It has been shown that physicians’ work satisfaction is influenced by factors such as patient care, workload, income and prestige, self-fulfillment, and relations with fellow co-workers [1]. Factors that negatively influence physicians’ work satisfaction [2, 3] include time, pressure, lack of leisure time, and time for one’s self, a decline in quality of life, feelings of less autonomy in decision making, less time spent on actual patient care, and more time spent doing administrative work.
No difference in work satisfaction was found [4] among physicians who dedicate most of their time to patient care compared to physicians who dedicate their time to medical research. Nevertheless, physicians who spend more time with patients reported a greater insult to their quality of life. The determining factors for their dissatisfaction were less time for their families, themselves, and leisure activities.
Burnout is a “psychological syndrome of emotional exhaustion, depersonalization and low sense of achievement” [5]. Among physicians, it is a long-term stress reaction that influences work satisfaction and derives from some characterizing factors of today’s medical profession. These factors include physicians’ loss of autonomy and prestige, the financial transformation of health systems [6], work stress, and time pressure, and to some extent from personality traits of physicians. Personality traits such as obsessiveness and rigidity, together with high levels of intelligence, might lead physicians to feel accountable and overcommitted [7].
In the beginning of the burnout process among physicians [5], one can find a group of general background variables such as age, number of children, marital status, and work hours, which interact with mediating variables, namely autonomy at work, home–work relations, and home support. When the background variables combine well with the mediating variables (meaning the physician is practicing in his or her field of choice, is satisfied with work hours, manages to keep a good balance between work and private life, and is getting good support from his or her family), this combination leads to high levels of satisfaction and may prevent burnout. However, when the combination of all the factors is other than perfect, the outcome is most likely to be some degree of burnout.
A sense of burnout is directly related to dissatisfaction, which in turn may lead to a decline in the desire of the physician to treat patients, a tendency to order expensive laboratory examinations, and an ongoing interest in early retirement. Burned-out physicians [7] suffer from social isolation, lack of joy and happiness, depression, and denial. Eventually they become cynical and ironic.
It is likely that the relatively high rates [6] of mental illness among physicians (male and female alike) and the high rates of suicide attempts are related to the combination of problematic work conditions and work dissatisfaction together with some primary predisposing personality factors.
In comparison to male physicians [8], female physicians reported greater levels of dissatisfaction with their autonomy at work and time pressure, and reported 1.6 times greater rates of burnout. Among female physicians who practice surgery [9] there were differences in academic ranking compared to male physicians, as well as differences in level of income, work status, and work relations. The research also showed that almost 30% of the female physicians are seriously considering leaving their work because of these differences.
Despite these findings, a large study [10] of 12,474 physicians in the United States did not find any differences between male and female physicians in terms of work satisfaction.
There is a clear connection [10] between work satisfaction and the type of specialty chosen. Physicians who practice “procedural” fields such as obstetrics and gynecology, ophthalmology, and orthopedic surgery, stated greater dissatisfaction with their work than physicians who practice “non-procedural” fields such as geriatric medicine, pediatric medicine, and dermatology. The difference between the groups was caused by the changes in the health care systems in the United States in the last few years, which affected the social status of physicians, their autonomy, and their salaries.
In the survey conducted by Clarke and Associates, which focused on job satisfaction and stress among neonatologists, it was found that almost all neonatologists experienced stress at work: 34% moderately severe and 16% very severe stress. Major causes of stress were excessive work load, on call too often, and calls at night; problems in patient care, especially dealing with infant death; and staff disagreements, especially nurse or house staff conflicts. One-sixth of the neonatologists were either moderately or very dissatisfied with their career. Major dissatisfactions were: too much work, especially managing many sick patients; lack of resources, including inadequate salary; too much stress at work; and administrative demands. Job satisfaction was derived from patient care, teaching, intellectual stimulation, and research. Altering their subspecialty had been considered at some time by 58% (15% very seriously). The researchers also suggested that job stress is a greater problem than job dissatisfaction [11].
Overall, the satisfaction level of physicians in the last few decades has been declining [12–14]. Since the 1970s, work dissatisfaction among physicians doubled from less than 15% to more than 30% in the late 1990s. About 40% of the physicians stated they would not have chosen to practice medicine again if given the chance, and a larger percentage said they will not recommend their children do so. [15] In addition, 41% of the physicians have contemplated leaving the medical profession because of their discontent [16].
Similar to the above mentioned changes, the choice of medical specialty by medical students in the United States went through great changes in the last few years [17]. A study conducted between 1996 and 2002 found that specialty fields such as dermatology and anesthesiology, which traditionally had very low rates of interest among the graduating students, had multiplied the number of their candidates by tens and hundreds of percentages (anesthesiology – a rise of 500%, dermatology – a rise of 1000%). More than 55% of the students said that the factor that most strongly influenced their choice was the ability to have a “controllable lifestyle”, meaning having time that is free of the demands of their work, that could be dedicated to their leisure activities and families, and which is controlled by them. A similar change was noticed among Israeli medical school graduates [18], which demonstrated a rise in the popularity of specialties such as radiology and anesthesiology between 1980 and 1995. Unfortunately, it is not the case in neonatology in Israel – the number of physicians choosing neonatology as a subspecialty is constantly insufficient, an average of 5 per year in the last 20 years [19], whereas the number of live births is steadily increasing [20]. The severity of situation, caused the Amourai Committee in 2002 to declare neonatology as one of the “in crisis specialties” [21]. In contrast, in the United States, the number of neonatologists rose by 150%, whereas the number of premature babies had risen only by 18% [22].
The current study aimed to describe the level of work satisfaction, quality of life, and leisure time of senior neonatologists and neonatologist fellows in Israel by age, gender, status in their department, and time in the profession. The term “neonatology fellowship” is being used here to refer to advanced training in neonatology. All participants in the neonatology training programs have already completed a basic residency in pediatrics. In Israel, pediatricians participating in such advanced training are often referred to as “residents in neonatology”, with the training in neonatology functioning as a second (advanced) residency.
We asked all active senior neonatologists and neonatologist fellows in Israel, between July 2008 and March 2009, to participate in the current study. In Israel there are 25 medical centers specializing in neonatal care, with a total of 114 practicing neonatologists. Most of these centers provide neonatal services including prenatal counseling for high risk pregnancies, neonatal care in the delivery room, normal postnatal follow-up and care, services for neonates with congenital defects with follow-up, treatment in special care units and in neonatal intensive care units (NICU), and neonatal counseling. In Israel there were 151,679 live-births in 2007 [20]. This number is consistent with a steady rise in live births over the last 50 years. At the same year, according to the Ministry of Health data, the number of beds for special neonatal care in Israel was only 556 [23]. In comparison, according to a workforce report from the American Academy of Pediatrics in October 1996, there were at that time 3688 board-certified and board-eligible neonatologists in the United States. This means that in the U.S. there are 1.2 neonatologists per 10,000 people in comparison to 1.4 neonatologists per 10,000 people in Israel. This seems a fair comparison until we compare the live birth ratio, which is 14/1000 in the US vs. 20/1000 in Israel.
