Assessment of job satisfaction among resident doctors in a public healthcare facility in Enugu state Southeast Nigeria

INTRODUCTION

The degree of employee satisfaction at work describes how they feel about their work within an organization.¹ Job satisfaction has been conceptualized both globally (general job satisfaction) as well as dimensionally (satisfaction with specific aspects of a job, such as personal development, relationship with colleagues, and remuneration).¹ The concept of job satisfaction is very multifaceted and can be split into two types: intrinsic and extrinsic.² Intrinsic job satisfaction is related to the job itself (the sense of achievement and autonomy), whereas extrinsic is related to the work environment.³ Job satisfaction consists of feeling positive and happy about your work environment, fulfilling your needs at the workplace, and having job equity. These characteristics are influenced by a range of factors such as personal, emotional, and workplace factors.³ In Nigeria, factors like pay, working conditions, tools and infrastructure, learning and training opportunities/sponsorship, leadership style, welfare packages, contingent reward, operating procedures, communication and job autonomy have been documented to influence the job satisfaction of healthcare workers.^4-7

Most of these factors that influence healthcare workers’ job satisfaction in Nigeria have also been found to contribute to the brain drain among health workers.^8,9

Consequently, dissatisfaction among health workers leads to an increase in medical errors, recovery times, and a decline in patient satisfaction and care.¹⁰ As job satisfaction can influence the implementation of evidence-based practice (EBP) in health care, therefore, human resource managers, supervisors, and managers of other healthcare providers should focus on improving employee job satisfaction.^11,12 A resident doctor is a trainee doctor appointed under the Residency Training Programme which is Postgraduate Specialist Training for medical practitioners to be certified as specialists in a specialized branch of medicine. The resident doctors play a major role in ensuring that quality and immediate care is delivered to patients. In Nigeria, the Medical residency training act is an act that guides residency programme, however, it is yet to be fully implemented.¹³ Few studies carried out in Nigeria have affirmed low levels of job satisfaction among Nigerian doctors.^7,14,15

Evidence has also shown that low job satisfaction among doctors is associated with turnover intensions and this can lead to a shortage of doctors thus hindering the delivery of health services including patients care and safety.¹⁶ Thus, the remaining doctors will face a high burden of work, leading to stress and consequently burnout.¹⁷ Because of the attendant consequences of job dissatisfaction among doctors and the relevance of resident doctors in health service delivery, this study assessed the level of job satisfaction and the contributing factors to job satisfaction among resident doctors at a public healthcare facility in Nigeria. The findings from this study will help in a better understanding of job satisfaction among resident doctors and may influence policy aimed at increasing the retention of resident doctors and thus improving health service delivery.

METHODS

Study area

The study was conducted at the University of Nigeria Teaching Hospital (UNTH) Ituku/Ozalla, Enugu State, Nigeria. Enugu State is located in Southeast Nigeria and has seventeen Local Government Areas (LGAs) with Enugu Metropolitan city as the capital.¹⁸ UNTH Ituku/Ozalla is one of the tertiary health facilities in Enugu state that offers residency training programmes in all the major surgical and medical specialties. It also offers a range of health services including outpatient, inpatient, and surgical services.

Study design

This was a descriptive cross-sectional study.

Study population

The respondents were resident doctors receiving training at the time of the study, who had worked for one year and above.

Sample size determination and sampling

The minimum sample size required for the study was determined using the Cochran formula for single proportion (n = z2p (1-p)/d2).¹⁹ where n = minimum sample size, z = standard normal deviate corresponding to a confidence interval of 95%, d = margin of error at 95% confidence interval = 5% (0.05), P = prevalence of job satisfaction among resident doctors in Northern Nigeria (80.1%).²⁰ Adjusting for 10% non-response, therefore the minimum sample size (respondents) was 268 resident doctors. A total number of resident doctors at the time of the study, 271 were retrieved from the Association of Resident Doctors (ARD) membership database. ARD is the main group to which all the resident doctors in the institutions belong. Resident doctors who had worked for one year and above were included while those that were too ill to answer questions during the survey were excluded. Convenience sampling was used for the selection of eligible resident doctors.

