = 0.01 and f ²  = 0.01) and greater consideration of early retirement (B = 0.02, 95% CI [0.00, 0.03], p = 0.04 and f ²  = 0.004).

CONCLUSIONS

Working in value-discrepant environments predicts a range of poorer outcomes among healthcare professionals, including hindering the ability to be compassionate. Scalable organizational and systems-level interventions that address operational processes and practices that lead to the experience of value discrepancies are recommended to improve clinician performance and well-being outcomes.

Sustaining the Intrinsic Motivations of the "Good Physician": A Content Analysis of Medical Students' and Physicians' Responses from Two National Surveys

OBJECTIVE

Physician motivation has been described as the reason, purpose, and force that drives people to pursue their work, and motivating factors include those that are intrinsic or extrinsic to the work. Social forces may contribute to motivational disparities between medical school and actual practice.

METHODS

A secondary data analysis of two national surveys (medical students and practicing physicians from various specialties) was conducted. Content analysis was performed on open-ended survey items that elicited students' and physicians' responses to meaningful experiences in medicine.

RESULTS

In the medical student sample, four themes were identified as factors intrinsic to medicine: role models, clinical experiences, patient interactions, and peer interactions. In total, intrinsic factors comprised 86.5% (193/208) of coded responses. In the practicing physician sample, five themes were identified as factors intrinsic to medicine: difficult patient interactions, conflict with colleagues or staff, meaningful patient interactions, involvement in medical education-research-academia, and medicine as a calling/mission. In total, intrinsic factors comprised 24.0% (140/582) of coded responses.

CONCLUSIONS

Our findings suggest that the reality of social forces in medicine threatens the ability of practicing physicians to derive meaning from their work, although students and physicians still report intrinsic motivation from establishing meaningful relationships. Further research is needed to explore what strategies enable physicians to wisely navigate the dynamic interactions of intrinsic and extrinsic motivators over various stages of their careers. These strategies could include encouraging reflective spaces in physicians' workplaces that have a specific focus on sustaining intrinsic motivation in medicine.

Motivation and personality factors of Generation Z high school students aspiring to study human medicine

BACKGROUND

A new generation of medical students, Generation Z (Gen Z), is becoming the predominant population in medical schools and will join the workforce in a few years' time. Medicine has undergone serious changes in high-income countries recently. Therefore, it is unclear how attractive the medical profession still is for high school students of Gen Z. The aim of this study was to investigate what motivation leads Gen Z students in their choice to study human medicine, and how they see their professional future. Our study was guided by motivation theory and the influence of personality traits and other personal factors on students' choice of university major.

METHODS

In a cross-sectional online survey, we included third- and fourth-year high school students in Northern Switzerland. We examined the importance of criteria when choosing a university major: personality traits, career motivation, life goals, and other considerations influencing the choice of human medicine versus other fields of study. Results Of 1790 high school students, 456 (25.5%) participated in the survey (72.6% women, mean age 18.4 years); 32.7% of the respondents aspired to major in medicine at university. For all respondents, the foremost criterion for selecting a field of study was 'interest in the field,' followed by 'income' and 'job security.' High school students aiming to study human medicine attached high importance to 'meaningful work' as a criterion; supported by 36.2% of those students answering that helping and healing people was a core motivation to them. They also scored high on altruism (p < 0.001 against all groups compared) and intrinsic motivation (p < 0.001) and were highly performance- (p < 0.001) and career-minded (p < 0.001). In contrast, all the other groups except the law/economics group had higher scores on extraprofessional concerns.

CONCLUSIONS

Swiss Gen Z students aspiring to study human medicine show high intrinsic motivation, altruism, and willingness to perform, sharing many values with previous generations. Adequate work-life balance and job security are important issues for Gen Z. Regarding the current working conditions, the ongoing shortage of physicians, and recent findings on physicians' well-being, the potential for improvement and optimization is high.

Do medical specialists cope with stressors through fulfillment of basic psychological needs of self-determination theory

OBJECTIVES

To explore factors influencing work motivation negatively and the role of the fulfillment of basic psychological needs, described by the self-determination theory of motivation, as a possible coping mechanism for medical specialists.

METHODS

A qualitative study was conducted in an academic medical center in the United States. Twelve medical specialists from different disciplines were recruited through convenience, snowball, and purposive sampling and shadowed for two days each. Semi-structured interviews were conducted afterwards. Data were transcribed, and thematic analysis was used for coding. Themes were finalized through discussion and consensus.

