|Year : 2015 | Volume
| Issue : 1 | Page : 12-18
Satisfaction of plastic surgeons with job, working environment, and practice in Nigeria: A pilot study
Emmanuel E Esezobor1, Ojochide S Ebune2, Festus A Okhimamhe3
1 Department of Surgery, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
2 Department of Surgery, University of Benin, Benin City, Edo State, Nigeria
3 Department of Surgery, Federal Medical Centre, Lokoja, Kogi State, Nigeria
|Date of Web Publication||8-Oct-2015|
Emmanuel E Esezobor
Irrua Specialist Teaching Hospital, P.M.B 8, Irrua, Edo State
Source of Support: None, Conflict of Interest: None
Introduction: Dissatisfaction has serious consequences for both the physicians and patients. Studies had shown that job dissatisfaction among physicians is associated with increase rate of medical errors thus jeopardizing patients' safety. Plastic surgeons are not exempted from this problem. This study is aimed at knowing the level of satisfaction of plastic surgeons with their job, working environment and practice in Nigeria
Materials and Methods: This is a cross-sectional study of plastic surgeons that attended the 19th annual scientific conference and annual general meeting of Nigerian Association of Plastic, Reconstructive and Aesthetic Surgeons (NAPRAS) in Lokoja Kogi State, Nigeria. Data on the determinant of Job satisfaction as described in “Medicine in Australia: Balancing Employment and Life (MABEL) questionnaire” was used. The level of significance was set at P ≤ 0.05.
Result: There were 31 respondents with all the geographical zones except North-West represented. The mean age was 41.06 ± 5.84 years and the Female: Male ratio was 1: 5.2. There were more respondents who were indecisive on the level of satisfaction with the patients they see. Of those who were decisive (41.9%), more were dissatisfied (25.8%). Most respondents are dissatisfied with the level of support provided and work location. On objectively assessing the level of job satisfaction among this same group of plastic surgeons, only one (3.2%) respondent was satisfied.
Conclusion: Plastic surgeons in Nigeria are not satisfied with their job. Remuneration seem to be far down the list of the causes of their job dissatisfaction.
Keywords: Job, Nigeria, plastic surgeons, satisfaction
|How to cite this article:|
Esezobor EE, Ebune OS, Okhimamhe FA. Satisfaction of plastic surgeons with job, working environment, and practice in Nigeria: A pilot study. Nigerian J Plast Surg 2015;11:12-8
|How to cite this URL:|
Esezobor EE, Ebune OS, Okhimamhe FA. Satisfaction of plastic surgeons with job, working environment, and practice in Nigeria: A pilot study. Nigerian J Plast Surg [serial online] 2015 [cited 2021 Feb 26];11:12-8. Available from: https://www.njps.org/text.asp?2015/11/1/12/166850
| Introduction|| |
Job dissatisfaction has serious consequences for both physicians and patients. While it can affect the mental status of the former, the consequence on the latter is the poor quality of health care received. There are studies that have correlated physicians' dissatisfaction with increased likelihood of unionizing, strikes, medical problems, and exiting the medical profession. Other studies have further shown that job dissatisfaction among physicians is associated with increased rates of medical error, thus jeopardizing their patients' safety; Furthermore, it is pertinent to note that satisfied patients are more likely to be compliant and cooperative with their treatment.
In Nigeria, the health-care system is facing a lot of challenges ranging from poor infrastructure and paucity of medical equipment to falling standards of medical training and lack of investment in human capacity development. These are further compounded by incessant strikes as a result of interprofessional rivalry and poor conditions of service.
The surgical specialty is demanding, and plastic surgery, which is a highly subspecialized area of surgery, is no different. Lepnurm et al. observed that compared to other specialties of medicine, surgeons are more negatively impacted by “physical exhaustion” and conflicts between professional and personal life. The work of Balch et al. which compared career satisfaction among 14 surgical specialties in the US revealed lower average workload, burnout rate and work/home conflict among plastic surgeons. Despite these, it was further observed that they ranked second in terms of career dissatisfaction and fourth among those who do not encourage their children to be surgeons.
