Mounting evidence suggests that faculty in medicine are increasingly unhappy, dissatisfied, and burned out.1 Although purported to be a national crisis, the actual understanding of the origins, consequences, and effective approaches to prevent and treat burnout remains limited.2,3 Academic medical centers have a tripartite mission to provide high-quality clinical care, to advance knowledge through research, and to train the next generation of health care professionals, each in the context of increased financial pressures and administrative burdens.4 Comprehending what factors are associated with satisfaction at work in academic health care centers is an important step toward addressing faculty burnout.
We conducted an online cross-sectional confidential survey in June 2016 of all 988 faculty members holding full-time appointments in the Department of Medicine at the Massachusetts General Hospital to examine the culture of workplace respect, collegiality, satisfaction, and mentoring. The primary outcome was each faculty member’s overall professional satisfaction (measured on a scale from very unsatisfied to very satisfied), and the secondary outcome was that member’s reported sense of feeling valued (measured on a scale from strongly disagree to strongly agree). Using multivariable logistic regression (SAS, version 9.4; SAS Institute Inc), we examined the associations of these outcomes with demographic information; personal and professional characteristics; and perceptions of leadership, diversity, collegiality, and collaboration, together with other domains associated with mentoring (experience and quality of mentorship, and role as a mentor) that were reported elsewhere.5 The final models included only those with a bivariate P < .10 from χ2 tests. All P values were from 2-sided tests and results were deemed statistically significant at P < .05. The Partners Healthcare Institutional Review Board approved this study (protocol number: 2016P000935). The Partners Healthcare Human Research Committee determined that the project met the criteria for institutional review board exemption because the research was limited to the use of survey data and was not subject to US Food and Drug Administration regulations, and there was not more than minimal risk to study participants. Completion of the survey was considered implied consent of participation. All data used were strictly anonymized; only a research coordinator, who was not involved in this study, had access to the file linking responses with identifiers.
A total of 553 faculty members (56.0%) responded (Table 1); respondents were similar in sex and rank to the full Department of Medicine faculty. Multivariable analyses identified the following factors that were significantly associated with job satisfaction: feeling valued (odds ratio [OR], 4.73; 95% CI, 2.35-9.51), feeling treated with respect (OR, 3.45; 95% CI, 2.07-5.75), and working in a social and supportive environment (OR, 1.80; 95% CI, 1.05-3.09) (Table 2). Sex, race/ethnicity, and rank were not significantly associated with satisfaction after controlling for other factors. The following variables were significantly associated with outcome of feeling valued: feeling cared about as a person (OR, 28.0; 95% CI, 15.3-51.3), not feeling taken for granted (OR, 4.52; 95% CI, 2.28-8.97), feeling resources were provided for his or her professional growth (OR, 2.38; 95% CI, 1.16-4.89), and not feeling discriminated against by sex (OR, 2.29; 95% CI, 1.02-5.16). Race/ethnicity, rank, and feeling fairly compensated were not independently associated with feeling valued.
At a time when concern about faculty well-being is high, with much speculation about causes of burnout,2 we find that investment in social capital and sense of value and respect for employees may be most critical to faculty members’ satisfaction with work. A challenge of the fast-paced, technology-driven environment that is rapidly growing around us is the imperative to stay connected personally—not electronically—and reduce isolation. Intentional efforts to establish and nurture social and supportive environments—modifiable factors for all organizations that require relational, rather than financial, investment—will be ever more critical in the years ahead.
More important, we found no association with job satisfaction or feeling valued with sex, rank, or feeling compensated fairly, highlighting that financial incentives may not be effective alone in boosting satisfaction in the workplace. Limitations of this study include its modest size and single site, although there is no reason to postulate that similar factors associated with satisfaction would be unique to medicine or this academic health center.
Our findings call attention to the importance of promoting a sense of value and respect in the work environment for academic faculty, identifying and eliminating sources of discrimination, and expanding endeavors to facilitate collegiality. As we think about the urgent call to alleviate burnout, efforts focused in the domain of social capital seem vital.
Accepted for Publication: February 1, 2019.
Corresponding Author: Arabella L. Simpkin, MD, MMSc, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Ste 1645, Boston, MA 02114 (firstname.lastname@example.org).
Published Online: May 6, 2019. doi:10.1001/jamainternmed.2019.0377
Author Contributions: Drs Simpkin and Chang had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Simpkin, Campbell, Armstrong, Walensky.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Simpkin, Chang, Walensky.
Critical revision of the manuscript for important intellectual content: Simpkin, Yu, Campbell, Armstrong, Walensky.
Statistical analysis: Simpkin, Chang, Yu, Walensky.
Administrative, technical, or material support: Simpkin, Campbell, Armstrong, Walensky.
Supervision: Campbell, Armstrong, Walensky.
Conflict of Interest Disclosures: Dr Campbell reported serving as an expert witness on law cases related to financial conflicts of interest between physicians and drug companies. No other disclosures were reported.
Funding/Support: This study was supported by the Steve and Deborah Gorlin Massachusetts General Hospital Research Scholar (Dr Walensky).
Role of the Funder/Sponsor: The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.