Published online in BMC Health Services Research, the study indicates that better tracking of medical students and residents into specialty areas — and better education as to what each of those specialties entail — is necessary to assure long-term career satisfaction in medicine.
"Students need to know what they are getting into and set reasonable expectations for their careers, allowing them to better explore options early on," said Paul Leigh, professor in the UC Davis Center for Healthcare Policy and Research and lead author of the study. "It is important that they get this specific guidance early on, since it is very difficult for physicians to undergo mid-career changes after making the significant initial training investment."
In addition to helping retool medical education, Leigh, a specialist in labor and health economics, believes the findings are important because physician satisfaction has a direct impact on quality of care.
"Physician satisfaction is associated with patient satisfaction and outcomes, while physician dissatisfaction is associated with an increase in medical errors," said Leigh. "It is important to identify issues of physician satisfaction and make changes that can reverse those trends."
For the study, Leigh gathered data on 6,590 U.S. physicians from the Community Tracking Physician Study, which contains health and health-care information collected in 2004-05 from households, health plans and physicians practicing in 42 specialty areas and 60 communities. Leigh and his team analyzed the physician data for various demographic, community and practice factors and compared it to data on satisfaction.
The key findings include:
- Pediatric emergency medicine, geriatric medicine and dermatology were associated with higher satisfaction levels, while neurological surgery, pulmonary critical care medicine and obstetrics and gynecology had lower satisfaction levels
- Of the 10 specialties associated with higher satisfaction, six were pediatric specialties.
- Of the 11 specialties associated with less satisfaction, five were surgical specialties.
- In terms of workplaces, sole proprietors had less satisfaction, while academic physicians had higher levels of satisfaction.
- Higher percentages of revenue from managed care were associated with lower levels of satisfaction.
- Income of $400,000 or more per year was positively associated with satisfaction.
- Physicians working more than 50 hours per week had lower levels of satisfaction.
Leigh thinks a potential reason for lower physician satisfaction in some specialties could be the differences between projected and actual job experiences.
"Job satisfaction tends to be related to whether or not expectations held at the beginning of a career are met later on," said Leigh. "For instance, it's possible that students selected certain practice areas based on what they heard about salaries, but they found out later that what they heard wasn't actually true or that other factors like work hours or reimbursement issues mitigate those salaries. There is much more to a career than income."
According to senior study author Richard Kravitz, professor with the UC Davis Center for Healthcare Policy and Research, closing the gap between the perceptions and realities of the medical professions could help ensure continued patient access to diverse specialty care.
"A robust array of specialists is indicative of the overall quality of medical care," said Kravitz. "Dissatisfaction among physicians in particular specialties could make it difficult to recruit physicians into those specialty areas and may eventually lead to workforce shortages."
In addition to Leigh and Kravitz, the research team included Daniel Tancredi, assistant professor of pediatrics.
A copy of "Physician Career Satisfaction within Specialties" can be downloaded at www.biomedcentral.com/1472-6963/9/166. The research was funded by the National Institute for Occupational Safety and Health and the UC Davis Office of the Vice Chancellor for Research.
The UC Davis Center for Healthcare Policy and Research facilitates research, promotes education and informs policy on health and health-care issues, focusing on disparities, access, clinician-patient interactions, utilization, cost-effectiveness and quality. For more information, visit www.ucdmc.ucdavis.edu/chsrpc/.