Measuring and predicting academic generalists' work satisfaction: implications for retaining faculty

Assessment of Areas of Worklife Among Pharmacy Educators

Objective. To assess in pharmacy academicians the six domains of worklife (community, control, fairness, reward, workload, values) that have been associated with burnout and poor job satisfaction.Methods. We aimed to assess the Areas of Worklife Survey (AWS) among a sample of pharmacy academicians attending a national meeting to evaluate personal, environmental, or workplace factors that may influence the worklife environment. Data were analyzed using SPSS, descriptive statistics were identified, and Kruskal-Wallis and Pearson correlations were performed.Results. The participant response rate was 40% (n=49/121 attendees). Eighty-eight percent of participants reported working more than 40 hours per week. Mean AWS scores ranged from 2.7 to 3.9 (whereby 1 indicated a strong mismatch between person and work environment and 5 indicated a strong match). The workload and fairness domains had the lowest reported scores, whereas control had the highest. Higher mean scores were reported for control and reward in those with a mentor and for fairness in those having a hobby.Conclusion. Participants gave the lowest ratings to two worklife areas, workload and fairness. Developing targeted interventions, such as in mentorship, hobbies, and transparency in the work setting, may be important for preventing burnout in pharmacy academicians. Further studies in a larger population may help to determine factors associated with the areas of worklife that received low ratings.

Current Status and Best Practices of Shared Governance in US Pharmacy Programs

Objective. To characterize shared governance in US schools and colleges of pharmacy and recommend best practices to promote faculty engagement and satisfaction. Findings. The literature review revealed only one study on governance in a pharmacy school and some data from an AACP Faculty Survey. Of the 926 faculty members who responded to the survey, the majority were satisfied or very satisfied with faculty governance (64%) and the level of input into faculty governance (63%) at their school. Faculty members in administrative positions and those at public institutions were more satisfied with governance. The forum resulted in the development of five themes: establish a clear vision of governance in all areas; ensure that faculty members are aware of their roles and responsibilities within the governance structure; ensure faculty members are able to join committees of interest; recognize and reward faculty contributions to governance; and involve all full-time faculty members in governance, regardless of their tenure status. Summary. Establishing shared governance within a school or college of pharmacy impacts overall faculty satisfaction and potentially faculty retention.

Facility evaluation of resigned hospital physicians:managerial implications for hospital physician manpower

INTRODUCTION

Turnover of physicians might be responsible for reducing patients' trust and affecting hospital performance. This study aimed to understand physicians' psychological status regarding their hospital work environment and the resources of independent practitioners.

METHOD

This was a cross-sectional study with 774 physicians who had resigned from hospitals and were now practicing privately in clinics in Taichung City as its study population. A mail survey with a multidimensional questionnaire was sent to each subject.

RESULTS

This study revealed that older physicians were less satisfied regarding the work environment in their respective former hospitals. Male physicians were found to be more satisfied with the tangible resources of their hospitals. Internal medicine physicians were found to be less satisfied overall with the intangible resources. Gynecologists and pediatricians were found to be more satisfied with their hospital environments. The physicians who worked long hours per week reported that they were less satisfied with their job content. The physicians who had opportunities to learn advanced skills and enhance their knowledge were more satisfied with their hospital environment, tangible resources, and intangible resources. In addition, physicians in private hospitals were found to be more satisfied with their job content, but they were less satisfied with work motivation and retention and intangible resources. In addition, physicians who worked in hospitals located in Taichung city reported that they were less satisfied with their tangible resources than the physicians working in hospitals outside of the city.

CONCLUSION

This study focused on the satisfaction of physicians who had already left their respective hospitals instead of current retained physicians. From this study, it is our recommendation that hospital managers should pay closer attention to the real needs and expectations of the physicians they employ, and managers should consider adjusting their managerial perspectives when establishing new human resources policies or making decisions.

Predictors of workplace satisfaction for U.S. medical school faculty in an era of change and challenge

PURPOSE

To examine the current state of satisfaction with the academic medicine workplace among U.S. medical school faculty and the workplace factors that have the greatest influence on global satisfaction.

METHOD

The authors used data from the 2009 administration of a medical school faculty job satisfaction survey and used descriptive statistics and χ analyses to assess levels of overall satisfaction within faculty subgroups. Multiple regressions used the mean scores of the 18 survey dimensions and demographic variables to predict three global satisfaction measures.

