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Job Satisfaction Among Academic Family Physicians

Denny Fe Agana, MPH; Maribeth Porter, MD, MS; Robert Hatch, MD, MPH; Daniel Rubin, MD; Peter Carek, MD, MS

Background and Objectives: Family physicians report some of the highest rates of burnout among their physician peers. Over the past few years, this rate has increased and work-life balance has decreased. In academic medicine, many report lack of career satisfaction and have considered leaving academia. Our aim was to explore the factors that contribute to job satisfaction and burnout in faculty members in a family medicine department.

Methods: Six academic family medicine clinics were invited to participate in this qualitative study. Focus groups were conducted to allow for free-flowing, rich dialogue between the moderator and the physician participants. Transcripts were analyzed in a systematic manner by independent investigators trained in grounded theory. The constant comparison method was used to code and synthesize the qualitative data.

Results: Six main themes emerged: time (62%), benefits (9%), resources (8%), undervalue (8%), physician well-being (7%), and practice demand (6%). Within the main theme of time, four subthemes emerged: administrative tasks/emails (61%), teaching (17%), electronic medical records (EMR) requirements (13%), and patient care (9%).

Conclusions: Academic family physicians believe that a main contributor to job satisfaction is time. They desire more resources, like staff, to assist with increasing work demands. Overall, they enjoy the academic primary care environment. Future directions would include identifying the specific time restraints that prevent them from completing tasks, the type of staff that would assist with the work demands, and the life stressors the physicians are experiencing.

(Fam Med. 2017;49(8):622-5.)

Professional burnout, characterized by emotional exhaustion, feelings of cynicism, and decreased sense of personal accomplishment, is common amongst physicians in training and practicing physicians.1-5 Lack of autonomy, affecting the ability to provide high-quality patient care, maintain doctor-patient relationships, spend adequate time with patients, and have the freedom to make clinical decisions, has been reported as the most consistent and largest deterrent to physician satisfaction and cause of burnout.6

Physicians in academia are in the unique position of being tasked with patient care, research, education, and administrative duties. One survey of medical school faculty found 42% of respondents were “seriously considering leaving academic medicine in the next 5 years” and 40% were not satisfied with their career progression.7 In another study, 34% of academic faculty members met burnout criteria. 8

This pilot study examined factors contributing to job satisfaction and burnout in academic family medicine faculty as an initial step in addressing underlying causes.

 

Methods

 
 

Qualitative methods involving grounded theory were used. A focus group moderator guide was created based on common themes associated with primary care physician burnout: work-life balance, patient satisfaction requirements, and administrative work.1-8,10-12 Content of the guide was also influenced by the authors’ observations of commonly discussed clinic issues. The guide was reviewed by a family medicine physician for ease of understanding, and adjusted based on comments and suggestions.

Physician recruitment involved an investigator contacting directors of all six department clinics to explain the study. The directors invited their physicians to participate through email. Each focus group lasted about 45 minutes and was held at the respective clinic. Participants were compensated for their time with lunch. The focus group moderator was trained in leading groups, and elicited information regarding all themes in the script. The Institutional Review Board approved this study.

Sessions were voice recorded and transcribed. All identifiers were removed before transcript analysis. Analysis was completed in a systematic manner by two independent investigators trained in qualitative research using the constant comparison method to code and synthesize data.9 Investigators independently applied line-by-line open coding to transcripts and created memos to document findings before meeting to compare common themes. This inductive process was repeated until no new themes emerged. Differences were resolved through discussion and further review of data. The final coding structure consisted of six nodes, which were applied to each transcript. After initial analysis of two transcripts, the investigators met to evaluate reliability by comparing open codes to identify similarities and differences in the reoccurring concepts. Node (main theme) percentages were calculated by the number of open codes associated with each theme divided by the total number of open codes.

 

Results

 
 

Twenty-six physicians participated in this study, equaling a response rate of 87%. Six main themes emerged (Figure 1). Time was the most common (62% of all open codes) theme discussed pertaining to family medicine physicians’ satisfaction (Table 1). Other main themes included benefits (9%), resources (8%), undervalue (8%), physician well- being (7%), and practice demand (6%).

figure1

 

table1

Within the main theme of time, a majority of comments (62%) included the subtheme of administrative tasks/emails followed by teaching and EMR requirements (Figure 2). Comments associated with administrative and EMR tasks were mostly negative as physicians felt that they did not have enough time to complete them. Time teaching was associated with both positive and negative comments.

 

figure2

 

The benefits of academic family medicine constituted 9% of the conversations, with relationships with patients and patient families comprising over half (54%) of the comments. Other positive subthemes included the variety of diagnoses (21%), practice preference/flexibility (21%), and teamwork (4%), all of which are characteristic of family medicine.

Resources had two subthemes: financial and salaries (56%), and department resources for providers (44%). Negative comments surrounding resources included needing more resources, like staff, to help with increasing work demands. Additionally, physicians felt they were not compensated enough for their work.

Undervalue as a theme appeared as family medicine physicians reported feeling underappreciated by the government (56%), specialists (35%), and patients (9%). Physician well-being as a theme appeared as physicians’ mental health was discussed. Peer support (36%) was the main subtheme of well-being, followed by thoughts of quitting (27%), self-evaluation (18%), department support (14%), and time for vacation (5%). Practice demand appeared as a theme and had three subthemes: patient satisfaction (47%), psychological burden (47%), and quality guidelines (6%).

 

Discussion

 
 

Overwhelmingly, time was the most common main theme throughout this study, followed by benefits, resources, undervalue, physician well-being, and practice demand. Physicians did not feel they had the time to complete administrative tasks of patient care such as medication refills, clinic notes in the EMR, and result notifications as well as other administrative burdens like emails and scholarly activity. While teaching is generally a positive experience of academic medicine, it did contribute to time constraints as well, and hence was seen as both positive and negative. Further breakdown of the time node is needed to clarify the needs of the faculty, but were not part of this pilot study.

The benefits of family medicine theme provided some insight into positive aspects of clinical work as perceived by physicians, yet it was clear that these historical benefits of being a family physician were overshadowed by the difficulties associated with time.

Limitations of this study include the lack of specificity about factors contributing to inability to complete tasks. For example, our results do not reveal whether physicians want more time with each patient, or are unable to finish their patient care schedule in order to meet other professional or personal responsibilities. Our results do not provide direction on whether systemic or individual interventions would be effective in decreasing physician burnout. This is consistent with the findings of a recent meta-analysis.13

In conclusion, time associated with administrative activities and the EMR were found to be overwhelmingly associated with negative comments by academic family physicians compared to other themes associated with physician burnout. The issues associated with these activities and potential solutions to reduce physician burnout warrant further study.

Acknowledgements: Special thanks to Caitlin McNally who assisted with background research and transcribing. Thank you to Gina Martornana, MPH and Alex Zirulnik, MPH for assistance with transcribing.

Presentations: University of Florida Community Health and Family Medicine Research Day-June 23, 2016; Gainesville, FL

Society of Teachers of Family Medicine Annual Meeting-May 4, 2016; Minneapolis, MN

University of Florida College of Medicine Celebration of Research Day-February 22, 2016; Gainesville, FL

Corresponding Author: Address correspondence to Denny Fe Garcia Agana, Department of Community Health and Family Medicine, College of Medicine, University of Florida, PO Box 100237. 352-294-4980. dfgagana@ufl.edu.

 

References

 
 
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From the Department of Community Health and Family Medicine and the H. James Free Center for Primary Care Education and Innovation at the University of Florida.


Copyright 2017 by Society of Teachers of Family Medicine