Bunton, Sarah A. PhD; Corrice, April M.; Pollart, Susan M. MD, MS; Novielli, Karen D. MD; Williams, Valerie N. PhD; Morrison, Leslie A. MD; Mylona, Elza PhD; Fox, Shannon PhD
A medical school’s faculty is arguably its most important asset. Faculty train the next generation of physicians to deliver high-quality, patient-centered health care; they are a significant source of innovation in health care delivery as well as being providers of that care; and they contribute substantively to the scholarship that informs the delivery of high-quality health care to the public. Despite the important roles that these professionals play, academic medicine has a poor track record of retaining physicians and scientists who enter medical school careers,1,2 and the direct cost of faculty turnover to these institutions is high.3,4
Given the pivotal role that faculty play in determining how successfully a medical school accomplishes its mission, it is critical to attract, develop, and retain a highly qualified cadre of faculty.
The level of satisfaction of a medical school’s faculty plays a central role in determining the effectiveness of that institution’s academic workforce. Physicians within and outside of academic medicine who are satisfied with their jobs are more likely to remain at their respective places of work,5–8 provide better-quality patient care,9–12 and foster greater patient satisfaction.13 Research has linked these variables to positive organizational performance outcomes like productivity.14,15 Furthermore, the empirical linkages among job satisfaction, retention, and organizational performance have also been demonstrated for faculty and other groups in the workforce.16–19
Over the past few decades, medical school faculty and the academic medicine milieu have undergone dramatic change—faculty members are aging, many baby boomers will retire in the coming decade,20 and the workforce is increasingly demographically diverse.21–23 New faculty members enter academic medicine with different expectations than those of preceding generations,24 including a desire for better work–life balance.25,26 Additionally, there have been significant shifts in the faculty work environment, including the effects of substantial changes to reimbursement practices and an increased pressure to generate clinical revenue,27 increased clinical workloads through reduced resident work hours,28 fewer resources for education,29 and unprecedented competition for federal research funding30—all occurring within the context of the recent U.S. economic decline. These changes contribute to the increasing demands on faculty for research, teaching, patient care, and administration31,32 and highlight the array of factors that may influence medical school faculty’s job satisfaction. Institutions that understand these issues and create excellent workplace environments are well positioned to attract and retain faculty as they seek excellence in their missions.
In the extant literature, specific aspects of physician and faculty satisfaction have been addressed, but few studies systematically identify the workplace variables that have the greatest impact on levels of overall satisfaction across institutions. The purposes of this study are, first, to examine the current state of satisfaction with the medical school workplace among full-time U.S. medical school faculty and, second, to examine the workplace factors that have the greatest influence on faculty satisfaction (i.e., the relative impact of different workplace aspects on global satisfaction).
Data for this study are from the 2009 Web-based administration of the medical school faculty job satisfaction survey administered to the census of all full-time faculty members at 23 U.S. medical schools accredited by the Liaison Committee on Medical Education (LCME). Participating institutions self-selected to have the survey administered to their faculty as part of the Faculty Forward initiative, which is a collaboration between U.S. medical schools and the Association of American Medical Colleges to apply evidence-based approaches to improve faculty workplace environments, and were reasonably representative of all LCME-accredited medical schools (see Table 1). The committee on the use of human subjects at Harvard University approved this study.
We designed the survey instrument to assess the satisfaction of faculty members. Experts in survey design, statistics, economics, psychology, and medical faculty affairs contributed to the development and review of the instrument, which has been tested in focus groups and a rigorous pilot study (including a survey administration to the census of faculty at 10 medical schools). Literature reviews, expert feedback, and focus groups informed the development of faculty satisfaction survey items, which addressed workplace areas including nature of work, climate/culture, feedback/mentoring, pay/benefits, institutional governance, operations, clinical practice, and global satisfaction. The rigor involved in this instrument design and testing and the items on various facets of the faculty workplace support the content and construct validity of the survey to assess faculty satisfaction and perceptions of the workplace.