RESULTS

The survey was completed by 9,638 full-time faculty from 23 U.S. medical schools. Respondents were mostly satisfied on global satisfaction measures including satisfaction with their department (6,506/9,128; 71.3%) and medical school (5,796/9,124; 63.5%) and whether they would again choose to work at their medical school (5,968/8,506; 70.2%). The survey dimensions predicted global satisfaction well, with the final models explaining 51% to 67% of the variance in the dependent measures. Predictors across models include organization, governance, and transparency; focus of mission; recruitment and retention effectiveness; department relationships; workplace culture; and nature of work.

CONCLUSIONS

Despite the relatively unpredictable environmental challenges facing medical schools today, leaders have opportunities to influence and improve the workplace satisfaction of their faculty. Examples of opportunities include fostering a culture characterized by open communication and occasions for faculty input, and remaining vigilant regarding factors contributing to faculty burnout. Understanding what drives faculty satisfaction is crucial for medical schools as they continue to seek excellence in all missions and recruit and retain high-quality faculty.

Predictors of job satisfaction among academic faculty members: do instructional and clinical staff differ?

OBJECTIVES

This study aimed to identify and compare predictors of job satisfaction between instructional and clinical faculty members.

METHODS

A 61-item faculty job satisfaction survey was distributed to 1898 academic faculty members at the University of Michigan Medical School. The anonymous survey was web-based. Questions covered topics on departmental organisation, research, clinical and teaching support, compensation, mentorship, and promotion. Levels of satisfaction were contrasted between faculty members on the two tracks, and predictors of job satisfaction were identified using linear regression models.

RESULTS

Response rates for the instructional and clinical faculty groups were 43.1% and 46.7%, respectively. Clinical faculty members reported being less satisfied with how they were mentored and fewer reported understanding the process for promotion. There was no significant difference in overall job satisfaction between the two faculty groups. Surprisingly, clinical faculty members with mentors were significantly less satisfied with how they were mentored and with career advancement, and were significantly less likely to choose an academic career if they had to do it all over again compared with instructional faculty mentees. Additionally, senior-level clinical faculty members were significantly less satisfied with their opportunities to mentor junior faculty members compared with senior-level instructional faculty staff. Significant predictors of job satisfaction for both groups included areas of autonomy, meeting career expectations, work-life balance, and departmental leadership. In the clinical track only, compensation and career advancement variables also emerged as significant predictors of overall job satisfaction.

CONCLUSIONS

Greater emphasis must be placed on faculty members' well-being at both the institutional level and the level of departmental leadership. Efforts to enhance job satisfaction and improve retention are more likely to succeed if they are directed by locally designed assessments involving department chairs and are specifically aimed at fostering more effective mentoring relationships and increasing the opportunities available for career advancement activities such as research work. Our findings show that these strategies can have significant impacts on job satisfaction and the retention of clinical track faculty members.

The relationship between social capital in hospitals and physician job satisfaction

BACKGROUND

Job satisfaction in the hospital is an important predictor for many significant management ratios. Acceptance in professional life or high workload are known as important predictors for job satisfaction. The influence of social capital in hospitals on job satisfaction within the health care system, however, remains to be determined. Thus, this article aimed at analysing the relationship between overall job satisfaction of physicians and social capital in hospitals.

METHODS

The results of this study are based upon questionnaires sent by mail to 454 physicians working in the field of patient care in 4 different German hospitals in 2002. 277 clinicians responded to the poll, for a response rate of 61%. Analysis was performed using three linear regression models with physician overall job satisfaction as the dependent variable and age, gender, professional experience, workload, and social capital as independent variables.

RESULTS

The first regression model explained nearly 9% of the variance of job satisfaction. Whereas job satisfaction increased slightly with age, gender and professional experience were not identified as significant factors to explain the variance. Setting up a second model with the addition of subjectively-perceived workload to the analysis, the explained variance increased to 18% and job satisfaction decreased significantly with increasing workload. The third model including social capital in hospital explained 36% of the variance with social capital, professional experience and workload as significant factors.

CONCLUSION

This analysis demonstrated that the social capital of an organisation, in addition to professional experience and workload, represents a significant predictor of overall job satisfaction of physicians working in the field of patient care. Trust, mutual understanding, shared aims, and ethical values are qualities of social capital that unify members of social networks and communities and enable them to act cooperatively.

