Original Research
Predictors of Professional and Personal Satisfaction
With a Career in Psychiatry
Paul E Garfinkel, MD, FRCPC1,
R Michael Bagby, PhD, CPsych2,
Deborah R Schuller, MD, FRCPC3,
Susan E Dickens, MA4,
Fiona S Schulte, MA5
| |
Background: Many factors, including personal experience and personality traits, contribute to the emotional difficulties that psychiatrists experience in their professional work. The nature of the work itself also plays a significant role.
Objective: To determine those personal and professional characteristics that predict satisfaction with the practice of psychiatry.
Method: We mailed a questionnaire that included items pertaining to aspects of personal and professional life to the entire population of psychiatrists in Ontario (N = 1574).
Results: Of the 1574, 52% (n = 802) responded. We conducted a series of regression analyses to determine factors related to career satisfaction or regret. A belief in the intrinsic value of psychiatry, a low perceived degree of emotional burden from patients, financial success, and satisfaction with psychotherapeutic work emerged consistently as significant predictors. A subsequent discriminant function analysis indicated that all 4 of these variables accurately predicted those psychiatrists with extreme satisfaction or dissatisfaction with work.
Conclusions: These results reveal several variables associated with career satisfaction in the practice of psychiatry that might be useful to discuss with residents who are beginning their careers.
(Can J Psychiatry 2005;50:333–341)
Click here for author affiliations.
|
Clinical Implications
Limitations
-
The study was limited to psychiatrists in Ontario.
-
The evaluation was cross-sectional.
-
We collected self-report data only.
|
Key Words: career satisfaction, professional practice characteristics, emotional vulnerability
Résumé : Les prédicteurs de la satisfaction professionnelle et personnelle
d’une carrière en psychiatrie
|
Psychiatrists are known to be at risk for depression, anxiety, and burnout (1–4). The perceived stress associated with the practice of psychiatry is a factor in dissuading medical students of different cultural backgrounds from choosing psychiatry as a specialty (5). Many factors—including experience and personality traits—contribute to the emotional difficulties that psychiatrists experience (6). The nature of the work itself, however, clearly contributes further. The emotional burden of treating very ill patients, the relative isolation of the work, and an inability to balance personal and professional lives all play an important role. Recent studies from the US have also related career dissatisfaction to changing practice patterns, reimbursement, managed care, and increased competition from nonphysician mental health professionals (7–9).
Nevertheless, psychiatrists also experience tremendous satisfaction in caring for others. There is now an expanded therapeutic armamentarium that includes evidence-based psychotherapies and newly developed medications, which affords a greater probability of treatment success. To possess the ability and perseverance necessary to successfully treat patients in serious emotional distress is for many psychiatrists intrinsically rewarding. Recently, using data from a survey of over 600 physicians, Sturm found that only 21.2% of psychiatrists in his sample reported being dissatisfied with their careers (10). Similar rates were found among a cohort of Dutch psychiatrists (11). Dissatisfaction in this cohort was predicted by feeling poorly managed and resourced, feeling devalued, and feeling a lack of intellectual stimulation, as well as by poor communicative responsiveness and social support from colleagues.
An earlier report on another cohort of psychiatrists that the first author has been following for more than 20 years (12) found that personal satisfaction and external measures of career success were related to personality traits and to attributes associated with the psychiatrists’ personal and professional lives. These findings, however, were based on a small sample of psychiatrists who graduated from their residency programs in the 1970s and were followed longitudinally, limiting the generalizability of the results.
In the current study, we used data from a survey of a large sample of Ontario psychiatrists to examine factors related to psychiatrists’ perception of professional and personal satisfaction with their careers. In contrast to our previous study (12), which was also limited by a small sample size, we were able to test a large number of predictor variables that the previous literature suggested as potential predictors of career satisfaction. We also used 4 different questions to assess professional and personal satisfaction, compared with a single outcome variable, which we believe enhances the generalizability of our results.
Method
Subjects, Procedure, and Questionnaire Design
In the spring of 1999, as part of a study of Ontario psychiatrists’ practice characteristics, we mailed a 12-page survey to the entire population of licensed psychiatrists in Ontario (N = 1547). The questionnaires were accompanied by a cover letter explaining the nature of the study and an anonymous form for responding. Four months later, we sent a follow-up mailing to those who did not respond to the initial mailing. Of the potential respondents, 802 (52%) completed and returned their questionnaire in response to these 2 mailings. This return rate is comparable to similar studies that have been conducted with physicians in other specialties (13,14). The mean age of the overall sample was 50.1 years, SD 10.4; 552 (68.8%) were men; and 250 (31.2%) were women. The modal year of graduation from psychiatric residency was 1986, while the median year was 1983. The earliest year of graduation from psychiatric residency was 1951, and the latest was 1999.
