Interactions with colleagues and their effects on the satisfaction of rural primary care physicians

Social support in the workplace for physicians in specialization training

When becoming a specialist, learning-through-service plays a significant role. The workplace affords good opportunities for learning, but the service-learning period may also impose stress on phycisians in specialization training. In medical work, social support has proved to be a very important factor in managing stress. Social support may afford advantages also for learning and professional identity building. However, little was known about how social support is perceived by doctors in specialization training. This study aimed to understand the perceptions of physicians in specialization training regarding social support communication in their workplace during their learning-through-service period. The study was conducted qualitatively by inductively analyzing the physicians' descriptions of workplace communication. The dataset included 120 essays, 60 each from hospitals and primary healthcare centres. Physicians in specialization training explained the need of social support with the responsibilities and demands of their clinical work and the inability to control and manage their workloads. They perceived that social support works well for managing stress, but also for strengthening relational ties and one's professional identity. A leader's support was perceived as being effective, and both senior and junior colleagues were described as an important source of social support. Also co-workers, such as the individual nurse partner with whom one works, was mentioned as an important source of social support. The results of this study indicate that social support works at the relational and identity levels, which is due to the multi-functional nature of workplace communication. For example, consultation functions as situational problem-solving, but also the tone of social interaction is meaningful. Thus, strengthening one's professional identity or collegial relationships requires further attention to workplace communication. Abbreviations PiST: Physician in specialization training.

Primary care providers and practice locations: examining the relationships

BACKGROUND

The authors conducted a study in which they explored the geographical distributions of primary care dentists, physicians and pharmacists to determine if a spatial pattern existed between provider types across cities in Iowa.

METHODS

The authors analyzed practice locations of primary care providers, including dentists, pharmacists and physicians, at the city and county levels in Iowa for 2000 and 2010. They categorized cities on the basis of types of primary care providers in each city and compared population characteristics.

RESULTS

Among cities with primary care providers of any type, the most common scenario was for all three provider types to be found together. Several cities that had at least one physician and pharmacist but no dentist in 2000 gained one by 2010.

CONCLUSIONS

There appears to be a heterarchy of primary care providers in Iowa cities, with pharmacists more prevalent than physicians and dentists.

CLINICAL IMPLICATIONS

Communities with at least one physician and pharmacist but no dentist may be able to offer new or relocating dentists a competitive opportunity for practice.

U.S. physician satisfaction: a systematic review

INTRODUCTION

There is concern in the US about the burden and potential ramifications of dissatisfaction among physicians. The purpose of this article is to systematically review the literature on US physician satisfaction.

METHODS

A MEDLINE search with the medical subject headings (MeSH) phrases: (physicians OR physician's role OR physician's women) AND (job satisfaction OR career satisfaction OR burnout), limited to humans and abstracts, with 1157 abstracts reviewed. After exclusions by 2 independent reviewers, 97 articles were included. Physician type sampled, sample size/response rate, satisfaction type, and satisfaction results were extracted for each study. Satisfaction trends were extracted from those studies with longitudinal or repeated cross sectional design. Variables associated with satisfaction were extracted from those studies that included multivariate analyses.

RESULTS

Physician satisfaction was relatively stable, with small decreases primarily among primary care physicians (PCPs). The major pertinent mediating factors of satisfaction for hospitalists include both physician factors (age and specialty), and job factors (job demands, job control, collegial support, income, and incentives).

CONCLUSIONS

The majority of factors associated with satisfaction are modifiable. Tangible recommendations for measuring and diminishing dissatisfaction are given.

The shortage of pediatrician workforce in rural areas of Japan

The shortage of physicians is of great concern in Japan. We aim to assess the pediatrician workforce in rural areas of Japan. Data were obtained from a governmental survey that included the number of physicians and child population in each municipality (i.e., 888 cities and 1,466 towns, villages, or rural areas). The supply of pediatricians was evaluated by physician-to-child population ratios of pediatricians and non-pediatricians in pediatric practice, and geographical distributions using Lorenz curves and Gini indices. Lorenz curves are drawn to visualize geographical mal-distribution of physicians and the Gini indices range from 0 to 1, with higher values indicating larger inequity in physician distribution. Between 1996 and 2004, the numbers of pediatricians per 100,000 children increased from 69 to 84 and this increase was constantly observed both in cities, and towns/villages. Lorenz curves showed that both pediatricians and non-pediatricians in pediatric practice were relatively equally distributed in cities. The Gini indices in 1996 and 2004 were 0.337 and 0.321, respectively in pediatricians and 0.264 and 0.278, respectively in non-pediatricians in pediatric practice. In contrast, pediatricians were unequally distributed in rural areas (the Gini indices; 0.723 and 0.703, respectively). In such areas, non-pediatricians in pediatric practice were more equally distributed than pediatricians (0.419 and 0.482, respectively). These results suggest that non-pediatricians in pediatric practice have played a significant role in supporting pediatric care in rural areas. In conclusion, the absolute numbers of pediatricians increased in Japan between 1996 and 2004; however, they were mal-distributed in rural areas.