Effects of resident work hour limitations on faculty professional lives

BACKGROUND

The Accreditation Council for Graduate Medical Education resident work hour limitations were implemented in July, 2003. Effects on faculty are not well understood.

OBJECTIVE

The objective of this study was to determine the effects of the resident work hour limitations on the professional lives of faculty physicians.

DESIGN AND PARTICIPANTS

Survey of faculty physicians at three teaching hospitals associated with university-based internal medicine and surgery residency programs in Seattle, Washington. Physicians who attended on Internal Medicine and Surgery in-patient services during the 10 mo after implementation of work hour limitations were eligible for participation (N = 366); 282 physicians (77%) returned surveys.

MEASUREMENTS

Participants were asked about the effects of resident work hour limitations on aspects of their professional lives, including clinical work, research, teaching, and professional satisfaction.

RESULTS

Most attending physicians reported that, because of work hour limitations, they spent more time on clinical work (52%), felt more responsibility for supervising patient care (65%), and spent less time on research or other academic pursuits (51%) and teaching residents (72%). Reported changes in work content were independently associated with the self-reported probability of leaving academic medicine in the next 3 y.

CONCLUSIONS

Resident work hour limitations have had large effects on the professional lives of faculty. These findings may have important implications for recruiting and retaining faculty at academic medical centers.

The polity of academic medicine: evidence-based democracy

The authors consider the empirical data examining relationships between democratic governance and organizational success. There is overwhelming evidence that democratically run organizations excel in key parameters of success, such as business valuation, productivity, responsiveness, innovation, decision making, and worker morale and satisfaction. A review of physician surveys shows that discontent with academic administration is a major contributor to faculty turnover. Other data indicate that the basic concepts justifying autocratic governance of a department are deeply flawed and that autocratic governance is counterproductive. The authors conclude that the democratic governance of academic departments is the only model that is scientifically valid and would greatly enhance all missions of academic medicine in the 21st century.

Faculty attrition in obstetrics and gynecology

OBJECTIVE

The purpose of this study was to explore why obstetrician/gynecologists leave academic practice.

STUDY DESIGN

From a sample of 5000 ACOG fellows, we identified obstetrician/gynecologists in faculty positions and those who had left academic practice. These groups were sent a survey to explore aspects of job satisfaction. Relationships between variables were tested using chi2 analyses. Means were computed for each subscale and differences between current and past faculty were tested with a multivariate analysis of variance model.

RESULTS

There was a 65% response rate to the job satisfaction survey for a total of 280 current faculty and 146 previous faculty. There was no difference between the groups in job satisfaction. Faculty rated opportunities for teaching and administration more important as components of job satisfaction. Practitioners who left academics were more likely to be previous junior faculty and generalists.

CONCLUSION

Junior faculty and generalists are more likely to leave academic practice than senior faculty and subspecialists.

Career choice in academic medicine: systematic review

OBJECTIVES

To review systematically the evidence about what factors influence the decision to choose or not choose a career in academic medicine.

DESIGN

A systematic review of relevant literature from 1990 to May 2005.

DATA SOURCES

Searches of The Cochrane Library, Medline (using Ovid and PubMed) from 1990 to May 2005, and EMBASE from 1990 to May 2005 were completed to identify relevant studies that explored the influential factors. Additional articles were identified from searching the bibliographies of retrieved articles.

SELECTION OF STUDIES

We attempted to identify studies that included residents, fellows, or staff physicians. No restrictions were placed on the study methodologies identified and all articles presenting empirical evidence were retrieved. For cohort, case-control, and cross-sectional studies, minimum inclusion criteria were the presence of defined groups, and the ability to extract relevant data. For surveys that involved case series, minimum inclusion criteria were a description of the population, and the availability of extractable data. Minimum inclusion criteria for qualitative studies were descriptions of the sampling strategy and methods.

RESULTS

The search identified 251 abstracts; 25 articles were included in this review. Completion of an MD with a graduate degree or fellowship program is associated with a career in academic medicine. Of the articles identified in this review, this finding is supported by the highest quality of evidence. Similarly, the completion of research and publication of this research in medical school and residency are associated with a career in academic medicine. The desire to teach, conduct research, and the intellectual stimulation and challenge provided in academia may also persuade people to choose this career path. The influence of a role model or a mentor was reported by physicians to impact their decision making. Trainees' interest in academic medicine wanes as they progress through their residency.

