Job Satisfaction Level among the Public Hospital Doctors in Chongqing China and Its associated Factors

Copyright: © 2016 Xi-Tong L, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. *Corresponding author: Zhong Xiao-ni, School of Health and Medicine Management, No.1 Yixueyuan Road, Yuzhong District, Chongqing 400016, P. R. China, Tel: 13308368059; E-mail: zxn66@vip.sina.com, 1145290973@qq.com


Data analysis
Statistical analysis was undertaken using the MS Office Excel and SPSS version 22.0 software packages.Categorical variables were reported using percentages, while continuous data were reported using means and standard deviations, univariate analysis was applied to evaluate the differences between factors of the overall job satisfaction.Dependent variable was the overall job satisfaction (the score ≤ 3 was regarded as 0-dissatisfied, and the score >3 was regarded as 1-satisfied).Independent variables were gender (female=0, male=1), current employment (temporary=0, permanent=1), management position (yes=1, no=0), marital status (single as reference group), education (high school or under as reference group), professional title (primary title as reference group), hospital level (community health services center and rural township hospital as reference group).Age, service years, average annual income per capita (in thousand Yuan), working hours per week, and night watch per month here were analyzed as continuous variables.Meaning of work, workload, learning and training opportunities, interpersonal relationship, physical working condition, promotion opportunity, reward, doctorpatient relationship, social opinions and overall job satisfaction were measured by a 5-point Likert scale: 1point for absolutely dissatisfied, 2 points for dissatisfied, 3 points for partly satisfied, 4 points for satisfied, and 5 points for absolutely satisfied, the score ≤ 3 was regarded as 0-dissatisfied, and the score >3 was regarded as 1-satisfied.The combined impact of the aforementioned risk factors on the overall job satisfaction was considered by means of two multiple logistic regression analysis using the stepwise method, and the odds ratio (OR) was reported with 95% (CI) where applicable.5% was chosen to be level of statistical significance.

The Socio-demographic characteristics of study sampling
Table 2 shows the Socio-demographic characteristics of respondents.Among the 589 participants, the majority were male (61.0%), married (83.0%), college-educated or beyond (70.6%),permanently employed (85.7%).More than half of the respondents (51.4%) were of primary title, 28.9% were of middle title, and 19.7% were of senior title.Only 29.9% respondents were in management position.Less than half of the respondents (40.1%) worked in top-class hospitals, 34.1% worked in second-class hospitals, and only 25.8% worked in community health services centers and rural township hospitals.The average age of respondents was 37.31 years (ranging from 22 to 59) with an average working experience of 14.34 years (ranging from 1 to 43).83.02% respondents worked for more than 40 hours per week, and average working hours was 58.15 hours.The average night watches per month were 4.95.The average annual income was 45.89 thousand RMB ($ 1.00=6.23RMB in 2013).

Level of job satisfaction among doctors
The overall job satisfaction mean score was 3.31, ranging from 1.00 to 5.00 and standard deviation was 0.97.Nature of satisfaction with the work itself mean score was 3.00 ranging from 1.53 to 4.27, standard deviations was 0.32 (The mean scores of meaning of work, workload, and learning and training opportunities were respectively 4.30 ± 0.72, 1.90 ± 0.57 and 4.21 ± 0.65).Work environment satisfaction mean score was 3.44 ranging from 1.50 to 5.00, standard deviations was 0.75 (The mean scores of interpersonal relationship and physical working condition were respectively 3.86 ± 0.77 and 3.03 ± 0.98).Compensation packages satisfaction mean score was 2.93 ranging from 1.00 to 5.00, standard deviations was 0.95 (The mean score of promotion opportunity and reward were respectively 3.25 ± 1.01 and 2.61 ± 1.14).Social environment mean score was 3.28 ranging from 1.00 to 5.00, standard deviations was 0.65 (The mean scores of doctor-patient relationship and social opinions were respectively 3.36 ± 0.64 and 2.95 ± 1.023) (Table 1).

Univariate analysis of the factors that influence the overall job satisfaction degree of doctors
This study used univariate analysis to determine the correlation between all variables (including socio-demographic factors and the 4 dimensions of job satisfaction level) and the overall job satisfaction level of doctors.The overall job satisfaction level (numbered from 1 to 5) was evaluated on a five-point scale, and reported using means and standard deviations.The results showed that, among the socio-demographic and job satisfaction level variables of doctors, current employment (F=6.69,P=0.01), working hours per week (F=6.53,P=0.00), night watches per month (F=4.13,P=0.02), significance of work (F=5.99,P=0.02), learning and training opportunities (F=38.22,P=0.00), interpersonal relationship (F=98.86,P=0.00), physical working condition (F=233.43,P=0.00), promotion opportunity (F=195.20,P=0.00), reward (F=153.22,P=0.00), doctor-patient relationship (F=44.39,P=0.00) and social opinion (F=24.87,P=0.00) were related to the overall job satisfaction level of doctors (Table 2).

