Work satisfaction, quality of life, and leisure time of neonatology fellows and senior neonatologists in Israel

Cross-sectional research that examined basic feelings and positions among all senior physicians and fellows in neonatology in Israel.

In Israel there are 118 neonatologists of working age. Of these, 114 were active and practicing in Israel at the time the survey was conducted; 112 (98.25%) participated in the current research. A neonatologist is defined as a physician who possesses an Israel Ministry of Health certificate in neonatology or one that has begun his neonatology fellowship, but did not yet finish it.

Dependent variables: satisfaction level, quality of life, and leisure time.

Independent variables: age, gender, place of medical education, and country of origin.

Research questionnaires: Based on similar questionnaires [1, 4, 14, 24], a questionnaire was designed by the researchers to include questions about work satisfaction and quality of life. Additional questions about leisure time were composed by the researchers, based on prior studies [25]. The work satisfaction section of the questionnaire was divided into five sub-categories: Patient care, Work load, Income–prestige, Self–reward, and Work relations. The questionnaire used a seven-point Likert scale (1 = totally dissatisfied, 7 = very satisfied). Each category was summed to create an index measurement. The sum of these five indices was used to create a summative index of work satisfaction. Different indices were created for the questions about the quality of life and leisure time. Finally, in order to demonstrate the relation between work satisfaction, quality of life, and leisure time, we created the index of indices that summarizes all the questions regarding these issues.

The next stage was the actual mail/fax/hand delivery of the questionnaires to the neonatologists in the hospitals, after receiving their permission. A researcher was available to answer any questions, and received the questionnaires in the same way they were sent. The participants were all promised full confidentiality.

In order to measure the level of satisfaction, we compared the relevant central measurement with the mid-range value, so that when the central measurement (median or mean value) was higher than the mid-range value the satisfaction was considered high.

In Israel there were 118 senior physicians and fellows in neonatology of working age at the time of the survey. All of them were qualified specialists in pediatrics. Of those, 114 were practicing neonatologists, and 112 (98.25%) participated in the current study. The majority of neonatologists were male (53.2%), married (91.7%), 40–60 years old (69.7%), and studied in Israeli medical schools (62.0%). Most of them did their pediatric residencies and fellowships in Israel (97.2% and 75.7%, respectively). The average number of night/on-call shifts of fellows and senior neonatologists was 8.8 per month (SD ± 3.425) and the number of active on-call shifts (when the senior physician had to attend the hospital) was 4.04 (SD ± 3.194).

The satisfaction level of neonatologists in Israeli medical centers with patient care, self-reward, work relations, and quality of life was high, but their satisfaction level with workload, income and prestige, and leisure time was low in relation to the mid-range value. As a result, the general index of work satisfaction and the general index of indices were both high in relation to the mid-range values.

The satisfaction level of the neonatologists in Israeli medical centers when looking at their leisure time was generally higher than the mid-range value. They were not satisfied with the frequency with which they went to the movies and the number of vacations in their home country, but were satisfied with all other mentioned activities.

The majority of neonatologists (n = 98, 87.5%) stated that, given the chance, they would again have chosen to practice medicine. Most of them (n = 78, 69.6%) would encourage medical students to choose the same specialty they had chosen. Only a few (n = 7, 6.25%) neonatologists were contemplating changing their choice of specialty. As for leaving the medical profession, most neonatologists (n = 99, 88.4%) want to continue practicing medicine; however, a high number (n = 39, 34.8%) of the neonatologists in Israel will not recommend that their children practice medicine.

We compared the satisfaction level between different groups of neonatologists:

A) Senior neonatologists, compared with fellows after the pediatric residency alone, were more satisfied regarding personal satisfaction (p = 0.009) and more satisfied with their quality of life (p = 0.042).

We also compared the satisfaction level between neonatologists and fellows (as described in our previous research [25]). The results in Table 2 show that neonatologists have higher indices such as patient care, workload, income, work satisfaction, leisure time, and the general index than fellows.

Work satisfaction level alone, apart from leisure time, among the neonatologists was high, especially with patient care, sense of self-reward, and work relations. High satisfaction levels are well-matched with our findings that a majority of the neonatologists surveyed would choose to practice medicine again, would recommend that medical students choose their line of specialty, and are not considering a change of internship or contemplating a change in profession. But the satisfaction levels from workload and income were low. These low satisfaction levels matched a significant number of neonatologists who stated that they would not recommend that their children practice medicine. Moreover, it is reasonable to presume that these low satisfaction levels have direct implications on neonatology as a profession in crisis in Israel, and upon the unwillingness of young physicians to choose neonatology as their subspecialty. Dissatisfaction with workload and income level correlates well with similar findings from the United States [2], where 600 physicians showed a substantial decline in their satisfaction level, especially due to increasing workload (which leaves less time for each patient) and the lack of financial reward for the work being done. Another study [3] points out that the balance between factors that positively influence satisfaction level (such as patient care) and factors that have a negative influence on satisfaction levels (such as workload and the lack of time for patients and for one’s self), must be vigorously kept. When this balance fails to be maintained, burnout and dissatisfaction prevail.