CONCLUSIONS

In order to revitalize academic medicine, we must engage trainees and retain their interest throughout their training. Research opportunities for medical students, and fellowships or graduate training can meet this challenge and influence career choice. Initiatives to stimulate and maintain interest in academic medicine should be evaluated in prospective studies across multiple sites.

Developing and testing an instrument for identifying performance incentives in the Greek health care sector

BACKGROUND

In the era of cost containment, managers are constantly pursuing increased organizational performance and productivity by aiming at the obvious target, i.e. the workforce. The health care sector, in which production processes are more complicated compared to other industries, is not an exception. In light of recent legislation in Greece in which efficiency improvement and achievement of specific performance targets are identified as undisputable health system goals, the purpose of this study was to develop a reliable and valid instrument for investigating the attitudes of Greek physicians, nurses and administrative personnel towards job-related aspects, and the extent to which these motivate them to improve performance and increase productivity.

METHODS

A methodological exploratory design was employed in three phases: a) content development and assessment, which resulted in a 28-item instrument, b) pilot testing (N = 74) and c) field testing (N = 353). Internal consistency reliability was tested via Cronbach's alpha coefficient and factor analysis was used to identify the underlying constructs. Tests of scaling assumptions, according to the Multitrait-Multimethod Matrix, were used to confirm the hypothesized component structure.

RESULTS

Four components, referring to intrinsic individual needs and external job-related aspects, were revealed and explain 59.61% of the variability. They were subsequently labeled: job attributes, remuneration, co-workers and achievement. Nine items not meeting item-scale criteria were removed, resulting in a 19-item instrument. Scale reliability ranged from 0.782 to 0.901 and internal item consistency and discriminant validity criteria were satisfied.

CONCLUSION

Overall, the instrument appears to be a promising tool for hospital administrations in their attempt to identify job-related factors, which motivate their employees. The psychometric properties were good and warrant administration to a larger sample of employees in the Greek healthcare system.

Viewpoint: enhancing the professional fulfillment of physicians

Academic medical centers (AMCs) devote countless hours to studying the diagnosis and treatment of disease, yet little or no time to determining the factors that enhance or detract from physicians' professional fulfillment. This is unfortunate because physicians' degree of professional engagement, the quality of care they provide, and their tendency to burn out all depend on the fulfillment they find in work.Indeed, if AMCs are to thrive, it is vital to understand and promote the professional fulfillment of physicians. This article reviews the sources of professional fulfillment among physicians and outlines ways to enhance it within physicians' organizations.

The role of cultural diversity climate in recruitment, promotion, and retention of faculty in academic medicine

BACKGROUND

Ethnic diversity among physicians may be linked to improved access and quality of care for minorities. Academic medical institutions are challenged to increase representation of ethnic minorities among health professionals.

OBJECTIVES

To explore the perceptions of physician faculty regarding the following: (1) the institution's cultural diversity climate and (2) facilitators and barriers to success and professional satisfaction in academic medicine within this context.

DESIGN

Qualitative study using focus groups and semi-structured interviews.

PARTICIPANTS

Nontenured physicians in the tenure track at the Johns Hopkins University School of Medicine.

APPROACH

Focus groups and interviews were audio-taped, transcribed verbatim, and reviewed for thematic content in a 3-stage independent review/adjudication process.

RESULTS

Study participants included 29 faculty representing 9 clinical departments, 4 career tracks, and 4 ethnic groups. In defining cultural diversity, faculty noted visible (race/ethnicity, foreign-born status, gender) and invisible (religion, sexual orientation) dimensions. They believe visible dimensions provoke bias and cumulative advantages or disadvantages in the workplace. Minority and foreign-born faculty report ethnicity-based disparities in recruitment and subtle manifestations of bias in the promotion process. Minority and majority faculty agree that ethnic differences in prior educational opportunities lead to disparities in exposure to career options, and qualifications for and subsequent recruitment to training programs and faculty positions. Minority faculty also describe structural barriers (poor retention efforts, lack of mentorship) that hinder their success and professional satisfaction after recruitment. To effectively manage the diversity climate, our faculty recommended 4 strategies for improving the psychological climate and structural diversity of the institution.