Because the job satisfaction survey contained over 70 conceptually and empirically related items, we performed exploratory analyses to determine how to aggregate these results to address broader dimensions of faculty satisfaction. We identified overarching survey dimensions by reviewing correlations between items and correlations of items with overall satisfaction items, and by assessing item content for conceptual consistency. During this process, we removed 10 survey items from our analysis because of large amounts of missing data or redundancy among constructs, resulting in 18 dimensions of faculty job satisfaction. Table 2 displays these survey dimensions, descriptions of the items contained within each, and their calculated internal consistency.
We used descriptive summary statistics for levels of satisfaction and agreement on survey items and χ2 analyses to assess significant differences between demographic groups on the collapsed Likert scale items (e.g., satisfied/very satisfied, neither satisfied nor dissatisfied, or dissatisfied/very dissatisfied). Department type comparisons include the distinction between basic science and clinical MD faculty, as basic science faculty are most often involved in research activities and clinical MD faculty are most often involved in clinical care. We defined statistical significance as P < .05 for two-sided tests with confidence intervals at 95%.
We conducted a series of multiple regression analyses to assess the relative impact of the different survey dimensions on the measures of global satisfaction: (1) overall satisfaction with department, (2) overall satisfaction with medical school, and (3) agreement that, if given the opportunity, they would again choose to work at their medical school. Specifically, we used the mean score of each dimension and demographic variables (i.e., the independent variables) to predict the global satisfaction measures (i.e., the dependent variables).
We conducted model trimming techniques to identify the independent variables with significant relationships to the dependent variables, which involved loading all independent variables into the regression analyses and removing the least significant predictors one-by-one until all independent variables left in the model were statistically significant. Although all the variables in our final models were statistically significant, we focus our discussion on consistent predictors throughout the models with beta coefficients equal to or greater than 0.10. We performed all analyses using PASW Statistics version 17 (Chicago, Illinois).
The survey population varied at the participating medical schools, ranging from 379 to 1,861, with an average of 826 faculty members, resulting in a total population of 19,001. We achieved a response rate of 50.7% (9,638 faculty members). Response rates varied across demographic groups (see Table 3). Calculated response rates are conservative because we assumed that all nonrespondents were survey eligible. Survey participants and nonparticipants differed with respect to department type, gender, and race/ethnicity. Basic science faculty were more likely to respond to the survey than clinical MD faculty (χ2 = 217.0; P < .001), female faculty were more likely to respond than male faculty (χ2 = 16.1; P < .001), and racial majority faculty were more likely to respond than racial minority faculty (χ2 = 9.2; P < .01).
A majority of faculty respondents were satisfied or very satisfied with their department (6,506/9,128; 71.3%) and with their medical school (5,796/9,124; 63.5%) as places to work, and 70.2% (5,968/8,506) of respondents agreed or strongly agreed that, if given the opportunity, they would again choose to work at their medical school. Across these measures, some significant differences between groups of faculty existed by department type and rank but not by gender (see Table 4).
Our regression analyses revealed that the survey dimensions predicted the global satisfaction measures quite well (see Table 5). The model predicting faculty satisfaction with their department explained 67% of the variance in the dependent variable, the model predicting faculty satisfaction with their medical school accounted for 60% of the variance, and the model predicting whether faculty would again choose to work at their medical school explained 51% of the variance.
Several survey dimensions were consistent predictors of global satisfaction throughout the models. Medical school organization, governance, and transparency predicted faculty satisfaction with their medical school as a place to work (b = 0.30; P < .001) and with again choosing to work at their medical school (b = 0.11; P < .001), whereas department organization, governance, and transparency predicted faculty satisfaction with their department (b = 0.32; P < .001). Focus of medical school mission predicted faculty satisfaction with their medical school (b = 0.11; P < .001), whereas focus of department mission predicted faculty satisfaction with their department (b = 0.11; P < .001). Recruitment and retention effectiveness was a significant predictor of faculty satisfaction with their department (b = 0.11; P < .001), faculty satisfaction with their medical school (b = 0.13; P < .001), and whether faculty would again choose to work at their medical school (b = 0.19; P < .001). Department relationships significantly predicted both faculty satisfaction with their department (b = 0.24; P < .001) and with again choosing to work at their medical school (b = 0.11; P < .001). Workplace culture was a significant predictor of faculty satisfaction with their medical school (b = .16; P < .001) and with again choosing to work at their medical school (b = .11; P < .001). Nature of work also significantly predicted the three global satisfaction measures with beta coefficients of 0.10 (P < .001) in each model.
