Indian J Med Sci, Vol. 63, No. 4, April 2009
139
A STUDY OF JOB SATISFACTION AND WORK ENVIRONMENT
PERCEPTION AMONG DOCTORS IN A TERTIARY HOSPITAL IN DELHI
SUMINDER KAUR, RAHUL SHARMA, RICHA TALWAR, ANITA VERMA, SAUDAN SINGH
ABSTRACT
BACKGROUND: Many doctors are dissatisfied with their jobs, which is due to long
working hours and overwork. This can affect patient care and reduce quality of care.
OBJECTIVES: To study job satisfaction among doctors in a tertiary hospital in Delhi and
the various factors related with it. MATERIALS AND METHODS Data collection was
done among 250 doctors on tenure-based job, selected by stratified random sampling,
in a teaching hospital in Delhi, by using a self-administered questionnaire. STATISTICAL
ANALYSIS: Proportions and Chi-square tests. RESULTS: The mean number of work-hours
among doctors was 9.7 ± 2.7 hours per day, and the mean number of night shifts was
5.6 per month. About half (49.6%) of the doctors were dissatisfied with the average
number of work-hours per day. Dissatisfaction was significantly more in those who had
an average of >8 work-hours per day and who had ≥8 night shifts per month. About
half (45.6%) of the doctors considered their salary as ‘bad,’ and this was significantly
more among unmarried doctors, interns and those who had ≥8 night shifts per month.
More than half (55.2%) of the doctors were dissatisfied with their choice of profession,
i.e., being a doctor, as compared to other professions. CONCLUSIONS: A significant
proportion of doctors were found to be dissatisfied with the average number of their
work-hours and salary. Factors like the average number of work-hours per day and
the number of night shifts per month were found to have a significant relation with
dissatisfaction. Further studies are needed to explore how best the work-hours of doctors
could be adjusted to improve their job satisfaction.
Key words: Delhi, doctors, satisfaction, work environment, work-hours
DOI: 10.4103/0019-5359.50762
Department of Community Medicine, Vardhman
Mahavir Medical College and Safdarjung Hospital,
New Delhi, India
Correspondence:
Dr. Suminder Kaur,
56, Gujral Nagar, Jalandhar -144 001, Punjab, India
E-mail: dr_suminderkaur@yahoo.com
INTRODUCTION
The prevalence of dissatisfaction among
doctors has been given considerable
importance in recent years as it affects patient
satisfaction
[1]
and can adversely influence
patient behavior (e.g., adherence to medical
treatment),
[2]
leading to a reduction in the
quality of care. At the individual level, low
level of job satisfaction and high level of job
stress are threats to mental and physical
health, quality of life, goal achievement and
personal development. At the workplace, these
conditions can lead to increased absenteeism,
conflict and turnover; and reduced quality
Indian J Med Sci, Vol. 63, No. 4, April 2009
140
and quantity of work.
[3]
Job satisfaction is also
important to the future recruitment of new
doctors and retention of the existing doctors,
in addition to the productivity and quality of
the services provided by the doctors, who are
an essential and integral component of our
medical care system.
[4]
Although many studies have been conducted
to Þ nd out the level of job satisfaction among
doctors, yet very few have been conducted in
India, especially in the recent past. This study
was planned with the objective of determining
the level of job satisfaction among doctors
working in a tertiary hospital in Delhi and the
various factors associated with it.
MATERIALS AND METHODS
Delhi is the capital of India, with a population
of 13.8 million. There are 6 teaching hospitals
located in Delhi itself, and the present study
was carried out in one of these. There are
2 types of doctors in a hospital — those on
permanent faculty posts; and those on tenure-
based jobs: senior residents, junior residents,
postgraduate students and interns. Senior
residency is the period of in-house training
for duration of 3 years after the completion
of postgraduation, while junior residency is
the period of in-house training for duration
of 1 year after the completion of graduation.
Postgraduation is a term of 3 years after MBBS.
Internship is the 1-year rotatory posting at
the end of the MBBS course. These doctors
were included in the present study because
it has been found in some studies
[1,5]
that
resident doctors have greater dissatisfaction
and stress due to their long working hours,
less independence in work and more stressful
promotional conditions than the faculty. This
cross-sectional study was conducted in one of
the tertiary care hospitals in Delhi in September
2008.
Stratified random sampling was done with
the target being to cover at least 25% in
each group of doctors. Ethical clearance
was obtained. Informed consent was taken
from all the participants. A self-administered
close-ended questionnaire was used to obtain
information from the doctors on various aspects
of job satisfaction. These included satisfaction
with the average number of working hours
per day, perception of work environment,
perception of the relations with colleagues and
satisfaction with salary. Satisfaction with their
choice of profession, i.e., being a doctor, as
compared to other professions was also asked
about. The data collection was anonymous,
and the questionnaires were collected in
closed boxes which were opened only at the
time of analysis. The data thus collected was
converted into a computer-based spreadsheet.
The statistical analysis included calculating
proportions and applying Chi-square tests for
test of signiÞ cance.