If the plastic surgeons in the developed world are dissatisfied with their jobs, it will be of interest to know how satisfied those in Nigeria are.
| Materials and Methods|| |
This was a cross-sectional study of plastic surgeons who attended the 19th Annual Scientific Conference and Annual General Meeting of the Nigerian Association of Plastic, Reconstructive and Aesthetic Surgeons (NAPRAS) in Lokoja, Kogi State, Nigeria, an annual conference that hosts about 60-70% of the approximately 75 practicing plastic surgeons in Nigeria.
Those included in this study are certified plastic surgeons practicing in public hospitals in Nigeria.
The instruments used for data generation were questionnaires filled in by the surgeons, from which the biodata and sociodemographic information were retrieved. Data on the determinants of job satisfaction as described in the “Medicine in Australia: Balancing Employment and Life (MABEL) questionnaire" were used. The questions were evaluated using the five-point Likert scale, ranging from “very satisfied” to “very dissatisfied", “strongly agree” to “strongly disagree,” and “very likely” to “very unlikely.” The surgeons were asked for their satisfaction with patient awareness and consultation, job routine, work hours, and opportunities. Other information sought was about their satisfaction with remuneration, infrastructure, equipment, and staff support. We also set out to know how satisfied they were with the balance between work and personal life, professional commitments, and their likelihood of leaving the profession. Responses were interpreted as satisfied when a respondent ticked “satisfied” and/or “very satisfied,” while ticking “dissatisfied” and/or “very dissatisfied” was taken as the marker of dissatisfaction. “Agree” and “strongly agree” were taken as agreement, while “disagree” and “strongly disagree” were taken as disagreement. “Likely” and “very likely” were taken as indicators of likelihood, while “unlikely” and “very unlikely” were taken to mean unlikely. “Neutral” was interpreted as indecision.
The data obtained were analyzed using the Statistical Package for Social Science, Job satisfaction among plastic surgeons in Nigeria (SPSS Inc., version 16.0, Chicago, IL, USA) software package, and presented in tabular and descriptive forms. A test of significance was carried out using the Chi-square test, while the Pearson correlation coefficient was used to determine correlation among variables. The level of significance was set at P ≤ 0.05.
| Results|| |
There were 31 respondents, with all the geographical zones except the Northwest represented. The mean age was 41.06 ± 5.84 years and the Female: Male ratio was 1:5.2. Those with less than 5 years in practice constituted 48.4% (n = 15), while those in practice for 5-10 years and for longer than 10 years constituted 35.5% (n = 11) and 16.1% (n = 5) respectively. The mean duration of practice was 6.19 ± 4.93 years [Table 1]. There was a positive, nonsignificant correlation between job satisfaction and duration of practice (r = 0.209; P = 0.260) [Table 2].
Hand surgery dominated their practice, followed by burns surgery. Cosmetic surgery accounted for the least cases seen [Figure 1].
Satisfaction with patients
We observed that satisfaction in this group of plastic surgeons had a statistically significant positive correlation with the level of satisfaction with their patients (r = 0.597; P = 0.0001) [Table 2]. Though plastic surgeons were dissatisfied with the level of awareness of their specialty in their practice location [38.7% (n = 12)], a majority were satisfied with the appropriateness of the referrals [45.1% (n = 14)], consultations for emergency services [41.9% (n = 13)], and the level of unrealistic expectation expressed by their patients [41.9% (n = 13)] [Table 3]. Most respondents were indecisive about the level of satisfaction with the patients they saw. Of those who were decisive (41.9%), most were dissatisfied (25.8%) [Figure 2].
|Table 3: Component assessing plastic surgeons' satisfaction with their patients |
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Satisfaction with working environment
Most respondents were satisfied with the level of freedom they had to choose their method of working [64.6% (n = 20)], the amount of case variety seen [58% (n = 18)], the opportunity they had to use their abilities [45.2% (n = 14)], their colleagues and fellow workers [64.5% (n = 20)], the recognition they received for good work [48.4% (n = 15)], and the amount of responsibility they were given [58.1% (n = 18)].