RESULTS

Medical specialists experience three main themes that are identified as stressors; 1) administrative tasks, so-called "administrative jungle", 2) delays and inefficiencies, and 3) poor patient outcomes. To be able to cope with these stressors, medical specialists construct different copingnarratives. Two coping narratives could be linked to autonomy: a narrative of acceptance and a narrative of reinstating autonomy. One coping narrative could be linked to relatedness: a narrative of relationships. No coping narrative could be linked to competence.

CONCLUSIONS

The results indicate that coping narratives about autonomy and relatedness are used to cope with moments of pressure, demand, or difficulty, so that patient care can continue to be the first priority. Becoming aware of these coping narratives, using them and reflecting on one's own can help medical specialists in successfully coping with stressors in their work lives. In turn, this can improve specialists wellbeing and performance for patient care as motivation remains.

Spiritual Motivations to Practice Medicine: A Survey of Cancer Care Providers

BACKGROUND

There is increased interest in the role of spirituality in the cancer care context, but how it may inspire individuals to pursue a career as a healthcare provider is unknown. We sought to determine the relationship between intrinsic religiosity, religious identity, provider role, and spiritual motivations to practice medicine.

METHODS

A cross-sectional survey was administered to healthcare providers at a large, Midwest Comprehensive Cancer Center. The relationship between provider type, intrinsic religiosity, religious identity, and spiritual motivations to practice medicine was assessed with binary logistic regression.

RESULTS

Among 340 participants, most were female (82.1%) or Caucasian (82.6%) and identified as being religious (57.5%); median age was 35 years (IQR: 31-48). Providers included nurses (64.7%), physicians (17.9%), and "other" (17.4%). Compared with physicians, nurses were less likely to agree that they felt responsible for reducing pain and suffering in the world (OR: 0.12, p = 0.03). Similarly, "other" providers were less likely than physicians to believe that the practice of medicine was a calling (OR: 0.28, p = 0.02). Providers with a high self-reported intrinsic religiosity demonstrated a much greater likelihood to believe that the practice of medicine is a calling (OR:1.75, p = 0.001), as well as believe that personal R&S beliefs influence the practice of medicine (OR:3.57, p < 0.001). Provider religious identity was not associated with spiritual motivations to practice medicine (all p > 0.05).

CONCLUSION

Intrinsic religiosity had the strongest relationship with spiritual motivations to practice medicine. Understanding these motivations may inform interventions to avoid symptoms of provider burnout in cancer care.

Association of Intrinsic Motivating Factors and Joy in Practice: A National Physician Survey

OBJECTIVES

In response to the need to identify positive measures that more accurately describe physician wellness, this study seeks to assess the validity of a novel joy in practice measure using validated physician well-being measures and test its association with certain intrinsic and extrinsic motivators.

METHODS

Secondary data analysis using a nationally representative dataset of 2000 US physicians, fielded October-December 2011. Multivariable logistic models with survey design provided nationally representative individual-level estimates. Primary outcome variables included joy in practice (enthusiasm, fulfillment, and clinical stamina in an after-hours setting). Secondary outcomes were validated measures of physician well-being such as job and life satisfaction and life meaning. Primary explanatory variables were sense of calling, number of personally rewarding hours per day, long-term relationships with patients, and burnout.

RESULTS

The survey response rate was 64.5% (1289/2000). Physicians who demonstrated joy in practice were most likely to report high life satisfaction (odds ratio [OR] 2.75, 95% confidence interval [CI] 1.52-4.98) and high life meaning (OR 2.62, 95% CI 1.41-4.85). Joy in practice was strongly associated with having a sense of calling (OR 10.8, 95% CI 2.21-52.8) and ≥ 7.5 personally rewarding hours per day (OR 3.75, 95% CI 1.51-9.36); meanwhile, it was negatively associated with burnout (OR 0.26, 95% CI 0.14-0.51). Extrinsic factors such as specialty, practice setting, and annual income were not significantly associated with joy in practice in most regressions.

CONCLUSIONS

The joy in practice measure shows preliminary promise as a positive marker of well-being, highlighting the need for future interventions that support physicians' intrinsic motivators and foster joy in one's practice.

How Physician Compensation and Education Debt Affects Financial Stress and Burnout: A Survey Study of Women in Physical Medicine and Rehabilitation

OBJECTIVE

To investigate the contribution of financial stress to physician burnout and satisfaction among women physiatrists. Relationships among education debt and compensation with demographic, sociologic, and workplace factors were also assessed.

