Team, Career, and Management: Mental Maps of Working Conditions and Intention to Stay of Physicians in Academic Medicine

Abstract

Job satisfaction has a strong impact on the intention to stay which is an important aspect to counter skills shortage in academic medicine. In an interview study combining qualitative and quantitative methods we investigated how the mental representation of working conditions influences job satisfaction and its impact on the intention to stay. In a first study chief physicians participated in interviews about job satisfaction in academic hospitals. Answers were segmented into statements, ordered by topics and rated according to their valence. In a second study assistant physicians (residents) during and after their training period talked about strength, weaknesses and potential improvements of working conditions. Again, answers were segmented, ordered, rated and used to develop a ‘job satisfaction scale’. In a third study, assistant physicians participated in a computer-led repertory grid procedure composing ‘mental maps’ of job satisfaction factors, filled in the job satisfaction scale and rated if they would recommend work and training in their clinic as well as their intention to stay. Comparing the interview results with recommendation rates and intention to stay show that a negative attitude is linked to high workload and poor career perspectives. A positive attitude towards work environment and high intention to stay are linked to sufficient personnel and technical capacities, reliable duty scheduling and fair salaries. The third study using repertory grids showed that the perception of current teamwork and future developments concerning work environment were the main aspects to improve job satisfaction and the intention to stay. The results of the interview studies were used to develop an array of adaptive improvement measure. The results support prior findings that job dissatisfaction is mostly based on generally known “hygiene factors” and whereas job satisfaction is due to individual aspects.

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“…An example question concerning support from colleagues reads as follows: "For my work I get sufficient appreciation and support from my colleagues" (positive pole = 1) or "My work is not appreciated and unnecessarily criticized by my colleagues" (negative pole = 10). The scale is highly reliable with Cronbach’s Alpha = 0.91 in this and 0.78 a prior study [ 66 , 67 ]. Discriminant analyses show a perfect match of the scale with intention to stay as well as promotion scores of working conditions (100% correct classification) supporting its convergent validity.…”

“…The different aspects reflected in the scale show only little overlap indicated by significant intercorrelations. Also, high satisfaction was correlated with high frequencies of positive statements and dissatisfaction with high frequencies of negative statements suggesting a good discriminant validity [ 66 , 67 ].…”

“…Job satisfaction and job demands. In an interview study with 178 interviews about retention and intention-to-leave, we identified central aspects of satisfaction and dissatisfaction of professional medical staff [63][64][65][66] and combined these aspects in a polarity profile [64,67], which includes questions to be scored from 1 (positive pole) to 10 (negative pole; see Table 2). An example question concerning support from colleagues reads as follows: "For my work I get sufficient appreciation and support from my colleagues" (positive pole = 1) or "My work is not appreciated and unnecessarily criticized by my colleagues" (negative pole = 10).…”