RESULTS
A total of 250 doctors were included in the
study. The mean age of the doctors was 27.9
± 3.2 years, with 176 (70.4%) in the age group
of 25-30 years. About two thirds (166; 66.4%)
of the doctors were male and one third (84;
33.6%) were female. Majority (175; 70%) were
unmarried, 72 (28.8%) were married while 3
(1.2%) were divorced. Out of the 250 doctors,
67 (26.8%) resided in their own house; 87
(35.2%), in a hostel; and 96 (38%), in rented
INDIAN JOURNAL OF MEDICAL SCIENCES
Indian J Med Sci, Vol. 63, No. 4, April 2009
141
accommodation. The mean number of working
hours in the last month prior to the interview
was 9.7 ± 2.7 hours per day, with a range of
3-20 hours. The mean number of night shifts
was 5.6 per month, with a range of 0-17 night
shifts / month.
Satisfaction with the average number of
working hours per day
It was found that about half (124; 49.6%)
of the doctors were dissatisfied with the
average number of working hours per day.
Dissatisfaction was signiÞ cantly greater among
doctors who had an average of >8 work-hours
per day (Chi-square = 15.05, P < 0.001), those
who had ≥8 night shifts per month (i.e., twice
a week) (Chi-square = 18.40, P < 0.001), and
those who had more than 1 adverse event in
the family in the last 1 year (Chi square = 8.61,
P = 0.013). However, it was not signiÞ cantly
associated with gender (Chi square = 0.96,
P = 0.33), marital status (Chi-square = 2.18,
P = 0.14) or designation (Chi-square = 0.63,
P = 0.89).
Perception of work environment
Work environment was perceived as ‘good’ by
89 (35.6%) doctors; ‘average,’ by 131 (52.4%)
doctors; and ‘bad,’ by 30 (12%) doctors. Table
1 shows that the doctors who had an average
of >8 work-hours per day (Chi-square = 9.08,
P = 0.01) and those who had ≥8 night
shifts per month (Chi-square = 16.60, P =
0.002) were more likely to perceive the work
environment as bad.
Perception of relations with colleagues at
workplace
About two thirds (166; 66.4%) of the doctors
perceived their relations with the colleagues
as being good, while one third (84; 33.6%)
considered their relations as being average
/ bad. The doctors who had ≥8 night shifts
per month (i.e., twice a week) (Chi-square
= 6.96, P = 0.03) and those who had more
than 1 adverse event in the family in the last
1 year (Chi-square = 16.42, P = 0.003) were
more likely to perceive their relations with
the colleagues at workplace as being bad.
Table 1: Variables associated with the perception of work environment among 250 doctors working in a tertiary
hospital
Variable Good Average Bad Total p*
n (%) n (%) n (%) n
Gender
Male 62 (37.3) 83 (50.0) 21 (12.7) 166 0.57
Female 27 (32.1) 48 (57.1) 9 (10.7) 84
Marital status
Single 56 (32.0) 98 (56.0) 21 (12.0) 175 0.12
Married 33 (45.8) 33 (45.8) 6 (8.3) 72
Work-hours/day
≤ 8 hours 42 (47.7) 36 (40.9) 10 (11.4) 88 0.01
> 8 hours 47 (29.0) 95 (58.6) 20 (12.3) 162
Night-shifts/month
0 32 (58.2) 19 (34.5) 4 (7.3) 55 0.002
< 8 35 (29.2) 71 (59.2) 14 (11.7) 120
≥ 8 22 (29.3) 41 (54.7) 12 (16.0) 75
Adverse event in family in last year
0 53 (37.9) 74 (52.9) 13 (9.3) 140 0.06
1 27 (34.6) 43 (55.1) 8 (10.3) 78
2 or more 9 (28.1) 14 (43.8) 9 (28.1) 32
Total 89 (35.6) 131 (52.4) 30 (12) 250
*P < 0.05 was considered signiÞ cant.
JOB SATISFACTION AMONG DOCTORS IN DELHI
Indian J Med Sci, Vol. 63, No. 4, April 2009
142
However, it was not signiÞ cantly associated
with gender (Chi-square = 0.74, P = 0.83),
marital status (Chi-square = 0.69, P = 0.44),
designation (Chi-square = 8.10, P = 0.46) or
the number of work-hours per day (chi square
= 0.02, P = 0.90).
Satisfaction with salary
About half (114; 45.6%) of the doctors
considered their salary to be ‘bad,’ while
99 (39.6%) considered it as ‘average,’ and
only 37 (14.8%) considered it to be ‘good.’
Dissatisfaction with salary was significantly
higher in doctors who were interns (Chi-square
= 21.69, P = 0.001) and those who had ≥8
night shifts per month (Chi-square = 14.24,
P = 0.007). However, it was not signiÞ cantly
associated with gender (Chi-square = 0.65,
P = 0.72) and the number of work-hours per
day (Chi-square = 5.48, P = 0.06).