Despite the high levels of work satisfaction found among neonatologists at Israeli medical centers, we found low levels of satisfaction with their leisure time. Surprisingly, the reported quality of life was high, in opposition to what we found in a recent survey of fellows from one Israeli medical center [25].

These findings are similar to physicians’ [2] feelings that their work prevents their having leisure time and emphasizes the importance of leisure time in maintaining a good quality of life. Engaging in leisure time activities, such as spending time with one’s family and friends, and being engaged in physical activities, can prevent burnout. The most crucial factors that influence physicians’ work satisfaction [4] were their quality of life, time spent with their families, and personal time for themselves and for leisure time. These factors have created a change in the specialty choices of graduating medical students [17] in the United States in the last few years. Specialty fields that are perceived as less time intensive are gaining popularity. This means that the issues of quality of life and leisure time are becoming more and more important as determining factors of physicians’ satisfaction.

Satisfaction levels were similar among female and male neonatologists. Some studies support our results [1, 10]. However, among 5704 U.S. physicians [8] differences were found between male and female physicians. Women were more satisfied than men with their work relations and field of choice, but were less satisfied with their autonomy at work, workload, and salary. Differences between genders [9] were also based on salary issues, prestige, and academic ranking. The fact that we did not find any difference between male and female physicians is intriguing, since we would expect that in at least one parameter – academic ranking – women would be less satisfied than men in Israel, the same as abroad, because they do not climb as fast as men in academic ranking [28].

Satisfaction levels were generally similar between physicians in the course of fellowships and senior neonatologists. Some studies [29] show an inverse relation between the fellow’s age and level of work satisfaction. The highest satisfaction level was demonstrated among very young and very old physicians [10], yet satisfaction level was directly related to age and experience [30].

In our study we found, in general, that fellows were as satisfied as seniors. The only exceptions were found among neonatology fellows with lower personal satisfaction and quality of life. It is logical to find these results, as it is well known that fellows have more on-call shifts and need to work harder due to their relative lack of experience in the field. These findings add to the results from other studies [1‐3, 8‐10, 13] that emphasize the importance of income level as a factor in determining work satisfaction.

Possible explanations for the nearly similar findings between these two groups may be the fact that fellows in neonatology have already completed their pediatric residencies and the length of their neonatology fellowship is shorter.

The place of medical education further explains the differences found between the two groups – Israeli fellows were less satisfied with issues regarding personal benefits from the job, as well as their workload. The low levels of satisfaction with workload among Israeli graduates is similar to that reported in another study [31] conducted in Israel, which found that the satisfaction level of immigrant physicians was higher regarding workload and burnout levels. Regarding self-reward, it is possible that the long and difficult course immigrant physicians must go through in order to work in Israel, combined with the difficulties of immigrating to another country, had a less negative influence on their sense of self-reward after becoming senior neonatologists, especially in comparison to Israeli graduates [32, 33]. Another finding that may explain the low satisfaction levels of Israeli graduates is that many more Israeli medical school-trained neonatologists have an additional academic degree, which means they spent more years in the university and thus have higher expectations.

The low levels of satisfaction among Israeli graduates found in the study are worrisome since it is well-established that low levels of satisfaction can eventually lead to burnout [5]. This burnout might have important personal implications for physicians as well as serious consequences for the health system at large. Burned-out physicians tend to be more angry and impatient, and tend to develop signs of depression, substance abuse, and suicide [34]. Burned-out physicians also report greater levels of exhaustion [35], which may lead to medical errors, impair their ability to learn and concentrate, and damage their professional and personal relations. From a wider perspective [5], burnout causes poor doctor–patient relations and a decline in the quality of care, and thus surely needs to be addressed.

Neonatologists were found to have higher indices in patient care, workload, income, work satisfaction, leisure time and the general index than fellows. But, this is a very problematic comparison – they compared to fellows, who are the main working force and most battered physicians in the field, and thus this improvement is nothing to brag about. Even worse is the fact that two important indices were not better with neonatologists – the index of self-reward and the index of work relations. This means that at the end of the day senior physicians, our neonatologists, did not fare better than simple fellows in the main issues that cause burn-out – self-fulfillment and work relations, things that should cause us to wonder how this may impact their motivation and working ability.

The questionnaires were sent by mail, fax, or distributed by hand, and filled out by neonatologists on their own time. Therefore, the opportunity to ask questions was only possible by contacting the researchers by telephone.

The response rate in this study was about 98.3%; however, not all the questions in all the questionnaires were answered.