Physician Career Satisfaction Across Specialties J. Paul Leigh, PhD; Richard L. Kravitz, MD, MSPH; Mike Schembri, MS; Steven J. Samuels, PhD; Shanaz Mobley, BS Background: The career satisfaction and dissatisfac- tion physicians experience likely influence the quality of medical care. Objective: To compare career satisfaction across spe- cialties among US physicians. Methods: We analyzed data from the Community Track- ing Study of 12 474 physicians (response rate, 65%) for the late 1990s. Data are cross-sectional. Two satisfac- tion variables were created: very satisfied and dissatis- fied. Thirty-three specialty categories were analyzed. Results: After adjusting for control variables, the follow- ing specialties are significantly more likely than family medicine to be very satisfying: geriatric internal medi- cine (odds ratio [OR], 2.04); neonatal-perinatal medi- cine (OR, 1.89); dermatology (OR, 1.48); and pediatrics (OR, 1.36). The following are significantly more likely than family medicine to be dissatisfying: otolaryngology (OR, 1.78); obstetrics-gynecology (OR, 1.61); ophthalmology (OR, 1.51); orthopedics (OR, 1.36); and internal medi- cine (OR, 1.22). Among the control variables, we also found nonlinear relations between age and satisfaction; high sat- isfaction among physicians in the west north Central and New England states and high dissatisfaction in the south Atlantic, west south Central, Mountain, and Pacific states; positive associations between income and satisfaction; and no differences between women and men. Conclusions: Career satisfaction and dissatisfaction vary across specialty as well as age, income, and region. These variations are likely to be of interest to residency direc- tors, managed care administrators, students selecting a specialty, and physicians in the groups with high satis- faction and dissatisfaction. Arch Intern Med. 2002;162:1577-1584 P HYSICIAN CAREER satisfaction and morale has received great attention recently. 1-8 There are reasons for this attention. First, physicians who are satisfied with their careers are likely to provide bet- ter health care than dissatisfied physicians. Physician satisfaction has been found to strongly correlate with patient satisfaction. 7 Second, high physician satisfaction is also likely to result from good outcomes with patients. 8 Satisfaction, therefore, may be an indirect measure of patient outcomes. Dissatisfaction is also of concern. First, an important factor in maintaining a high quality of medical care for all Americans at low cost is achieving a balance in the specialty mix of physicians. 9 Current dissatisfaction may forecast future declines in numbers of practitioners within a specialty. Second, dis- satisfaction, if prolonged, may result in health problems for the physicians themselves. 10 Third, dissatisfied physicians may be more inclined to unionize 11 and strike. 12 There are several possible sources of variation in physician satisfaction. Studies have looked at demographic factors. McMur- ray et al 1 found that women had a 60% greater chance than men of reporting “burnout.” Frank et al 2 found that women physicians were generally satisfied with their careers. Haas et al 3 found that younger physicians had lower satisfaction than middle-aged phy- sicians. Another line of research has ad- dressed whether managed care has resulted in a decline in physician career satisfaction. 4-6 Finally, a number of studies have addressed satisfaction within specific specialties: emer- gency medicine, 13 general internal medicine, 3 dermatology, 14 obstetrics-gynecology, 15 fam- ily medicine, 16 psychiatry, 17 and geriatrics. 18 To our knowledge, however, no study has focused exclusively on comparing the level of satisfaction across many specialties. Our study may be useful to directors of residency training programs and managed care admin- istrators 19 as well as to medical students choosing a specialty or physicians leaving a specialty. Finally, other factors may oper- ate in conjunction with specialty to influ- ence satisfaction. These factors—including age, educational background, and practice settings—may be of considerable interest in their own right. ORIGINAL INVESTIGATION From the Center for Health Services Research in Primary Care, Sacramento, Calif (Drs Leigh, Kravitz, and Samuels and Ms Mobley), and the Department of Family and Community Medicine, University of California, San Francisco (Mr Schembri). (REPRINTED) ARCH INTERN MED/ VOL 162, JULY 22, 2002 WWW.ARCHINTERNMED.COM 1577 ©2002 American Medical Association. All rights reserved. at Univ Of Connecticut Healh Center, on January 10, 2007 www.archinternmed.com Downloaded from