Data collection

Data were collected between May and August 2019 using a validated, semi-structured, self-administered questionnaire that consisted of two sections. Section A obtained information on socio-demographic characteristics while section B assessed the respondent’s satisfaction on 10 dimensions of job satisfaction and included a single item that assessed resident doctors’ overall level of job satisfaction. In this study, a validated 10-item version of the Warr-Cook-Wall (WCW) job satisfaction scale developed by Warr et al. was used to assess job satisfaction.²¹ In addition to measuring overall job satisfaction, the WCW measures satisfaction with nine domains related to work (amount of variety in job, opportunity to use abilities, freedom of working methods, amount of responsibility, physical working conditions, hours of work, income, recognition for work, and colleagues and fellow workers). The overall job satisfaction was assessed by answering Yes or No to the question "Considering everything, how do you feel about your job?" while the nine items of job satisfaction were rated on a seven-point Likert scale (1 = very dissatisfied to 7 = very satisfied).

The tool was designed to provide a measure of work-related attitude that is short, valid, reliable, and easy to use and has been widely used among various disciplines of healthcare workers.^16,22-24 The instrument was also found to have a high internal reliability.^23,25 Two research assistants were trained on the study objectives and data collection methods. Before the study, a pre-test was done among 30 resident doctors in another teaching hospital not selected for the study. The study was carried out during departmental clinical meetings and seminars.

Data analysis

Data were analyzed using the Statistical Packages for the Social Sciences software (SPSS) version 21. Continuous variables were summarized using mean and standard deviation while categorical variables were summarized using proportions. The Chi-square test was used to test associations between variables. Multivariate analysis using regression was used to determine the predictors of overall job satisfaction among the resident doctors. The level of statistical significance was determined by a p<0.05.

RESULTS

Out of 271 resident doctors, 255 participated in the study giving a response rate of 94%. The mean age of the resident doctors was 27.9±12.8. The majority of the respondents were married (72.5%) and were males (58.4%). More than half of the resident doctors were senior registrars (52.9%) A higher proportion of the respondents earn between 200,000 -300,000 naira (Table 1).

The overall prevalence of job satisfaction among resident doctors in the University of Nigeria Teaching Hospital, Enugu was 37.3%. However, the majority of the respondents (62.7) were not satisfied with their job. (Figure 1)

Regarding satisfaction with the different aspects of their job, the majority of the respondents were not satisfied with the physical working conditions (75.7%), hours worked (72.5), recognition for good work (66.7%), opportunity to use abilities (63.9%) while more than half (52.2%) were not satisfied with the amount of variety in the job. The majority were thus satisfied with the attitude of fellow workers (73.7%) and the amount of responsibility given in their job (60.4%). More than half were satisfied with the freedom to choose the desired working method (56.9), and income (53.3). (Table 2)

The relationship between socio-demographic characteristics and overall job satisfaction was determined using Chi-square test. There were statistically significant associations between monthly salary (χ2=7.166, p=0.028), area of specialization, (χ2=12.570, p<0.001), years in residency training (χ2=10.070, p=0.007), and job satisfaction. (Table 3).

DISCUSSION

In this study, we assessed the overall level of job satisfaction and factors associated with job satisfaction among resident doctors in Southeast, Nigeria. The finding indicated that only 37.3% of the respondents were satisfied with their job. However, no individual or work attributes were identified as predictors of overall job satisfaction. The low prevalence of job satisfaction noted in this study was comparable to that obtained from other studies on job satisfaction done among resident doctors from all the teaching and residency training hospitals in Nigeria who attended the National Postgraduate Medical College's Revision Course and also that done in Ibadan, Nigeria where only 32.7% and 26.7% of the resident doctors respectively were found to be satisfied with their job.^7,15

In Pakistan, registrars were also found to be more dissatisfied with their current job status because of the stressful nature of their job.²⁶ This is worrisome as it has been documented that the greater the doctor’s dissatisfaction is, the greater the level of stress and tendency towards an increased turnover.^16,27

On the contrary, a study conducted in Kaduna State, Nigeria showed a disproportionately higher level of job satisfaction (80.1%) among the resident doctors.²⁰ While our study and that done in Ibadan (Southern Nigeria) showed a low level of job satisfaction, that done in Northern Nigeria found a high prevalence.^15,20 The explanation could be because of the characteristics of the local environment/setting where the studies were conducted. However, the comparison with the different prevalence in the studies might not reflect an exact level of job satisfaction among resident doctors.