DESIGN

This was a cross-sectional survey study of women physicians in the field of physical medicine and rehabilitation (PM&R) in the United States. The survey consisted of 51 questions covering demographic information (current and maximum education debt, race/ethnicity, years out of training, practice type and setting, hours worked, family structure, and domestic duties), work/life satisfaction, and burnout. The association between current/maximum debt and demographic characteristics, work/life satisfaction, and physician burnout were examined.

RESULTS

Of the 245 U.S. women attending physiatrists who met inclusion criteria, 222 (90.6%) reported ever having education debt (median category $101 000-150 000) and 162 (66.1%) reported current debt (median category ≤ $50 000). Of these participants, 218 (90.5%) agreed that they would have fewer burnout symptoms if they were able to do more work that is core to their professional mission and 226 (92.2%) agreed that feeling undervalued at work is linked to physiatrists' burnout symptoms. Greater debt was seen in those who identified as Black/African American, were fewer years out of training, practiced general physiatry, and had both inpatient and outpatient responsibilities. Greater current debt had a significant relationship with measurements of work/life dissatisfaction. Burnout was associated with higher debt, lower compensation, more hours worked per week, and fewer hours of exercise performed per week.

CONCLUSIONS

This study examined women physiatrists' perceptions of financial stress and found that greater education debt was associated with personal life dissatisfaction, career regret, and burnout. Further research is needed to address related causes and solutions.

Residents' identification of learning moments and subsequent reflection: impact of peers, supervisors, and patients

BACKGROUND

The clinical workplace offers residents many opportunities for learning. Reflection on workplace experiences drives learning and development because experiences potentially make residents reconsider existing knowledge, action repertoires and beliefs. As reflective learning in the workplace cannot be taken for granted, we aimed to gain a better insight into the process of why residents identify experiences as learning moments, and how residents reflect on these moments.

METHODS

This study draws on semi-structured interviews with 33 medical residents. Interviews explored how residents identified learning moments and how they reflected on such moments, both in-action and on-action. Aiming for extensive explanations on the process of reflection, open-ended questions were used that built on and deepened residents' answers. After interviews were transcribed verbatim, a within-case and cross-case analysis was conducted to build a general pattern of explanation.

RESULTS

The data analysis yielded understanding of the crucial role of the social context. Interactions with peers, supervisors, and patients drive reflection, because residents want to measure up to their peers, meet supervisors' standards, and offer the best patient care. Conversely, quality and depth of reflection sometimes suffer, because residents prioritize patient care over learning. This urges them to seek immediate solutions or ask their peers or supervisor for advice, rather than reflectively deal with a learning moment themselves. Peer discussions potentially enhance deep reflection, while own supervisor involvement sometimes feels unsafe.

DISCUSSION

Our results adds to our understanding of the social-constructivist nature of reflection. We suggest that feelings of self-preservation during interactions with peers and supervisors in a highly demanding work environment shape reflection. Support from peers or supervisors helps residents to instantly deal with learning moments more easily, but it also makes them more dependent on others for learning. Since residents' devotion to patient care obscures the reflection process, residents need more dedicated time to reflect. Moreover, to elaborate deeply on learning moments, a supportive and safe learning climate with peers and supervisors is recommended.

Motivators for medical staff with a high gap in healthcare efficiency: Comparative research from Poland and Ukraine

INTRODUCTION

This article examines different motivators for medical staff in countries with a high gap in healthcare efficiency by comparing them in two healthcare systems-Polish (ie efficient) and Ukrainian (ie inefficient).

METHOD

This survey-based study applies a six-stage conceptual framework to two Polish and two Ukrainian hospitals as well as medical faculties of one university from each country. Following ethical approval, data were collected in the first quarter of 2019, using the 'Evaluation of motivators questionnaire for medical staff'.

FINDINGS

Medical staff perceived their working conditions in the inefficient healthcare system much worse than in the efficient system; however, they generally had a more optimistic outlook. Medical staff in efficient and inefficient healthcare systems has different motivational targets, including sizable differences from profession, gender, and age. These factors play an important role in developing a high-performance healthcare system. Results are illustrated in terms of motivators for medical staff.

CONCLUSION

Optimising a healthcare system requires useful reform of enablers, especially in countries with inefficient systems, including policymaking and regulatory action. Best practices must incorporate all stakeholders interested in high healthcare performance-usage of suitable practices from abroad can act as an important resource.

A qualitative study on factors influencing the situational and contextual motivation of medical specialists

OBJECTIVES

The aim was to investigate which factors influence the situational motivation of medical specialists and how situational and contextual motivation affect one another.