In all the models, demographic variables had relatively small relationships with the global satisfaction measures (with beta coefficients ranging from 0.02 to 0.04).
Overall, faculty respondents reported satisfaction on the global measures. The majority of respondents were satisfied with their department and their medical school as places to work and agreed that, if given the opportunity, they would again choose to work at their medical school. In the context of a changing health care system and the increased pressures faced by medical school faculty, these results are somewhat reassuring. Although the reported satisfaction levels of medical school faculty respondents are slightly lower than those of physicians over the past decade,33,34 these reported satisfaction levels are slightly higher than those of some other higher education faculty.35
Consistent predictors of global satisfaction
Our results show that the survey dimensions predicted the global satisfaction measures well and illustrate several dimensions that were consistent predictors across models. First, organization, governance, and transparency, within the department and the medical school, predicted faculty satisfaction with their department and medical school, respectively. These results confirm previous research demonstrating that departmental and institutional leadership factors are important predictors of faculty satisfaction,36,37 and speak to the considerable role that departmental and institutional leaders can have in improving faculty satisfaction. This finding is notable because, despite significant environmental challenges like the evolving health care system, leaders still can have a strong, positive influence on their faculty. We posit that a culture characterized by open communication, consistency in decision making, and opportunities for faculty input contributes to faculty perceptions of their worth to their institution and of institutional equity, all of which foster satisfaction. Our results are consistent with past research identifying decreased opportunities for participation in institutional governance, including little influence on the allocation of resources, as a prime contributor to faculty discontent.1
Next, our results show that focus of mission, within the department and medical school, is a predictor of faculty satisfaction with their department and medical school, respectively. These results highlight the importance of the relative value that institutions place on various types of faculty work. Previous research has shown great disconnect between stated institutional mission values and actions.38 Explicit or implicit devaluation of any one of an institution’s stated mission areas may decrease faculty satisfaction and lead to negative outcomes. For example, decreased opportunities for scholarship may jeopardize the potential for continued discovery and contradict the importance of an academic culture.39
Our results also underscore the importance of colleagues and relationships in fostering global satisfaction. Both recruitment and retention effectiveness and department relationships were consistent predictors of faculty satisfaction across models. The former dimension may relate to faculty turnover having a negative impact on the remaining faculty, including decreased morale, disruptions to organizational culture, and an unbalanced distribution of workload among the remaining faculty.4 On the other hand, the success of medical schools in recruiting and retaining high-quality faculty may contribute to a culture of enhanced collegiality, institutional pride, and faculty engagement. These results, showing the importance of department relationships, are consistent with previous research indicating that professional relationships predict academic medical faculty satisfaction,40 turnover intentions of pharmacy faculty,41 and job satisfaction beyond any other work characteristics among a variety of professions.42
Next, nature of work was a predictor of faculty satisfaction across the models and reflects satisfaction with time spent at work and in different missions, schedule control, and autonomy. This finding is consistent with previous research demonstrating that autonomy is a significant predictor of faculty satisfaction.1,40 We can easily suspect that too much time spent at work and little control over one’s schedule lead to burnout. The critical importance of this issue is reflected in research showing that work overload, autonomy, and burnout predict physicians’ quality of patient care.43 Extensive research has been conducted on models of workplace burnout and employee engagement,44,45 some of which demonstrate great overlap between the issues addressed in our dimension (e.g., workload, control) and the factors affecting satisfaction and burnout in other industries.46
Contrary to what one might expect, pay and compensation did not have a significant relationship with any of our global satisfaction measures. Although some past research has identified compensation as an important predictor of faculty satisfaction,40,47 our findings suggest that other workplace factors have a stronger impact on overall satisfaction. Additionally, although academic medicine has seen changing workforce demographics over the past decade, demographic variables were not strong predictors of global satisfaction measures. These results, however, do not suggest that medical schools should not pay attention to the unique issues facing different faculty groups. In the future, researchers should continue to study the factors that impact job satisfaction for these groups, and longitudinal studies should assess the evolving nature of workplace satisfaction in parallel with an increasingly diverse workforce.
