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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. Journal of Hospital Medicine 2009;4:560–570. © 2009 Society of Hospital Medicine.

Enynes and diynes react with "ZrCp," (where Cp = 7'-CSHs) generated by treating C12ZrCp, with Mg and HgCl, or 2 equiv of an alkyllithium, such as n-BuLi, or a Grignard reagent, such as EtMgBr, and can produce in excellent yields zirconabicycles represented by 2 (M = Zr) and 8, respectively. Their protonolysis can provide the corresponding exocyclic alkenes and conjugated dienes 9, respectively. Iodinolysis of 2 (M = Zr) can give the corresponding diiodides in high yields, while carbonylation of 2 (M = Zr) can produce bicyclic enones 3 (Y = 0) in moderate to good yields. Although the bicyclization reaction fails with terminal alkyne containing substrates, various types of substituents on the alkyne moiety, such as alkyl, alkenyl, aryl, trialkylsilyl, and trialkylstannyl groups, can be accommodated. Investigation of the n-BuLi-C12ZrCp, reaction has revealed that it gives first (~-B U )~Z~C~, at -78 "C, which then decomposes to give Cp,Zr(CH,=CHEt), identified as its PMe3 complex 11. The PMe3-stabilized complex reacts with diphenylacetylene to produce a crystalline compound which has been identified as a zirconacyclopropene, 36a. This demonstrated, for the first time, the feasibility of converting alkynes into zirconacyclopropenes. The reaction of preformed, three-membered zirconacycles with alkynes gives five-membered zirconacycles. The reaction of diphenylacetylene is ca. 150 times as fast as that of (@stilbene. These results support a mechanism involving formation of a zirconacyclopropene intermediate followed by its intramolecular carbometalation with the alkene moiety of enynes for the Zr-promoted bicyclization of enynes.Direct conversion of enynes into the corresponding metallabicycles followed by their conversion into bicyclic or even monocyclic organic compounds is, in principle, a synthetically attractive methodology2 (eq 1). Consideration of molecular orbital /=-z 3 \= R 1 4 R=C and heteroatom-containing chain. X=H. halogen,etc , Y = O , e t c , Z = H . C , S i , G e , o r Sn ( 1 )interactions suggested to us that it would be desirable to generate a 14-electron species with a t least one filled nonbonding orbital (5) or its equivalent containing a transition metal for facile conversion of 1 into 2 via a concerted process. Interaction of 1 with 5 can, in principle, lead to the formation of 6 or 7 through the use of a pair of orbitals: a filled nonbonding orbital ( H O M O ) and an empty orbital ( L U M O ) . Intramolecular carbometalation involving the second empty orbital should lead to the formation of 2 (eq 2). Indeed, "ZrCp," equivalents, where C p = $-C5H5, generated by two-electron reduction of Cp,Zr(IV) derivatives were (1) Metal-Promoted Cyclization. 19. Part 18: Negishi, E.; Boardman, L. D.; Sawada, H.; Bagheri, V.; Tour, J. M.; Rand, C. L. J. Am. Chem. SOC. 1988, 110, 5383. Some preliminary results of the work have been communicated: (a) Neghish, E.; Holmes, S. J.; Tour, J. M.; Miller, J. A. A cobalt-promoted methodology for converting 1 into 3 was known at the outset of our investigation. (a) Kha...

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When designing jobs, the degree of specialization is a key consideration. Though functional specialization allows workers to develop deep areas of expertise, it also increases the challenge of coordinating their work. In this article, we propose the concepts of stage‐ and site‐based specialization and posit that together they can counteract the divisive effects of functional specialization. Taking advantage of a natural experiment in physician job design at a Massachusetts hospital, we explore the impact of stage‐ and site‐based specialization on coordination and performance outcomes. Building on recent interest in relational approaches to job design, this study is the first to link relational job design to relational outcomes such as coordination. Our findings have practical implications for job design in professional service settings such as education, consulting, and health care. © 2008 Wiley Periodicals, Inc.