[Social support and physicians' health]

OBJECTIVES

Over the last decades, social support (SU) has proved to be an important psychological health resource in the prevention of mental and physical illness as well as for the promotion and restoration of general health. This study evaluates the relevance of social support for the health and well-being of physicians.

METHOD

This is a systematic literature review using PubMed from 1970 to 2007 with the keywords "social support", "physicians", "physician's role", and respectively "medical staff, hospital" from medical subheadings (MeSH). From the retrieved articles the additionally relevant keywords "marriage", "spouse", "friends", and "self-help groups" (MeSH) were identified and researched.

RESULTS

Social support with distinct effects on physician's health could be shown in the areas of colleagues and professional network (30 sources), marriage/spouse (47), friends (3), and support groups (13). Female physicians appeared to seek and profit more from SU than did male physicians. Informal friendships have yet to be evaluated thoroughly.

CONCLUSION

In the light of a physician's daily stress, SU appears to be a jeopardized resource that could significantly contribute to the prevention of burnout or other profession-related symptoms or illnesses.

Using the theory of reasoned action to model retention in rural primary care physicians

CONTEXT

Much research attention has focused on medical students', residents', and physicians' decisions to join a rural practice, but far fewer studies have examined retention of rural primary care physicians.

PURPOSE

The current review uses Fishbein and Ajzen's Theory of Reasoned Action (TRA) to organize the literature on the predictors and correlates of retention of rural practicing physicians. TRA suggests turnover behavior is directly predicted by one's turnover intentions, which are, in turn, predicted by one's attitudes about rural practice and perceptions of salient others' (eg, spouse's) attitudes about rural practice and rural living.

METHODS

Narrative literature review of scholarship in predicting and understanding predictors and correlates of rural physician retention.

FINDINGS

The TRA model provides a useful conceptual model to organize the literature on rural physician retention. Physicians' subjective norms regarding rural practice are an important source of influence in the decision to remain or leave one's position, and this relation should be more fully examined in future research.

Rural physician satisfaction: its sources and relationship to retention

This study uses survey data to identify areas of satisfaction and dissatisfaction for primary care physicians working in rural areas across the country. It also identifies the specific areas of satisfaction associated with longer retention within a given rural practice, as well as the characteristics of individuals, practices, jobs, and communities associated with the areas of satisfaction that predict retention. Study subjects comprised a sample of 1,600 primary care physicians who moved to nonmetropolitan counties nationwide during the years 1987 through 1990, with oversampling of those who moved to federally designated health professional shortage areas (HPSAs). Physicians serving in the National Health Service Corps (NHSC) were excluded. Sixty-nine percent of the eligible subjects returned completed mail questionnaires in 1991. Analyses for this study were limited to the 620 primary care physicians who worked more than 20 hours per week in towns of fewer than 35,000 population; who were neither in the military nor the NHSC; and who were not in urgent care, emergency room, or full-time teaching positions. Analyses revealed that the areas of rural physicians' greatest satisfaction were their relationships with patients, clinical autonomy, the care they provided to medically needy patients, and life in small communities. Physicians were least satisfied with their access to urban amenities and the amount of time they spent away from their practices. Retention was independently associated only with physicians' satisfaction with their communities and their opportunities to achieve professional goals. Retention was also marginally related to physicians' satisfaction with their earnings. Among the areas of satisfaction not related to retention were satisfaction with autonomy, access to medical information and consultants, and the quality of doctor-patient relationships. In a subsequent series of analyses of the factors that predict the three areas of satisfaction that were associated with retention (satisfaction with the community, professional goal attainment, and earnings), a variety of physician, work, and community factors were identified. These findings reveal that specific features of rural physicians, their work, and their communities predict each of the various aspects of satisfaction and that only certain aspects of satisfaction predict rural physicians' retention. There are no magic bullets to make rural physicians satisfied in all ways. Nevertheless, there are identified approaches to elevate the specific aspects of rural physicians' satisfaction important to their retention. Programs to improve the satisfaction of rural physicians should focus on those areas of satisfaction that predict longer retention and other important outcomes.

Satisfaction with practice in a rural state: perceptions of nurse practitioners and nurse midwives

Data from nurse practitioners and certified nurse midwives are used to explore contributions to primary care in a rural state and how regulatory restrictiveness and other factors affect satisfaction with practice (N = 151). Satisfaction is high, especially with home communities and professional aspects of work, including collaboration with physicians. However, many feel limited by regulations and are less satisfied, especially those with a master's degree and those in organizational versus office practice sites. Reducing restrictive regulations, reevaluating practice structures, and providing for full scope of practice and other incentives consistent with rising educational levels can increase access to care.