The questionnaire included items designed to assess a psychiatrist’s personal and professional life and the interface between each (see Appendix). As well, the following questions were specifically designed to address in different ways the respondents’ sense of professional and personal satisfaction with their career as psychiatrists: “To what degree do you have regrets about choosing psychiatry as a profession?” “To what degree have the expectations that led you to choose psychiatry as a specialty at the beginning of your career been met?” “If you were able to choose again, would you choose psychiatry as a specialty?” “Overall, how satisfied are you with your professional career?” Responses were recorded on a Likert scale ranging from 1 to 5, where 1 indicated the more negative response and 5 reflected a highly positive response. The questions were generated by a working group that included 2 psychiatrists with extensive knowledge and experience of psychiatrists’ professional and academic responsibilities within the private and public sectors. This questionnaire was used in our earlier study (12) and received approval for use by the Research Ethics Board of the University of Toronto and the Centre for Addiction and Mental Health.
Statistical Analysis
We performed 4 regression analyses, 1 for each of the 4 questions assessing professional and personal satisfaction (which served as criterion variables) together with the 23 questions listed in the Appendix (which served as predictor variables). All predictor variables were entered according to a stepwise method, with entry level set at P < 0.05. Despite the large number of predictor variables, the subject-to-variable ratio was 33 to 1, providing more than adequate statistical power. We selected the items that formed the criterion and predictor variables from both an extensive review of the literature and the findings of our previous longitudinal study (12) together with the hypotheses emanating from it. For each regression analysis, we report unadjusted R2 values (see the Results section) as well as the standardized beta coefficients and partial and part correlations (reported in Tables 1 to 4). These statistics provide an estimation of the association between identified predictor and criterion variables directly and also control for the association between the other predictor variables and the criterion variable.
|
Table 1 Regression analysis for variables found to predict “regrets with
choosing psychiatry as a career choice”
|
|
|
|
|
|
|
|
|
|
Final model
|
|
Step
|
Predictorsa
|
R2
|
F
|
df
|
R2chg
|
Fchg
|
df
|
B
|
SE
|
b
|
Partial r
|
Part r
|
|
|
1
|
Intrinsic value of work
|
016
|
126.63**
|
1,684
|
|
|
|
-0.43
|
0.04
|
-0.29
|
–0.31
|
-0.27
|
|
2
|
Degree of emotional burden
|
|
|
|
0.06
|
55.48**
|
1,683
|
0.20
|
0.03
|
0.20
|
0.22
|
0.19
|
|
3
|
Academic recognition
|
|
|
|
0.03
|
25.63**
|
1,682
|
-0.10
|
0.03
|
-0.11
|
-0.12
|
-0.10
|
|
4
|
Financial success
|
|
|
|
0.02
|
17.72**
|
1,681
|
-0.14
|
0.04
|
-0.13
|
–0.14
|
-0.12
|
|
5
|
Availability of professional contact
|
|
|
|
0.01
|
9.16**
|
1,680
|
-0.08
|
0.03
|
-0.10
|
–0.11
|
-0.09
|
|
6
|
Psychotherapy satisfaction
|
|
|
|
0.01
|
5.38*
|
1,679
|
-0.07
|
0.03
|
-0.08
|
–0.09
|
-0.07
|
|
7
|
Community recognition
|
|
|
|
0.004
|
4.24*
|
1,678
|
-0.07
|
0.03
|
-0.07
|
–0.08
|
-0.07
|
|
|
Overall model
|
028
|
38.96**
|
7,678
|
|
|
|
|
|
|
|
|
aOnly variables that emerged as significant predictors of regret with choosing
psychiatry as a career choice are included.