Our study found that the majority of the resident doctors were not satisfied with their physical work condition, hours worked, recognition for good work, and opportunities to use abilities.

This finding is comparable to other studies, among healthcare workers that also reported dissatisfaction with similar issues; poor work conditions, and length of working hours.^7,30 Unfortunately, in Nigeria, no rule guides the number of hours a resident should work in a day and so, many have had to endure extended work shifts.^7,28-30 Working hours of resident doctors should be made flexible as long working hours can lead to fatigue, stress, burnout, and low performance among doctors.³⁰ It is imperative to improve the working environment of resident doctors as the conditions under which employees work have shown to have an impact on employees’ comfort and safety.²⁸ In Nigeria, a poor working environment has been shown as a major cause of emigration among doctors.³¹ The migration of resident doctors from Nigeria signifies a huge problem in the Nigerian healthcare system as it leads to brain drain and its dire consequences.^31,32 This study showed that there were strong associations between salary levels, area of specialization (being a surgical resident), years in residency training, and overall job satisfaction. Though on further analysis, none of these factors was found to be a predictor of overall job satisfaction. Those earning more than 400,000 naira monthly were found to be more satisfied than those earning a lesser amount. In similar studies in Nigeria, doctors were also found to be less satisfied with their salaries.^22,33 It is thus necessary to improve the resident doctor’s salary and therefore restore their satisfaction as poor remunerations have been documented as an important cause of industrial action and emigration of doctors in Nigeria.^29,34,35 Respondents that have spent more than six years were found to be more satisfied than their counterparts that have spent lesser years. This could be explained by the fact that most might have passed their fellowship examinations and are excited about their achievements, skills acquired and soon become specialist consultants.

More working years are accompanied by increasing salary and promotion, leading to greater social status and confidence in future career development; it is thus unsurprising that these factors lead to increased job satisfaction.³⁶ This is unlikely at the start of the residency programme when the doctors may be tensed, anxious, and not well guided in their job description. Similarly, studies conducted among health care workers in Nigeria showed that job satisfaction increases with tenure of service.³⁷ It can then be deduced that experience on a job reduces the level of stress, and then enhances the satisfaction that is derived from the job.²² Respondents in the surgery department were less satisfied with their job than those in the medicine department. In a similar study, job satisfaction was lowest among resident doctors in obstetrics and gynaecology.²⁰ This might be because of the high work burden and the number of hours worked daily by these residents including the additional surgical duties. A systematic review has shown that surgeons undergo an immense amount of stress throughout their training and burnout was documented as the single greatest predictor of surgeons' satisfaction with career and specialty choices.^38,39

Limitations

Since our respondents were recruited from one public health facility, the generalization of our findings could be difficult. Therefore, a more inclusive multi-center study involving the different geopolitical regions in Nigeria is recommended. Due to the cross-sectional nature of this study, it will be difficult to establish a true cause and effect relationship between job satisfaction and associated factors. Also, our study is prone to response bias as a convenience sampling technique was applied and this could have had some influence on the findings.

CONCLUSION

The study showed that there was a low level of job satisfaction among resident doctors in University of Nigeria Teaching Hospital (UNTH) Ituku/Ozalla, Enugu State, Nigeria. There is a need for the hospital management and policymakers to design and implement interventions, ensuring that appropriate measures are taken and potential solutions implemented to improve job satisfaction among resident doctors. These actions may be helpful to reduce the current state of a shortage of doctors in Nigeria.

ACKNOWLEDGEMENTS

The authors are thankful to all the study respondents an

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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