CONCLUSIONS

Soliciting input from faculty provides tangible ideas regarding interventions to improve an institution's diversity climate.

A Longitudinal Study of Determinants of Career Satisfaction in Medical Students

CONTEXT

There is evidence of significant career dissatisfaction among practicing physicians and those considering medicine as a profession. Most research on career satisfaction has examined practicing physicians. This study was undertaken to look at determinants of satisfaction in those at the earliest stage of their medical careers - medical students.

METHODS

As part of a larger study, students comprising one class at the University of Washington School of Medicine were surveyed three times over the course of their medical education. For the present study we examined measures specifically related to determinants of career satisfaction.

FINDINGS

Over time, students' sense of the importance of most measured determinants of satisfaction showed significant change, the majority of which were in the direction of decreased importance. However, most of the change was relative. That is, factors that students considered to be most important at the start of medical school continued to be most important throughout the educational experience and those factors students considered to be least important at Year 1 continued to be least important at Years 2 and 4.

DISCUSSION

These findings have implications for medical education, a time when students are forming expectations that will impact their career satisfaction. In addition to information on career satisfaction, students should understand the professional values of medicine, their own values and expectations, current practice patterns, economics, and the role of advocacy.

Resident job satisfaction: will 80 hours make a difference?

OBJECTIVE

This study was undertaken to assess job satisfaction and quality of life among obstetrics and gynecology residents before the 80-hour work week.

STUDY DESIGN

We administered a job satisfaction survey to residents before July 1, 2003, assessing satisfaction with residency training, indicators of current quality of life, and predictions for the effect of reduced work hours.

RESULTS

Residents were satisfied with training, with important outliers, including leisure time, ability to pursue educational reading, and surgical experience. We created job satisfaction facets that were generally reliable constructs and valid predictors for overall residency satisfaction. Residents predict more free time and a healthier lifestyle under the new requirements, but do not anticipate using additional time to study or teach.

CONCLUSION

Job satisfaction facets for residents are proposed here and may be refined through further study. Lower scores for surgical experience are of concern in light of decreasing work hours. Educators must monitor self-directed learning efforts under new work hours.

Results of an academic promotion and career path survey of faculty at the Johns Hopkins University School of Medicine

PURPOSE

Clinician-educator faculty are increasing in numbers in academic medical centers, but their academic advancement is slower than that of research faculty. The authors sought to quantify the magnitude of this difference in career advancement and to explore the characteristics of faculty that might explain the difference.

METHOD

In 1999, a questionnaire was administered to all MD faculty at the rank of instructor and above (259) in the Department of Medicine at the Johns Hopkins University School of Medicine.

RESULTS

A total of 180 (69%) faculty returned questionnaires. Of these, 178 identified with one of four career paths: basic researcher (46), clinical researcher (69), academic clinician (38), or teacher-clinician (25). Career path did not differ by age, gender, rank, years on faculty, hours worked per week, family responsibility, or global work satisfaction. After adjusting for age, gender, time at rank, and work satisfaction, the odds of being at a higher rank were 85% less for academic clinicians (odds ratio,.15; 95% confidence interval, 0.06-0.40) and 69% less for teacher-clinicians (odds ratio,.31; 95% confidence interval, 0.11-0.88) than for basic researchers. Clinical researchers did not differ from basic researchers in the likelihood of being at higher rank. Similarly, compared with basic research faculty, the adjusted odds of being more satisfied with progress towards academic promotion were 92% lower for academic clinicians and 87% lower for teacher-clinicians.

CONCLUSIONS

Clinician-educator faculty were less likely to be at higher rank at this institution than were faculty in research paths. Differences in rank may be explained by lower rank at hire for faculty in these career paths, time available for scholarly activities, or other resources available to support scholarship. Retaining clinician-educators will require further exploration of barriers to promotion inherent to these career paths and methods of modifying these barriers.

The demands of 24/7 coverage: using faculty perceptions to measure fairness of the schedule

OBJECTIVES

Ensuring fair, equitable scheduling of faculty who work 24-hour, 7-day-per-week (24/7) clinical coverage is a challenge for academic emergency medicine (EM). Because most emergency department care is at personally valuable times (evenings, weekends, nights), optimizing clinical work is essential for the academic mission. To evaluate schedule fairness, the authors developed objective criteria for stress of the schedule, modified the schedule to improve equality, and evaluated faculty perceptions. They hypothesized that improved equality would increase faculty satisfaction.