We observed a statistically significant positive correlation between job satisfaction and the available means of support, i.e. specialized staff, office space, wards, burns unit, operation theater, instruments, and disposables (r = 0.385; P = 0.032) [Table 4] and [Table 5]. Our finding revealed that most respondents were dissatisfied with the level of support provided [Figure 3].
|Table 4: Component for assessment of job satisfaction among plastic surgeons |
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Satisfaction with the working conditions
Most respondents were indifferent to the question concerning change in their work hours [51.6% (n = 12)]. Of the remaining 48.4% who desired a change, only one (3.2%) supported an upward review in working hours (45.2%) [Figure 4]. Marginally more respondents were dissatisfied with their remuneration [51.6% (n = 12)] [Table 4].
Personal and family life
All the respondents except one worked in the urban area [96.8% (n = 30)] [Table 2]. Their responses to the questions that inquired about their practice location disagreed on the absence of friends and families members [77.4% (n = 24)] but affirmed the presence of choice of schools for their children [58.1% (n = 18)]. Of those who responded decisively as to whether there were good employment opportunities for their spouses in their practice location [77.3% (n = 24)], most were in disagreement [45.1% (n = 14)] [Table 6]. A majority claimed that it was challenging to pursue their hobbies and leisure [64.5% (n = 20)]. The overall ratings suggested that there were more respondents who were dissatisfied with their current location of practice [Figure 5].
|Table 6: Assessment of plastic surgeons' satisfaction with geographical location of workplace |
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Summary of general assessment of level of job satisfaction
When directly asked how they perceived their level of job satisfaction, 61.3% (n = 19) claimed that they were satisfied [Figure 6]. However, when all the parameters that objectively assessed the level of job satisfaction within this same group of plastic surgeons were considered, only one (3.2%) respondent was satisfied [Figure 7]. Despite this finding, most of the respondents were not considering leaving the profession soon [Figure 8].
| Discussion|| |
One of the greatest challenges facing health-care systems in sub-Saharan Africa is the deficiency of quantitative and qualitative human resources. Nigeria still has the highest number of doctors compared to other countries in sub-Saharan Africa. In 2007, Nigeria had 52,408 doctors and a doctor-to-population ratio of 35/10,000, while the sub-Saharan African average at this period was 15/10,000. The proportion of plastic surgeons among these registered medical practitioners was considerably low (n = 75), as found in the NAPRAS directory. Only about half of this population (n = 38) were present at the conference, of which 31 responded to the questionnaire. The response rate (81.5%) is good considering the published response rate for medical practitioners in large studies, which has been reported to be an average of 52% with a range of 11-90%, and this is still declining. The low mean age (41.06 ± 5.84 years) and a short mean duration of practice (6.19 ± 4.93 years) of the study sample point to the plastic surgery specialty in Nigeria being in its infancy. A similar study done in the USA was able to sample 458 plastic surgeons and it recorded a mean age of 50.8 years. Nearly all the respondents were practicing in the urban area, which is in line with the findings of other studies that observed that quality medical personnel are more attracted to urban areas.,
A good relationship with patients had been found to have a positive association with job satisfaction within a group of physicians. Though most of our respondents tilted toward dissatisfaction with the type of patients they saw, this may not be unconnected with the level of awareness of plastic surgery practice among these patients. An earlier study done in Nigeria among nonmedical professionals revealed a good level of awareness about plastic surgery. Our study contradicted this finding: We found that most plastic surgeons were in fact dissatisfied with the level of awareness of plastic surgery practice in their area. While a study from Pune in India, a developing country like Nigeria, revealed a low level of awareness about plastic surgery among physicians, our study revealed a high level of satisfaction with the appropriateness of referral from other physicians. This may imply a good level of plastic surgery awareness among other colleagues.
Efficiency can be impacted by the conditions under which a worker performs his/her duties. Various studies have suggested that freedom of decision-making improves efficiency.,,, Our finding revealed that most of our respondents were satisfied with the variety of cases they saw and the opportunity given to them to explore their potential.