**P < 0.01; *P < 0.05; SE = standard error
|
Table 2 Regression analysis for variables found to predict “expectations
of career in psychiatry”
|
|
|
|
|
|
|
|
|
|
Final model
|
|
Step
|
Predictorsa
|
R2
|
F
|
df
|
R2chg
|
Fchg
|
df
|
B
|
SE
|
b
|
Partial r
|
Part r
|
|
|
1
|
Intrinsic value of work
|
0.16
|
126.76**
|
1, 683
|
|
|
|
-0.28
|
0.04
|
-0.22
|
–0.25
|
-0.20
|
|
2
|
Degree of emotional burden
|
|
|
|
0.07
|
57.36**
|
1,682
|
0.11
|
0.03
|
0.13
|
0.15
|
0.12
|
|
3
|
Professional peer recognition
|
|
|
|
0.05
|
42.21**
|
1,681
|
-0.08
|
0.03
|
-0.09
|
–0.10
|
-0.08
|
|
4
|
Financial success
|
|
|
|
0.02
|
22.12**
|
1,680
|
-0.10
|
0.03
|
-0.11
|
–0.12
|
-0.09
|
|
5
|
Quality of professional contact
|
|
|
|
0.01
|
15.56**
|
1,679
|
-0.06
|
0.03
|
-0.08
|
–0.09
|
-0.07
|
|
6
|
Other medical profession respect
|
|
|
|
0.01
|
13.40**
|
1,678
|
-0.12
|
0.03
|
-0.12
|
–0.14
|
-0.11
|
|
7
|
Balance between professional and private life
|
|
|
|
0.01
|
11.03**
|
1,677
|
-0.07
|
0.03
|
-0.09
|
–0.10
|
-0.07
|
|
8
|
Psychotherapy satisfaction
|
|
|
|
0.01
|
8.64**
|
1,676
|
-0.06
|
0.02
|
-0.09
|
–0.11
|
-0.09
|
|
9
|
Time for professional career development
|
|
|
|
0.01
|
6.54*
|
1,675
|
-0.08
|
0.03
|
-0.09
|
–0.09
|
-0.08
|
|
10
|
Community involvement satisfaction
|
|
|
|
0.01
|
6.11*
|
1,674
|
-0.03
|
0.01
|
-0.08
|
–0.10
|
-0.08
|
|
11
|
Degree of professional isolation
|
|
|
|
0.004
|
4.62*
|
1,673
|
0.06
|
0.03
|
0.08
|
0.08
|
0.07
|
|
|
Overall model
|
0.36
|
33.79**
|
11,673
|
|
|
|
|
|
|
|
|
aOnly variables that emerged as significant predictors of expectations
of a career in psychiatry are included.
**P < 0.01; *P < 0.05; SE = standard error
|
Table 3 Regression analysis for variables found to predict “choose psychiatry
as a specialty again”
|
|
|
|
|
|
|
|
|
|
Final model
|
|
Step
|
Predictorsa
|
R2
|
F
|
df
|
R2chg
|
Fchg
|
df
|
B
|
SE
|
b
|
Partial r
|
Part r
|
|
|
1
|
Intrinsic value of work
|
0.17
|
137.59
|
1,682
|
|
|
|
-0.48
|
0.06
|
-0.29
|
–0.31
|
-0.27
|
|
2
|
Degree of emotional burden
|
|
|
|
0.04
|
36.65**
|
1,681
|
0.16
|
0.04
|
0.14
|
0.16
|
0.14
|
|
3
|
Financial success
|
|
|
|
0.03
|
26.79**
|
1,680
|
-0.14
|
0.04
|
-0.12
|
–0.12
|
-0.11
|
|
4
|
Availability of professional contact
|
|
|
|
0.02
|
15.59**
|
1,679
|
-0.10
|
0.03
|
-0.11
|
–0.12
|
-0.10
|
|
5
|
Professional peer recognition
|
|
|
|
0.01
|
9.03**
|
1,678
|
-0.10
|
0.04
|
-0.09
|
–0.09
|
-0.08
|
|
6
|
Psychotherapy satisfaction
|
|
|
|
0.01
|
6.28*
|
1,677
|
-0.07
|
0.03
|
-0.08
|
–0.09
|
-0.08
|
|
7
|
Time for professional career development
|
|
|
|
0.01
|
4.59*
|
1,676
|
-0.09
|
0.04
|
-0.08
|
-0.08
|
-0.07
|
|
|
Overall model
|
0.28
|
37.30**
|
7,676
|
|
|
|
|
|
|
|
|
aOnly variables that emerged as significant predictors of choose psychiatry
as a specialty again are included.