METHODS

A qualitative design was used, and a constructivist approach was adopted with the Self-Determination Theory of motivation as a framework. Twenty-two medical specialists from three medical centers in the Netherlands were recruited through convenience, snowball and purposive sampling and observed for two days each. At the end of the second observation day, a semi-structured interview was conducted. Data were transcribed and coded in an open manner. Themes were finalized through discussion and consensus.

RESULTS

Two-hundred and fifty hours of observation data together with the interview data identified that medical specialists experience six main themes influencing their situational motivation during a workday. Technical issues are influencing motivation negatively factors. Working with colleagues can be both a motivating factor and influence motivation negatively, e.g., filling in for each other through feelings of relatedness was motivating. Being in control of one's own planning through feelings of autonomy was motivating. Patient care, especially in combination with teaching, stimulated specialists' motivation.

CONCLUSIONS

The results indicate that factors influencing motivation negatively are mainly tasks and organizational processes that distract from patient care or that compromise the quality of care. When optimizing the work environment of medical specialists, autonomous motivation and continuing professional development are stimulated.  These, in turn, can improve the quality of patient care and wellbeing of specialists.

A National Longitudinal Survey of Medical Students' Intentions to Practice Among the Underserved

PURPOSE

To explore students' intentions to practice in medically underserved areas.

METHOD

In January 2011, 960 third-year medical students from 24 MD-granting U.S. medical schools were invited to participate in a survey on their intention to practice in a medically underserved area. A follow-up survey was sent to participants in September 2011. Covariates included student demographics, medical school characteristics, environmental exposures, work experiences, sense of calling, and religious characteristics.

RESULTS

Adjusted response rates were 564/919 (61.4%, first survey) and 474/564 (84.0%, follow-up survey). Among fourth-year medical students, an estimated 34.3% had an intention to practice among the underserved. In multivariate logistic regression modeling, predictors for intentions to practice among the underserved included growing up in an underserved setting (odds ratio [OR] range: 2.96-4.81), very strong sense of calling (OR range: 1.86-3.89), and high medical school social mission score (in fourth year: OR = 2.34 [95% confidence interval (CI), 1.31-4.21]). International experience was associated with favorable change of mind in the fourth year (OR = 2.86 [95% CI, 1.13-7.24]). High intrinsic religiosity was associated with intentions to practice primary care in underserved settings (in fourth year: OR = 2.29 [95% CI = 1.13-4.64]).

CONCLUSIONS

Growing up in medically underserved settings, work experience in religiously affiliated organizations, very strong sense of calling, and high medical school social mission score were associated with intentions to practice in underserved areas. Lack of formative educational experiences may dissuade students from considering underserved practice.

Association of Intrinsic Motivating Factors and Markers of Physician Well-Being: A National Physician Survey

BACKGROUND

Although intrinsic motivating factors play important roles in physician well-being and productivity, most studies have focused on extrinsic motivating factors such as salary and work environment.

OBJECTIVE

To examine the association of intrinsic motivators with physicians' career satisfaction, life satisfaction, and clinical commitment, while accounting for established extrinsic motivators as well.

DESIGN AND PARTICIPANTS

A nationally representative survey of 2000 US physicians, fielded October to December 2011.

MAIN MEASURES

Outcome variables were five measures of physician well-being: career satisfaction, life satisfaction, high life meaning, commitment to direct patient care, and commitment to clinical practice. Primary explanatory variables were sense of calling, personally rewarding hours per day, meaningful, long-term relationships with patients, and burnout. Multivariate logit models with survey design provided nationally representative individual-level estimates.

KEY RESULTS

Among 1289 respondents, 85.8% and 86.5% were satisfied with their career and life, respectively; 88.6% had high life meaning; 54.5% and 79.5% intended to retain time in direct patient care and continue clinical practice, respectively. Sense of calling was strongly positively associated with high life meaning (odds ratio [OR] 5.14, 95% confidence interval [95% CI] 2.87-9.19) and commitment to direct patient care (OR 2.50, 95% CI 1.53-4.07). Personally rewarding hours per day were most strongly associated with career satisfaction (OR 5.28, 95% CI 2.72-10.2), life satisfaction (OR 4.46, 95% CI 2.34-8.48), and commitment to clinical practice (OR 3.46, 95% CI 1.87-6.39). Long-term relationships with patients were positively associated with career and life satisfaction and high life meaning. Burnout was strongly negatively associated with all measures of physician well-being.