Analysis of the multiple factors that influence the overall level of job satisfaction of doctors
The binary logistic regression method was used to analyze the factors that influence the overall job satisfaction level of doctors.We analyzed the significantly related factors (p<0.05)obtained from a previous study.Learning and training opportunities, interpersonal relationship, physical working condition, promotion opportunity, reward, service years were significantly related to the overall job satisfaction level of doctors.
The overall job satisfaction level of doctors who were satisfied with their learning and training opportunities was 9.212 times higher than that of the doctors who were dissatisfied with their self-development (OR=9.21,95% CI=2.03-41.85,p=0.004).The overall job satisfaction level of doctors who were satisfied with their interpersonal relationship was 6.292 times higher than that of the doctors who were dissatisfied with their interpersonal relationship (OR=6.29,95% CI=2.71-14.59,p=0.000).The overall job satisfaction level of doctors who were satisfied with their physical working condition was 6.389 times higher than that of the doctors who were dissatisfied with their physical working condition Open Access 3 (OR=6.39,95%CI=3.87-10.55,p=0.000).Compared with the doctors who were dissatisfied with promotion opportunity, doctors who were satisfied with promotion opportunity had the overall job satisfaction level that was 3.444 times higher (OR=3.44,95% CI=2.12-5.61,p=0.000).Compared with the doctors who were dissatisfied with their reward, doctors who were satisfied with their reward had the overall job satisfaction level that was 4.752 times higher (OR=4.75,95% CI= 2.26-10.01,p=0.000).The satisfaction level of doctors who serviced more years was 0.042 times higher than that of the doctors who serviced less years (OR=1.04,95% CI=1.02-1.07,p=0.000) (

Discussion
This study was one of the most recent efforts to focus on the overall job satisfaction of doctors in Chongqing, China and its influential factors.The 589 respondents were interviewed by the self-administered job satisfaction questionnaire for doctors.The mean value of the overall job satisfaction (3.31 ± 0.97) was consistent with this in earlier studies on job satisfaction [7][8][9].
To assess the overall job satisfaction of doctors, we further analyzed the factors influencing the overall job satisfaction of doctors by univariate and multivariate analyses.Univariate analysis results showed that current employment, working hours per week, night watches per month, meaning of work, learning and training opportunities, interpersonal relationship, physical working condition, promotion opportunity, reward, doctorpatient relationship, and social opinions were related to the overall job satisfaction degree of doctors.However, multivariate analysis results showed that only learning and training opportunities, interpersonal relationship, physical working condition, promotion opportunity, and  Open Access 6 reward were significantly associated with the overall job satisfaction degree of doctors.None of the socio-demographic characteristics exhibited a significant correlation.It indicated that the influence on the overall job satisfaction degree of doctors from socio-demographic characteristics in this study was weaker than that from the nature of satisfaction with work itself, working environment, and compensation packages.This phenomenon could be attributed to great changes in the working conditions of medical staff and work-related factors in hospitals in China as a result of the implementation of the healthcare reform and hospital reform.Therefore, socio-demographic characteristics did not strongly influence job satisfaction, whereas the nature of satisfaction with work itself, working environment and compensation packages were statistically significant [4].The results of multivariate analysis indicated learning and training opportunities, interpersonal relationship, physical working condition, promotion opportunity, and rewards could result in more job satisfaction.These findings are consistent with those in earlier studies on job satisfaction [5,[10][11][12][13][14][15][16][17][18][19][20][21][22][23].For example, Janus K and Kumar R [24,25] conducted a survey in African countries; the result shows that professional development and training opportunities are the most important factor resulting in job satisfaction.Peters and his co-workers [26] found that many employees in India rated "training opportunities" as one of the motivating factors.Dolea C [27] has found that opportunities for personal development, pay/reward, management practices and organizational policies were important determinants of job motivation.The survey of Sara et al. [21] shows that international relationship, pay satisfaction, skill development, workplace civility, and satisfaction with senior management were positive factors.The results showed that income, the way organization policies are put into practice, amount of work, chances for advancement in the job, and working conditions are significant factors that contribute to the turnover intention of village doctors [27].A study in Vietnam has also found that the main motivating factors of doctors include the following: the appreciation expressed by their managers, competitive income, and training [28].Doctors in Ghana overwhelmingly identify low salaries as the main source of dissatisfaction on an interviewer-administered questionnaire [29].
The doctors in public hospital in Chongqing were evidently less satisfactory with the reward (2.61 ± 1.14) than with other factors of influence of the overall job satisfaction.This indicated that doctors considered that current remuneration did not match the amount of work, and the current remuneration provided for them did not satisfy the demands.At present, the average annual income of doctors in Chongqing (45.89 thousand RMB) is basically the same as the average annual income in other cities.The income level of public hospital doctors in China is well below the international one [4].In this study, public hospital doctors in Chongqing were exposed to higher work-related stress.This result could be attributed to the increasing number of patients, higher requirements for proficiency and comprehensive quality of medical staff, and reform measures of hospital administration system against the background of public hospital reform [30].Because of the healthcare reform, the medical care demand of the population is released and doctors must treat more patients.In China, many jobs require employees to work for only 8 hours a day, but the results of this study showed that more than half of the doctors (83.03%) in government owned hospitals in Chongqing work longer than that, and 75.89% of the respondents work overtime at night.Therefore, the government officials and hospital administrators should pay attention to these factors of influence and pay more attention to the needs of the doctors in public hospitals in Chongqing.At present four main aspects call for most attention: [31,32] 1.The hospital administrators should show more concern for the working conditions of the doctors in public hospitals, properly assign and arrange work, and appropriately reduce workload and work stress to promote job satisfaction.
2. The government officials and hospital administrators should improve the system of compensation packages, enhance income levels, and make the income match the workload and technical value of doctors in public hospitals.
3.More learning and training opportunities should be provided and created for doctors in public hospitals, in order to help them to improve their professional level and meet their individual development requirements.
4. Better interpersonal relationship and management system should be provided for the doctors in public hospitals, in order to promote their job satisfaction.