**P < 0.01; *P < 0.05; SE = standard error
|
Table 4 Regression analysis for variables found to predict “overall satisfaction
with career”
|
|
|
|
|
|
|
|
|
|
Final model
|
|
Step
|
Predictorsa
|
R2
|
F
|
df
|
R2chg
|
Fchg
|
df
|
B
|
SE
|
b
|
Partial r
|
Part r
|
|
|
1
|
Professional peer recognition
|
0.18
|
146.62**
|
1,685
|
|
|
|
-0.14
|
0.03
|
-0.17
|
–0.19
|
-0.14
|
|
2
|
Balance between professional and private life
|
|
|
|
0.10
|
95.47**
|
1,684
|
-0.11
|
0.02
|
-0.14
|
–0.17
|
-0.13
|
|
3
|
Appreciation from patients
|
|
|
|
0.07
|
76.07**
|
1,683
|
-0.21
|
0.03
|
-0.20
|
–0.24
|
-0.18
|
|
4
|
Degree of emotional burden
|
|
|
|
0.04
|
44.83**
|
1,682
|
0.12
|
0.02
|
0.15
|
0.19
|
0.14
|
|
5
|
Intrinsic value of work
|
|
|
|
0.03
|
40.23**
|
1,681
|
-0.19
|
0.04
|
-0.17
|
–0.20
|
-0.15
|
|
6
|
Financial success
|
|
|
|
0.03
|
32.14**
|
1,680
|
-0.13
|
0.03
|
-0.15
|
–0.18
|
-0.13
|
|
7
|
Time for professional career development
|
|
|
|
0.01
|
15.81**
|
1,679
|
-0.09
|
0.03
|
-0.11
|
–0.13
|
-0.09
|
|
8
|
Degree of professional isolation
|
|
|
|
0.01
|
11.36**
|
1,678
|
0.07
|
0.02
|
0.11
|
0.13
|
0.10
|
|
9
|
Psychotherapy satisfaction
|
|
|
|
0.01
|
8.87**
|
1,677
|
-0.06
|
0.02
|
-0.09
|
–0.11
|
-0.08
|
|
|
Overall model
|
0.48
|
68.88**
|
9,677
|
|
|
|
|
|
|
|
|
aOnly variables that emerged as significant predictors of overall satisfaction
with career are included.
**P < 0.01; SE = standard error
|
Results
Table 5 displays the means and SDs for the survey questions (the predictor and criterion variables used to evaluate overall level of career satisfaction in the regression analyses). Tables 1 to 4 display the results from the regression analyses. Overall, 15 of the 23 predictor variables that were entered into the model emerged as significant predictors for at least 1 of the 4 criterion variables assessing different aspects of professional and personal satisfaction (see Table 6). On average, the significantly predicting variables accounted for 35% of the variance. Four predictor variables—belief in the intrinsic value of psychiatric care, perceived degree of emotional burden, perceived financial success, and satisfaction derived from psychotherapeutic work—emerged consistently as the most reliable predictors. For 3 of the 4 criterion variables, the perceived intrinsic value of psychiatry proved to be the most powerful predictor.
Table 5 Descriptive statistics for the overall sample as derived from responses
to a Likert scale
|
|
Item
|
Mean
|
SD
|
|
|
1. Degree of emotional burden
|
3.21
|
1.02
|
|
2. Availability of professional contact
|
3.89
|
1.11
|
|
3. Quality of professional contact
|
4.09
|
1.00
|
|
4. Degree of professional isolation
|
2.35
|
1.17
|
|
5. Quality of contact
|
3.96
|
1.04
|
|
6. Medical specialists respect psychiatry
|
2.49
|
0.91
|
|
7. Nonmedical health professionals respect psychiatry
|
3.12
|
0.92
|
|
8. Able to devote time to professional career
|
3.28
|
0.99
|
|
9. Perception of financial success
|
3.31
|
0.95
|
|
10. Perception of professional peer recognition
|
3.44
|
0.98
|
|
11. Perception of academic recognition
|
2.61
|
1.19
|
|
12. Perception of community recognition
|
3.39
|
1.08
|
|
13. Appreciation from patients
|
4.18
|
0.74
|
|
14. Satisfaction from psychotherapy
|
4.10
|
1.25
|
|
15. Satisfaction from university teaching
|
4.91
|
2.83
|
|
16. Satisfaction from research
|
4.99
|
3.28
|
|
17. Satisfaction from community involvement
|
4.07
|
2.22
|
|
18. Good balance between professional and personal life
|
3.53
|
1.02
|
|
19. Struggle to achieve balance between professional and personal life
|
3.65
|
1.11
|
|
20. Nonprofessional commitments impinge on professional life
|
2.06
|
1.12
|
|
21. Professional commitments impinge on personal life
|
3.07
|
1.21
|
|
22. Nonprofessional aspects sustain professional life
|
4.02
|
1.01
|
|
23. Work has intrinsic value
|
4.51
|
0.70
|
|
24. Regrets about choosing psychiatrya
|
1.74
|
1.03
|
|
25. Expectations not been meta
|
3.96
|
0.89
|
|
26. Choose psychiatry againa
|
4.12
|
1.14
|
|
27. Satisfied with careera
|
4.01
|
0.81
|
aCriterion variables (all other variables are predictor variables).
|
Table 6 Variables that emerged as significant predictors for specific
criterion variables
|
|
Predictors
|
Regrets with
choosing psychiatry as a career choice
|
Expectations of
career in psychiatry
|
Choose psychiatry as a specialty again
|
Overall satisfaction with career
|
|
|
Intrinsic value of work
|
X
|
X
|
X
|
X
|
|
Time for professional career development
|
|
X
|
X
|
| |