Satisfaction with profession
Satisfaction with their choice of profession,
i.e., being a doctor, as compared to other
professions was also asked about. More than
half (138; 55.2%) of the doctors were found to
be dissatisÞ ed. Dissatisfaction with profession
was signiÞ cantly more in the doctors who were
married (Chi-square = 5.53, P = 0.02), females
(Chi-square = 5.40, P = 0.02), those who joined
this profession under family pressure (Chi-
square = 25.17, P < 0.001), and those who had
≥8 night shifts per month (Chi-square = 6.40,
P = 0.04) [Table 2].
DISCUSSION
In the present study, it was found that the
doctors who had an average of more than 8
work-hours per day were more likely to be
dissatisÞ ed with the number of working hours
per day. Similar results were found in the study
by Appleton among general practitioners in
Leeds
[6]
; and by Brondt, in Denmark.
[7]
The
doctors who had more night shifts were found
INDIAN JOURNAL OF MEDICAL SCIENCES
Table 2: Variables associated with satisfaction with the choice of profession, i.e., being a doctor, as compared
to other professions, among the 250 doctors working in a tertiary hospital
Variable Satisfi ed Dissatisfi ed Total P*
n (%) n (%) n
Gender
Male 83 (50) 83 (50) 166 0.02
Female 29 (34.5) 55 (65.5) 84
Marital status
Single 87 (49.7) 88 (50.3) 175 0.02
Married 24 (33.3) 48 (66.7) 72
Work-hours/day
≤ 8 hours 38 (43.2) 50 (56.8) 88 0.71
> 8 hours 74 (45.7) 88 (54.3) 162
Night-shifts/month
0 25 (45.5) 30 (54.5) 55 0.04
< 8 45 (37.5) 75 (62.5) 120
≥ 8 42 (56) 3 (44.0) 75
Adverse event in family in last year
0 77 (55.0) 63 (45.0) 140 0.001
1 27 (34.6) 51 (65.4) 78
>1 8 (25.0) 24 (75.0) 32
Choice of profession
Own 107 (52.2) 98 (47.8) 205 <0.001
Family pressure 5 (11.1) 40 (88.9) 45
Total 112 (44.8) 138 (55.2) 250
*P < 0.05 was considered signiÞ cant
Indian J Med Sci, Vol. 63, No. 4, April 2009
143
to be more dissatisÞ ed with their job, which
was also found by Sehlen among physicians
in Germany.
[8]
Majority (88%) of the doctors perceived their
work environment as good/average, which is
similar to the results found by Madaan, who
found that majority (76.7%) of the residents
in a tertiary hospital in Delhi perceived their
environment at work as being ‘cordial.’
[5]
In the
present study, salary was considered good
by only 14.8% of the doctors, while Madaan
found that about 27% of the doctors (faculty in
addition to the residents) said that their salary
was proportional to the workload.
[5]
The sample
population in the present study consisted of
doctors with tenure posts only, whose salary
was lower than the permanent faculty.
About half of the doctors were satisfied
with their profession. Similar results have
been found in a study by Frank among the
physicians in the U.S.
[9]
In our study, it was
found that males were more satisfied with
their profession, but Keeton in the U.S.
[10]
and
Cujec in Canada
[11]
found that gender was not
a strong independent predictor. This difference
may be attributed to cultural differences in the
context of these studies.
The present study has some limitations.
Job satisfaction has various individual,
departmental and institutional dimensions, out
of which the latter was not studied. The sample
did not cover doctors of all designations.
The data was collected before the Sixth Pay
Commission revised the salaries of doctors,
so the Þ gures on ‘satisfaction with salary’ may
have changed after such revision of salaries.
CONCLUSION
A signiÞ cant proportion of doctors were found
to be dissatisfied with the average number
of their working hours and salary. Many of
them did not perceived their work environment
as ‘good’. Factors like the average number
of work-hours per day and the number of
night shifts per month were found to have a
significant association with dissatisfaction.
Further studies are needed to explore how best
the work-hours of doctors could be adjusted to
improve job satisfaction among them; and also
to explore the inß uence of such high levels of
dissatisfaction among doctors on their own
health, on the optimal provision of patient care,
and on the society as a whole.
ACKNOWLEDGMENT
We are thankful to all the doctors of our institute
who participated and cooperated in this study.
REFERENCES
1. Haas JS, Cook EF, Puopolo AL, Burstin HR,
Cleary PD, Brennan TA. Is the professional
satisfaction of general internists associated
with patient satisfaction? J Gen Intern Med
2000;15:122-8.
2. DiMatteo MR, Sherbourne CD, Hays RD, Ordway
L, Kravitz RL, McGlynn EA, et al. Physicians’
characteristics influence patients’ adherence
to medical treatment: Results from the Medical
Outcomes Study. Health Psychol 1993;12:
93-102.
3. Khuwaja AK, Qureshi R, Andrades M, Fatmi Z,
Khuwaja NK. Comparison of job satisfaction and
stress among male and female doctors in teaching
hospitals of Karachi. J Ayub Med Coll Abbottabad
2004;16:23-7.
JOB SATISFACTION AMONG DOCTORS IN DELHI