The working environment, remuneration, and relationships with other professionals can affect physicians' levels of job satisfaction., Some studies had blamed poor job satisfaction on poor remuneration, working environment, and interpersonal relationships., Lack of medical equipment had also been associated with job dissatisfaction among doctors. Many highly trained Nigerian professionals abroad refuse to come home because of the poor working environment and remuneration. Deepening interprofessional rivalry may be impacting negatively on the doctors' levels of job satisfaction in government hospitals.
Intention to leave a job or profession has been associated with job dissatisfaction.,, Those not satisfied with their job have a higher tendency to want to leave. Despite the dissatisfaction expressed by majority of our respondents, they were still willing to remain in the profession.
Work location is where a worker spends his/her working hours. Studies have shown that there is a relationship between work location and satisfaction., Most health workers want to work in towns and cities, as reflected in our finding, and this may not be unconnected with closeness to better social and educational infrastructure, recreational facilities, and the availability of employment opportunities for their spouses. Most of our respondents resided and worked in cities/towns but were still dissatisfied with their work location. This may be because the so-called urban areas in Nigeria lack the minimum infrastructure to be accorded such status.
A study done by Balch et al. comparing the distress and satisfaction felt within 14 surgical specialties in America revealed that despite having a lower average workload with good equipment and support, the plastic surgeons still recorded one of the lowest levels of career satisfaction. Most of them stated that they would not become surgeons again if given another opportunity and would not recommend a medical career for their children.
Finally, it is obvious that job dissatisfaction among plastic surgeons in Nigeria is not caused by poor remuneration but by poor health education among patients and lack of investment in the staff training, equipment, and other facilities required for proper plastic surgery practice. Moreover, if the environment where a plastic surgeon will retire to after a hard day's job is devoid of basic infrastructure like pipe-borne water, constant electricity, good road networks, and security, the effect on job satisfaction will be negative.
| Conclusion|| |
Our study highlights the phenomenon of job dissatisfaction experienced by plastic surgeons in Nigeria. Their dissatisfaction was clearly observed to be due to poor patient enlightenment, lack of support to carry out their task efficiently, and poor infrastructural development around the location of their workplaces. These problems are surmountable if government willpower is present.
Financial support and sponsorship
Conflict of interest
There are no conflict of interest.
| References|| |
Gothe H, Köster AD, Storz P, Nolting HD, Häussler B. Job satisfaction among doctors. Arbeits und berufszufriedenheit von Ärzten. Dtsch Arztebl 2007;104:A1394-9.
Wada K, Arimatsu M, Higashi T, Yoshikawa T, Oda S, Taniguchi H, et al
. Physician job satisfaction and working conditions in Japan. J Occup Health 2009;51:261-6.
Burke RJ. Stress, satisfaction and militancy among canadian physicians: A longitudinal investigation. Soc Sci Med 1996;43:517-24.
Kravitz RL, Shapiro MF, Linn LS, Froelicher ES. Risk factors associated with participation in the ontario, canada doctors' strike. Am J Public Health 1989;79:1227-33.
Sundquist J, Johansson SE. High demand, low control and impaired general health: Working conditions in a sample of swedish general practitioners. Scand J Public Health 2000;28:123-31.
Landon BE, Reshovsky JD, Pham HH, Blumenthal D. Leaving medicine: The consequences of physician dissatisfaction. Med Care 2006;44:234-42.
Fahrenkopf AM, Sectich TL, Burger LK, Sharek PJ, Lewin D, Chiang VW, et al
. Rates of medication errors among depressed burnt out residents: Prospective cohort study. BMJ 2008;336:488-91.
Bleich SN, Ozaltin E, Murray CK. How does satisfaction with the health-care system relate to patient experience? Bull World Health Organ 2009;87:271-8.
Lepnurm R, Dobson R, Backman A, Keegan D. Factors explaining career satisfaction among psychiatrists and surgeons in canada. Can J Psychiatry 2006;51:243-55.
Balch CM, Shanafelt TD, Sloan JA, Satele DV, Freischlag JA. Distress and career satisfaction among 14 surgical specialties, comparing academic and private practice settings. Ann Surg 2011;254:558-68.