METHODS

Perceived stress was measured for types of clinical shifts. The seven daily shifts were classified as weekday, weekend, or holiday (plus one unique teaching-conference coverage shift). Faculty assigned perceived stress to shifts (ShiftStress) utilizing visual analog scales (VAS). Faculty schedules were measured (ShiftScores) for two years (1998-1999), and ShiftScore distribution of faculty was determined quarterly. Schedules were modified (1999) to reduce interindividual ShiftScore standard deviation (SD). The survey was performed pre- and postintervention.

RESULTS

Preintervention, 26 faculty (100% of eligible) assigned VAS to 22 shifts. Increased stress was perceived in progression (weekday data, 0-10 scale) from day to evening to night (2.07, 5.00, 6.67, respectively) and from weekday to weekend to holiday (day-shift data, 2.07, 4.93, 5.87). The intervention reduced interindividual ShiftScore SD by 21%. Postintervention survey revealed no change in perceived equality or satisfaction.

CONCLUSIONS

Faculty perceived no improvement despite scheduling modifications that improved equality of the schedule and provided objective measures. Other predictors of stress, fairness, and satisfaction with the demanding clinical schedule must be identified to ensure the success of EM faculty.

Physicians' perceptions of institutional and leadership factors influencing their job satisfaction at one academic medical center

PURPOSE

Academic physicians' perceptions about their institution's function and leadership should provide insights toward improving faculty recruitment and retention.

METHOD

The authors surveyed 105 non-management and non-emeritus physicians who had been hired by (57%) or left (43%) the University of Missouri-Columbia School of Medicine (MUHC) in 1991-1998. The questionnaire measured both the importance and the availability of 14 institutional and leadership factors and the physicians' perceptions of satisfaction with their careers. Open-ended questions assessed additional concerns.

RESULTS

In all, 56% of the overall satisfaction scores were unfavorable and, when grouped by faculty department, correlated inversely with departure rates (p =.04). Scores were surprisingly similar between those who left and those who remained at the institution. "Protected time for research or personal use" was the highest faculty priority regardless of level of overall satisfaction. "Equitable distribution of salary/resources" (p =.007) and "trust-communication with chair/division head" (p =.003) predicted good satisfaction independently. Openended responses for remaining at the university related to the pleasant local community (49%), intellectual issues (46%), and humanitarian issues (5%). Responses for considering opportunities elsewhere were administrative frustration (59%), income enhancement (18%), career advancement (9%), academic frustration (9%), and other (5%). Recommendations for enhancing recruitment and retention were fix administrative concerns (45%); improve research (20%), income (9%), physician support (9%), clinical programs (8%), and autonomy (5%); and other (4%).

CONCLUSIONS

Surveying physicians who were recently hired or who have left an institution provides useful information to promote organizational changes that could improve physician retention.

Job satisfaction and workplace characteristics of primary and specialty care physicians at a bimodal medical school

PURPOSE

A few medical schools are highly successful in obtaining research funding and producing primary care physicians. The authors compared the job satisfaction of primary and specialty care faculty at one of these bimodal schools.

METHODS

In 1998, all full-time physician-faculty (n = 408) in 15 clinical departments at the University of Iowa College of Medicine (a bimodal medical school) were sent a questionnaire based on the Price-Mueller model of job satisfaction. Faculty rated their global job satisfaction and perceptions about 18 workplace characteristics, stressors, and supports. Responses of primary and specialty care physicians were compared in these domains.

RESULTS

A total of 71% of surveyed faculty (n = 341) returned usable questionnaires. Primary and specialty care faculty reported similar levels of job satisfaction (p =.20), and similar percentages (51% versus 54%, p =.63) reported overall satisfaction with their jobs at the medical school. However, primary care faculty perceived less opportunity to advance (p <.01), greater professional-role ambiguity (p =.02), less collegiality (p =.02), and less ability to make full use of their clinical skills (p =.01). Primary and specialty care faculty reported similar intentions of leaving the medical school within the coming year (p =.41).

CONCLUSIONS

Primary and specialty care physicians at one bimodal medical school reported similar levels of job satisfaction. However, the primary care physicians rated several important job-related domains lower than did their specialty care colleagues, most notably the opportunity to advance within the medical school.