CONCLUSIONS

Intrinsic motivators (e.g., calling) were associated with each measure of physician well-being (satisfaction, meaning, and commitment), but extrinsic motivators (e.g., annual income) were not associated with meaning or commitment. Understanding the effects of intrinsic motivators may help inform efforts to support physician well-being.

Motivation of Dutch high school students from various backgrounds for applying to study medicine: a qualitative study

OBJECTIVE

To explore high school students' motivation for applying to study medicine and the factors that influence this. To find explanations for under-representation of minority students in medical education, descriptions of motivation of students with different background characteristics were compared.

DESIGN

Qualitative phenomenological study using semistructured one-on-one interviews.

SETTING

One predominantly white and one mixed high school in a large multicultural city in the Netherlands. The study was conducted in March-December 2015.

PARTICIPANTS

Twenty-four high school students, purposively sampled for demographic characteristics.

METHODS

The analysis consisted of the coding of data using a template based on the motivation types (autonomous and controlled motivation) described by self-determination theory and open coding for factors that influence motivation.

RESULTS

The main reasons for pursuing a medical career pertained to autonomous motivation (interest in science and helping people), but controlled motivation (eg, parental pressure, prestige) was also mentioned. Experiences with healthcare and patients positively influenced students' autonomous motivation and served as a reality check for students' expectations. Having to go through a selection process was an important demotivating factor, but did not prevent most students from applying. Having medical professionals in their network also sparked students' interest, while facilitating easier access to healthcare experiences.

CONCLUSIONS

The findings showed a complex interplay between healthcare experiences, growing up in a medical family, selection processes and motivation. Healthcare experiences, often one of the selection criteria, help students to form autonomous motivation for studying medicine. However, such experiences as well as support in the selection process seem unequally accessible to students. As a result, under-represented students' motivation decreases. Medical schools should be aware of this and could create opportunities to acquire healthcare experiences. High schools could incorporate internships as part of their study counselling programmes and offer tailor-made guidance to each individual student.

The Association Between a Sense of Calling and Physician Well-Being: A National Study of Primary Care Physicians and Psychiatrists

OBJECTIVE

This study assesses the association between calling and physician well-being, clinical commitment, and burnout.

METHODS

In 2009-2010, a survey was mailed to 1504 primary care physicians (PCPs) and 512 psychiatrists drawn from the American Medical Association Physician Masterfile. The primary independent variable was a single-item measure that assessed physicians' level of calling. Main outcomes were markers of physician well-being (career satisfaction and morale), clinical commitment (intentions to reduce time spent in direct patient care, leave practice in a few years), and experiences of burnout.

RESULTS

Adjusted response rates were 63 % (896/1427) for PCPs and 64 % (312/487) for psychiatrists. Forty-two percent of US PCPs and psychiatrists agree strongly that their practice of medicine is a calling. Physicians with a high sense of calling were less likely than those with low to report regret in choosing medicine as a career (18 vs. 38 %; odds ratio 0.3; 95 % confidence interval, 0.2-0.5), wanting to go into a different clinical specialty (28 vs. 49 %; OR 0.4; 95 % CI, 0.2-0.6), or wanting to leave the practice of medicine in the next few years (14 vs. 25 %, OR 0.4; 95 % CI 0.2-0.7). Physicians with a high sense of calling were less likely to report burnout (17 vs. 31 % low calling, OR 0.4; 95 % CI 0.3 to 0.7).

CONCLUSIONS

Physicians who reported that medicine was a calling may be experiencing higher levels of career satisfaction, more durable clinical commitments, and resilience from burnout. Though physicians may differ on their understanding of the concept of calling in medicine, this study highlights an important factor that should be investigated further when assessing long-term workforce retention in the fields of primary care and psychiatry.

Association Between Physician Burnout and Identification With Medicine as a Calling

OBJECTIVE

To evaluate the association between degree of professional burnout and physicians' sense of calling.

PARTICIPANTS AND METHODS

US physicians across all specialties were surveyed between October 24, 2014, and May 29, 2015. Professional burnout was assessed using a validated single-item measure. Sense of calling, defined as committing one's life to personally meaningful work that serves a prosocial purpose, was assessed using 6 validated true-false items. Associations between burnout and identification with calling items were assessed using multivariable logistic regressions.

