key: cord-0834517-c0uhsvuh authors: Lall, Michelle D.; Chang, Bernard P.; Park, Joel; Tabatabai, Ramin R.; Manfredi, Rita A.; Baren, Jill M.; Castillo, Jenny title: Are emergency physicians satisfied? An analysis of operational/organization factors date: 2021-12-21 journal: J Am Coll Emerg Physicians Open DOI: 10.1002/emp2.12546 sha: 08c29092ff1980c48d90b61a5ce1838869f97cdc doc_id: 834517 cord_uid: c0uhsvuh OBJECTIVE: Professional satisfaction is associated with career longevity, individual well‐being, and patient care and safety. Lack of physician engagement promotes the opposite. This study sought to identify important facets contributing to decreased career satisfaction using a large national data set of practicing emergency physicians. METHODS: We performed a secondary analysis of the national Longitudinal Study of Emergency Physicians survey conducted by the American Board of Emergency Medicine. The survey was composed of 57 variables including career satisfaction as well as occupational and psychological variables potentially associated with career satisfaction. Factor analysis was used to determine the important latent variables. Ordinal logistic regression was performed to determine statistical significance among the latent variables with overall career satisfaction. RESULTS: A total of 863 participants were recorded. The overall mean career satisfaction rate was 3.9 on a 5‐point Likert scale with 1 and 5 indicating “least satisfied” and “most satisfied,” respectively. Our analysis revealed 9 factors related to job satisfaction. Two latent factors, exhaustion/stress and administration/respect, were statistically significant. When comparing satisfaction scores between sex, there was a statistically significant difference with men reporting a higher satisfaction rate (P = 0.0092). Age was also statistically significant with overall satisfaction lower for younger physicians than older physicians. CONCLUSION: Our study found that emergency physicians are overall satisfied with emergency medicine, although with variability depending on sex and age. In addition, we characterized job satisfaction into 9 factors that significantly contribute to job satisfaction. Future work exploring these factors may help elucidate the development of targeted interventions to improve professional well‐being in the emergency medicine workforce. targeted interventions to improve professional well-being in the emergency medicine workforce. career satisfaction, emergency medicine, job factors INTRODUCTION Prior studies have found that emergency physicians consistently rank among the highest medical specialties in both clinician burnout and satisfaction with work-life integration. 1, 2 Although several studies have focused on determining the various contributors to burnout in emergency medicine, few have focused specifically on the determinants of emergency physician career satisfaction. Both external/organizational and internal/individual level factors contribute to career satisfaction. One qualitative study looking at emergency physician career satisfaction determined that both external stress factors (eg, long shifts, night shifts, psychological demands, lack of continuing education) and internal stress factors (eg, coping strategies, personality types, anxiety with making mistakes and medical malpractice) impact job satisfaction. 3 The aim of this study is to assess current career satisfaction among board-certified emergency physicians and to identify associated factors with satisfaction using the most recent 2014 ABEM data set. The multisection questionnaire addresses different aspects of emergency medicine including, but not limited to, personal aspirations, practice environment, and demographics. For this particular analysis, a subset of this questionnaire was used to create the cohort of interest. As this study investigates insights into emergency physician career satisfaction, sections A (professional interests, attitudes, and goals), C (professional experience), and E (demographics) were selected, which created a subset of 57 variables of interest. These variables focus on different components that could impact the physician's overall satisfaction with their career in emergency medicine. The aim of this work is to identify the different facets that contribute significantly to professional career satisfaction in emergency medicine. Although each question may not be identical, many cover similar content areas. Therefore, as a large number of variables are present, factor analysis was employed to reduce the dimensions of the data set into the important latent variables contributing to career satisfaction. The variable "Overall, how satisfied are you with your career in EM?" was used to measure overall career satisfaction on a 5-point Likert scale, with 1 and 5 indicating "least satisfied" and "most satisfied," respectively. Demographic characteristics are summarized in Table 2 . Overall, 1102 surveys were distributed, with a response rate of 80%. Satisfaction in emergency medicine is reported among 863 of the 1102 participants completing the survey. The mean career satisfaction was 3.9, with 34% reporting being most satisfied. The mean satisfaction for women was 3.699, and the mean satisfaction for men was 3.9726. The categorical distribution of the Likert scores between the 2 sexes was statistically significant (χ2 = 13.474; P = 0.0092). The majority of the participants were White married men with 2 children and an average age of 50.82 years old. Given the many individual items assessed on the survey, we conducted a factor analysis to evaluate whether these variables grouped in a more limited number of dimensions (Table 3) . Our factor analysis revealed 9 factors that we conceptualized based on the individual variables within each factor (Table 4 ). The ordinal logistic regression demonstrated that the following 2 latent factors had statistical significance ( After adjusting for sex, race, marital status, number of living children, and age, sex and age were found to be statistically significant, which suggests an association between sex and emergency medicine satisfaction and age with emergency medicine satisfaction. Sex was found to be statistically significant as an independent predictor of satisfaction in terms of one's career, with men having higher satisfaction than women (OR, 1.38; P = 0.0375). In addition, when the mean satisfaction for women (3.699) was compared with the mean satisfaction for men (3.9726), a statistically significant difference (χ2 = 13.474; P = 0.0092179) was found. Although this study had a large sample size, the data have several limi- Likert scale ratings: 1 = not satisfied, 3 = satisfied, 5 = very satisfied. imputation because of the potential of a heavy skew with data from a 5-point Likert scale. Therefore, we felt that the mean was less suitable than the median for analysis. Finally, physicians who are less satisfied with their work may have been less likely to participate in the survey, limiting our ability to accurately assess the level of career satisfaction. The absence of this cohort, as well as the lower number of minority and female respondents, may have skewed the data obtained regarding career satisfaction within emergency medicine. Career satisfaction is a vital factor impacting professional longevity, physician well-being, and patient safety. 11 When addressing physician well-being, career satisfaction is important because studies show less turnover and intention to leave the workplace when career satisfaction is higher. 12 There is also increasing evidence that poor staff perception of the workplace impacts staff retention and thus personnel and professionalcapital in the emergency department (ED). 13 In addition, workplace perceptions are centered on the following themes: perceived excessive workload, teamwork and feeling like a skilled and valued member of the team, the impacts of traumatic events, the need for support (managerial, peer, and social), and autonomy. 13 increasing workload and adverse events that were factors found in previous studies, ED boarding and crowding also leads to decreased job and career satisfaction. [19] [20] [21] In addition to organizational factors, personal factors also contribute to emergency medicine career satisfaction, highlighting the importance of work-life integration and the potential for the 2 to impact each other ( 25 Our study illustrates the concern of learning new skills and keeping up to date; however, it may be a reflection In conclusion, our study suggests that factors contributing to career satisfaction originate primarily at the system or organizational level of medicine with a relatively small proportion of factors originating at the personal or individual level. We found that most emergency physicians were satisfied and very satisfied with their career in emergency medicine despite being at significant risk for burnout. Our challenge as a specialty is to sustain this high level of satisfaction while creating systemic solutions that facilitate physician engagement and create a culture of change that prioritizes well-being. Future research focusing on organizational and operational factors as well as work-life integration may provide actionable initiatives to improve the well-being and professional satisfaction of emergency physicians. Studies focusing on URiM and female emergency physicians need to be conducted to provide a more comprehensive look at their unique challenges and how they contribute to career satisfaction. 28 Finally, the COVID-19 pandemic uncovered the moral injury that emergency physicians experience with consequences on career satisfaction, both short term and long term, which will need future evaluation. The post-pandemic level of career fulfillment may widely differ among physicians and be impacted by factors such as life stages and work environments. 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