Joyce CM, Scott A, Jeon S, Humphreys J, Kalb G, Witt J, et al
. The “Medicine in Australia: Balancing Employment and Life (MABEL)” longitudinal survey-Protocol and baseline data for a prospective cohort study of Australian doctors' workforce participation. BMC Health Serv Res 2010;10:50.
Faye A, Fournier P, Diop I, Philibert A, Morestin F, Dumont A. Developing a tool to measure satisfaction among health professionals in sub-Saharan Africa. Hum Resour Health 2013;11:30.
Labiran A. Mafe M. Onajole A. Lambo E. Health Workforce Country Profile for Nigeria. 1st
ed. Nigeria: Africa Health Workforce Observatory; 2008. p. 07.
Cummings SM, Savitz LA, Konrad TR. Reported response rates to mailed physician questionnaires. Health Serv Res 2001;35:1347-55.
Aitken C, Power R, Dwyer R. A very low response rate in an on-line survey of medical practitioners. Aust N
Z J Public Health 2008;32:288-9.
Dussault G. The health professions and the performance of future health systems in low-income countries: Support or obstacle? Soc Sci Med 2008;66:2088-95.
Vujicic M, Zurn P, Diallo K, Adams O, Dal Poz MR. The role of wages in the migration of health care professionals from developing countries. Hum Resour Health 2004;2:3.
Adeyemo WL, Mofikoya BO, Bamgbose BO. Knowledge and perceptions of facial plastic surgery among a selected group of professionals in Lagos, Nigeria. J Plast Reconstr Aesthet Surg 2010;63:578-82.
Panse N, Panse S, Kulkarni P, Dhongde R, Sahasrabudhe P. Awareness and perception of plastic surgery among healthcare professional in Pune, India: Do they really know what we do? Plast Surg Int 2012;2012:962169.
Ayers K. Creating a Responsible Workplace. Hum Resour Mag 2005;50.
von Vultée PJ, Axelsson R, Arnetz B. The impact of organisational settings on physician wellbeing. Int J Health Care Qual Assur 2007;20:506-15.
Loher BT, Noe RA, Moeller NL, Fitzgerald MP. A meta-analysis of the relation of job characteristics to job satisfaction. J Appl Psychol 1985;70:280-9.
Ross CE, Reskin B. Education, control at work and job satisfaction. Soc Sci Res 1992;21:134-8.
Spector PE. Perceived control by employee: A meta-analysis of studies concerning autonomy and participation at work. Human Relations 1986;39:1005-16.
Leshabari MT, Muhondwa EP, Mwangu MA, Mbembati NA. Motivation of health care workers in Tanzania: A case study of muhimbili national hospital. East Afr J Public Health 2008;5:32-7.
van Oostrom SH, van Mechelen W, Terluin B, de Vet HC, Anema JR. A Participatory workplace intervention for employees with distress and lost time: A feasibility evaluation within a randomized controlled trial. J Occup Rehabil 2009;19:212-22.
Liu C, Zhang L, Ye W, Zhu J, Cao J, Lu X, et al
. Job satisfaction and intention to leave: A questionnaire survey of hospital nurses in Shanghai of China. J Clin Nurs 2012;21:255-63.
Shields MA, Ward M. Improving nurse retention in the National Health Service in England: The impact of job satisfaction on intentions to quit. J Health Econ 2001;20:677-701.
Blaauw D, Ditlopo P, Maseko F, Chirwa M, Mwisongo A, Bidwell P, et al
. Comparing the job satisfaction and intention to leave of different categories of health workers in Tanzania, Malawi, and South Africa. Glob Health Action 2013;6:19287.
Arnold NL, Seekins T, Nelson R. A comparison of vocational rehabilitation counselors: Rural and urban differences. Rehabil Couns Bull 1997;41:2-14.
Joyce CM, Schurer S, Scott A, Humphreys J, Kalb G. Australian doctors' satisfaction with their work: Results from the MABEL longitudinal survey of doctors. Med J Aust 2011;194:30-3.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]