RESULTS

A total of 2263 physicians completed surveys (63.1% response rate). Among respondents, 28.5% (n=639) reported experiencing some degree of burnout. Compared with physicians who reported no burnout symptoms, those who were completely burned out had lower odds of finding their work rewarding (odds ratio [OR], 0.05; 95% CI, 0.02-0.10; P<.001), seeing their work as one of the most important things in their lives (OR, 0.38; 95% CI, 0.21-0.69; P<.001), or thinking their work makes the world a better place (OR, 0.38; 95% CI, 0.17-0.85; P=.02). Burnout was also associated with lower odds of enjoying talking about their work to others (OR, 0.23; 95% CI, 0.13-0.41; P<.001), choosing their work life again (OR, 0.11; 95% CI, 0.06-0.20; P<.001), or continuing with their current work even if they were no longer paid if they were financially stable (OR, 0.30; 95% CI, 0.15-0.59; P<.001).

CONCLUSION

Physicians who experience more burnout are less likely to identify with medicine as a calling. Erosion of the sense that medicine is a calling may have adverse consequences for physicians as well as those for whom they care.

Physician Burnout and the Calling to Care for the Dying: A National Survey

BACKGROUND

Physician burnout raises concerns over what sustains physicians' career motivations. We assess whether physicians in end-of-life specialties had higher rates of burnout and/or calling to care for the dying. We also examined whether the patient centeredness of the clinical environment was associated with burnout.

METHODS

In 2010 to 2011, we conducted a national survey of US physicians from multiple specialties. Primary outcomes were a validated single-item measure of burnout or sense of calling to end-of-life care. Primary predictors of burnout (or calling) included clinical specialty, frequency of encounters with dying patients, and patient centeredness of the clinical environments ("My clinical environment prioritizes the need of the patient over maximizing revenue").

RESULTS

Adjusted response rate among eligible respondents was 62% (1156 of 1878). Nearly a quarter of physicians (23%) experienced burnout, and rates were similar across all specialties. Half of the responding physicians (52%) agreed that they felt called to take care of patients who are dying. Burned-out physicians were more likely to report working in profit-centered clinical environments (multivariate odds ratio [OR] of 1.9; confidence interval [CI]: 1.3-2.8) or experiencing emotional exhaustion when caring for the dying (multivariate OR of 2.1; CI: 1.4-3.0). Physicians who identified their work as a calling were more likely to work in end-of-life specialties, to feel emotionally energized when caring for the dying, and to be religious.

CONCLUSION

Physicians from end-of-life specialties not only did not have increased rates of burnout but they were also more likely to report a sense of calling in caring for the dying.

Race-Conscious Professionalism and African American Representation in Academic Medicine

African Americans remain substantially less likely than other physicians to hold academic appointments. The roots of these disparities stem from different extrinsic and intrinsic forces that guide career development. Efforts to ameliorate African American underrepresentation in academic medicine have traditionally focused on modifying structural and extrinsic barriers through undergraduate and graduate outreach, diversity and inclusion initiatives at medical schools, and faculty development programs. Although essential, these initiatives fail to confront the unique intrinsic forces that shape career development. America's ignoble history of violence, racism, and exclusion exposes African American physicians to distinct personal pressures and motivations that shape professional development and career goals. This article explores these intrinsic pressures with a focus on their historical roots; reviews evidence of their effect on physician development; and considers the implications of these trends for improving African American representation in academic medicine. The paradigm of "race-conscious professionalism" is used to understand the dual obligation encountered by many minority physicians not only to pursue excellence in their field but also to leverage their professional stature to improve the well-being of their communities. Intrinsic motivations introduced by race-conscious professionalism complicate efforts to increase the representation of minorities in academic medicine. For many African American physicians, a desire to have their work focused on the community will be at odds with traditional paths to professional advancement. Specific policy options are discussed that would leverage race-conscious professionalism as a draw to a career in academic medicine, rather than a force that diverts commitment elsewhere.

Motivation of health workers and associated factors in public hospitals of West Amhara, Northwest Ethiopia

BACKGROUND

Health professionals' motivation reflects the interaction between health professionals and their work environment. It can potentially affect the provision of health services; however, this important attribute of the workplace climate in public hospitals is not usually given serious attention to the desired level. For this reason, the authors of this study have assessed the level of motivation of health professionals and associated factors in public hospitals of West Amhara, Northwest Ethiopia.

METHODS

A facility based cross-sectional study was conducted in eight public hospitals of West Amhara from June 1 to July 30, 2013. A total of 304 health professionals were included in this study. The collected data were analyzed using SPSS software version 20. The reliability of the instrument was assessed through Cronbach's α. Factor scores were generated for the items found to represent the scales (eigenvalue greater than one in varimax rotation) used in the measurement of the variables. The scores were further analyzed using one-way analysis of variance, t-tests, Pearson's correlation, and hierarchical multiple linear regression analyses. The cut-off point for the regression analysis to determine significance was set at β (95% confidence interval, P<0.05).