Possible Limitations
In this study, there are three possible limitations: first, a larger sample size and better sampling methods might result in a more conclusive comparison of job satisfaction in the future.Second, given that the study was conducted only in government owned hospitals of Chongqing, the findings of the study may not apply to doctors working in other areas in China.

Conclusion
The results of the investigation conducted in Chongqing showed that the satisfaction levels of reward (2.61 ± 1.14), physical working condition (3.03 ± 0.98), and promotion opportunity (3.25 ± 1.01) were lower than those of other aspects.More than half (60.95%) of doctors were dissatisfactory with their present job.The overall job satisfaction mean score was 3.31 ± 0.97.Self-development, interpersonal relationship, physical working condition, promotion opportunity, reward, and service years were significantly related to the overall job satisfaction level of doctors.The findings may be of interest to policy makers in health department considering the consequences of the current shortage of doctors.This study has highlighted the factors of influence of job satisfaction of doctors who devote themselves to health care services in Chongqing.
n H U B f o r S c i e n t i f i c R e s e a r c h Citation: Xi-Tong L, Yi T, Xiao-Ni Z (2016) Job Satisfaction Level among the Public Hospital Doctors in Chongqing China and Its associated Factors.J Epidemiol Public Health Rev 2(3): doi http://dx.doi.org/10.16966/2471-8211.111 n H U B f o r S c i e n t i f i c R e s e a r c h Citation: Xi-Tong L, Yi T, Xiao-Ni Z (2016) Job Satisfaction Level among the Public Hospital Doctors in Chongqing China and Its associated Factors.J Epidemiol Public Health Rev 2(3): doi http://dx.doi.org/10.16966/2471-8211.111
I can try the new things and develop my potentials through workThe work doesn't help my personal growth in any sense

Table 1 :
Variables of job satisfaction questionnaire and degree of job satisfaction among doctors Citation: Xi-Tong L, Yi T, Xiao-Ni Z (2016) Job Satisfaction Level among the Public Hospital Doctors in Chongqing China and Its associated Factors.J Epidemiol Public Health Rev 2(3): doi http://dx.doi.org/10.16966/2471-8211.111Citation: Xi-Tong L, Yi T, Xiao-Ni Z (2016) Job Satisfaction Level among the Public Hospital Doctors in Chongqing China and Its associated Factors.J Epidemiol Public Health Rev 2(3): doi http://dx.doi.org/10.16966/2471-8211.111

Table 2 :
Job satisfaction facets mono factor analysis of variance (N=589) * means p<0.05, and the difference is of statistical significance.

Table 3 :
Analysis of the multiple factors that influence the overall job satisfaction level