RESULTS

Mean motivation scores (as the percentage of maximum scale scores) were 58.6% for the overall motivation score, 71.0% for the conscientiousness scale, 52.8% for the organizational commitment scale, 58.3% for the intrinsic motivation scale, and 64.0% for organizational burnout scale. Professional category, age, type of the hospital, nonfinancial motivators like performance evaluation and management, staffing and work schedule, staff development and promotion, availability of necessary resources, and ease of communication were found to be strong predictors of health worker motivation. Across the hospitals and professional categories, health workers' overall level of motivation with absolute level of compensation was not significantly associated with their overall level of motivation.

CONCLUSION

The strongest drivers of all motivation dimensions were found to be nonfinancial human resource management tools, so policy makers and health workforce stake holders should focus on these tools to alleviate motivation problems.

Medical school ranking and medical student vocational identity

PHENOMENON: Vocational identity may play an important role in physicians' healthy professional development. Allopathic medical students' vocational identity may bear a relationship to the level of emphasis placed on research versus service at their medical school.

APPROACH

Social mission score (SMS) and the US News and World Report (USNWR) research ranking (year 2011) were used as schools' national rankings for service and research, respectively. A questionnaire was sent to 960 3rd-year medical students from 24 allopathic medical schools between January and April 2011. The scale for vocational identity was created using the responses from the Vocational Identity Scale (9 items), and we used an established cutoff from a previous study to categorize those students who had "strong" vocational identity.

FINDINGS

After categorizing allopathic medical schools into four groups based on SMS rankings, we found that medical students who attended allopathic medical schools from the two highest SMS ranking groups were more likely to report scores reflecting strong vocational identities-odds ratio [OR] = 2.9, 95% confidence interval (CI) [1.8, 4.7] and OR = 2.5, 95% CI [1.6, 4.0], respectively. In contrast, we did not find any associations between students from allopathic medical schools with high USNWR rankings and likelihood of reporting scores reflecting strong vocational identities. Insights: Social mission scores for allopathic medical schools may potentially serve as predictors of professional and vocational identity development. Further research is needed to better understand these findings, as this is one of the first studies both to examine allopathic medical students' sense of vocational identity and to explore the use of SMS rankings as predictors of medical students' professional development.

Addressing health disparities in the undergraduate curriculum: an approach to develop a knowledgeable biomedical workforce

Disparities in health and healthcare are a major concern in the United States and worldwide. Approaches to alleviate these disparities must be multifaceted and should include initiatives that touch upon the diverse areas that influence the healthcare system. Developing a strong biomedical workforce with an awareness of the issues concerning health disparities is crucial for addressing this issue. Establishing undergraduate health disparities courses that are accessible to undergraduate students in the life sciences is necessary to increase students' understanding and awareness of these issues and motivate them to address these disparities during their careers. The majority of universities do not include courses related to health disparities in their curricula, and only a few universities manage them from their life sciences departments. The figures are especially low for minority-serving institutions, which serve students from communities disproportionally affected by health disparities. Universities should consider several possible approaches to infuse their undergraduate curricula with health disparities courses or activities. Eliminating health disparities will require efforts from diverse stakeholders. Undergraduate institutions can play an important role in developing an aware biomedical workforce and helping to close the gap in health outcomes.

Capacity of middle management in health-care organizations for working with people-the case of Slovenian hospitals

BACKGROUND

Effective human resources management plays a vital role in the success of health-care sector reform. Leaders are selected for their clinical expertise and not their management skills, which is often the case at the middle-management level. The purpose of this study was to examine the situation in some fields that involve working with people in health-care organizations at middle-management level.

METHODS

The study included eight state-owned hospitals in Slovenia. A cross-sectional study included 119 middle managers and 778 employees. Quota sampling was used for the subgroups. Structured survey questionnaires were administered to leaders and employees, each consisting of 24 statements in four content sets evaluated on a 5-point Likert-type scale. Respondents were also asked about the type and number of training or education programmes they had participated in over the last three years. Descriptive statistics, two-way analysis of variance, Pearson's correlation coefficient and multiple linear regression were used. The study was conducted from March to December 2008.

RESULTS

Statistically significant differences were established between leaders and employees in all content sets; no significant differences were found when comparing health-care providers and health-administration workers. Employment position was found to be a significant predictor for employee development (β = 0.273, P < 0.001), the leader-employee relationship (β = 0.291, P < 0.001) and organizational motivation (β = 0.258, P < 0.001). Area of work (β = 0.113, P = 0.010) and employment position (β = 0.389, P < 0.001) were significant predictors for personal involvement. Level of education correlated negatively with total scores for organizational motivation: respondents with a higher level of education were rated with a lower score (β = -0.117, P = 0.024). Health-care providers participate in management programmes less frequently than do health-administration workers.

CONCLUSION

Employee participation in change-implementation processes was low, as was awareness of the importance of employee development. Education of employees in Slovenian hospitals for leadership roles is still not perceived as a necessary investment for improving work processes. Hospitals are state owned and a national strategy should be developed on how to improve leadership and management in Slovenian hospitals.

Motivation and job satisfaction among medical and nursing staff in a Cyprus public general hospital

BACKGROUND

The objective of this study was to investigate how medical and nursing staff of the Nicosia General Hospital is affected by specific motivation factors, and the association between job satisfaction and motivation. Furthermore, to determine the motivational drive of socio-demographic and job related factors in terms of improving work performance.

METHODS

A previously developed and validated instrument addressing four work-related motivators (job attributes, remuneration, co-workers and achievements) was used. Two categories of health care professionals, medical doctors and dentists (N = 67) and nurses (N = 219) participated and motivation and job satisfaction was compared across socio-demographic and occupational variables.

RESULTS

The survey revealed that achievements was ranked first among the four main motivators, followed by remuneration, co-workers and job attributes. The factor remuneration revealed statistically significant differences according to gender, and hospital sector, with female doctors and nurses and accident and emergency (A+E) outpatient doctors reporting greater mean scores (p < 0.005). The medical staff showed statistically significantly lower job satisfaction compared to the nursing staff. Surgical sector nurses and those >55 years of age reported higher job satisfaction when compared to the other groups.

CONCLUSIONS

The results are in agreement with the literature which focuses attention to management approaches employing both monetary and non-monetary incentives to motivate health care professionals. Health care professionals tend to be motivated more by intrinsic factors, implying that this should be a target for effective employee motivation. Strategies based on the survey's results to enhance employee motivation are suggested.

What do gastroenterology trainees want: recognition, remuneration or recreation?

BACKGROUND

Occupational psychologists have identified three factors important in motivating physicians: financial reward, academic recognition, time off.

AIM

To assess motivators among gastroenterology (GI) trainees.

METHODS

A questionnaire was distributed to GI trainees to assess their motivators: (1) work fewer hours for less lucrative rate, (2) reduction in salary/increase in hours for academic protected time, and (3) work longer hours for higher total salary, but less lucrative hourly rate.

RESULTS

Overall, 61 trainees responded; 52% of trainees would work shorter hours for less lucrative rate; 60% would accept a disproportionate reduction in salary/increase in hours for academic protected time; 54% would work longer hours for more money but less lucrative rate. Most trainees (93%) accepted at least one scenario.

CONCLUSIONS

Most GI trainees are willing to modify their job description to align with their personal values. Tailoring job descriptions according to these values can yield economic benefits to GI Divisions.

Implications of academic medicine's failure to recognize clinical excellence

OBJECTIVE

To better understand the implications of inadequately recognizing clinical excellence in academia by exploring the perspectives of clinically excellent faculty within prominent American departments of medicine.

DESIGN

Qualitative study.

SETTING

8 academic institutions.

PARTICIPANTS

24 clinically excellent department of medicine physicians.

METHODS

Between March 1 and May 31, 2007, investigators conducted in-depth semi-structured interviews with 24 clinically excellent physicians at leading academic institutions. Interview transcripts were independently coded by two investigators and compared for agreement. Content analysis identified themes related to clinical excellence in academia.

RESULTS

Twenty informants (83%) were Associate Professors or Professors, 8 (33%) were females, and the physicians hailed from a wide range of internal medicine specialties. The mean percent effort spent in clinical care by the physicians was 48%. The five domains that emerged related to academic medicine's failure to recognize clinical excellence were: (1) low morale and prestige among clinicians, (2) less than excellent patient care, (3) loss of talented clinicians, (4) a lack of commitment to improve patient care systems, and (5) fewer excellent clinician role models to inspire trainees.

CONCLUSIONS

If academic medical centers fail to recognize clinical excellence among its physicians, they may be doing a disservice to the patients that they pledge to serve. It is hoped that initiatives aiming to measure clinical performance in our academic medical centers will translate into meaningful recognition for those achieving excellence such that outstanding clinicians may feel valued and decide to stay in academia.