Several limitations to our study exist, including an overall response rate of 51%. There is no single response rate that is considered a standard, and published national surveys of physicians have a wide range of response rates (e.g., from 30% to 65%34,48). Because the survey was administered to the census of full-time faculty at the participating schools, we believe that our study offers important findings that facilitate a deeper understanding of overall faculty satisfaction and the relationship between workplace factors most highly related to faculty satisfaction. Another limitation is that the 23 schools in the study self-selected to participate, and, although they are reasonably representative of all LCME-accredited schools in terms of size, ownership, and distribution of faculty by type, they may differ in ways we did not detect, such as institutional leadership, salaries, and balance of institutional missions, which may limit the generalizability of our findings. Third, the global satisfaction measures that we used have not been shown to predict individual or institutional success, and although we speculate about such a relationship, further research needs to be done to establish their relationships and predictive validity empirically. This study is intended to lay the foundation for such future research by defining and exploring the dimensions that empirically drive overall faculty satisfaction. Finally, because we detected some differences between survey participants and nonparticipants, nonresponse bias may exist.
In conclusion, our results present a comprehensive and detailed analysis of overall faculty satisfaction and predictors of global satisfaction in academic medicine. To our knowledge, this study includes the largest analysis of medical school faculty satisfaction, with a breadth and depth of data from 23 U.S. medical schools, using the only national job satisfaction survey created specifically for physicians and scientists working in medical schools. It is the only study, of which we are aware, that provides information about the various dimensions of faculty satisfaction in a large, multischool population of academic medical faculty. Further, our survey instrument, with multiple factors representing specific dimensions of faculty satisfaction, provided an effective approach for teasing out the most salient aspects in understanding faculty satisfaction within departments and medical schools. Our findings contribute to the literature on faculty satisfaction because they are inclusive of all medical school faculty rather than focused on physicians alone like some other studies.5–7 Other noteworthy studies in the literature report on large samples but contain a target population of clinically active civilian physicians14 and do not mirror the scope of the participants in our study; report on individual medical schools8; or do not focus exclusively on faculty in academic medicine.16
Finally, our study contributes to the literature because it identifies many key drivers of global satisfaction, which point to specific components of the workplace that leaders can address to improve faculty satisfaction. Our findings explicate the construct of overall faculty satisfaction, which can be used for further rigorous study of satisfaction by faculty type, mission area, and an examination of the role of satisfaction as a predictor of positive individual and organizational outcomes. Many of the drivers of global satisfaction identified by faculty respondents are consistent with the past research that we have discussed here, suggesting content validity in our findings and evidence supporting our interpretations of the issues.
Keeping abreast of and understanding what drives faculty satisfaction is crucial for medical schools as they continue to educate future doctors, care for patients, conduct research, and provide service to their communities. With continued volatility in the health care industry and future workforce shortages, academic medical centers are facing extreme pressure to recruit and retain faculty. Knowledge of the underlying factors that contribute to faculty satisfaction can help institutional leaders target efforts and develop successful initiatives to sustain areas of strength and to improve faculty satisfaction and engagement—all of which in turn lead to positive outcomes for organizational performance. For example, the development of strong faculty relationships with administrative offices through town hall meetings, task forces, focus groups, and structured conversations with faculty about institutional issues, as well as a sense of openness and communication, may reinforce a culture of shared governance as institutions continue to address transparency, recruitment, and retention issues. Such an approach could improve workplace conditions related to organization, governance, and transparency, resulting in increased knowledge about the local issues surrounding other predictors of global satisfaction, such as recruitment and retention effectiveness. The role that faculty satisfaction plays in determining the effectiveness of an institution’s academic workforce, including links to productivity, ultimately leads to positive organizational performance outcomes,14,15 which is vital in the current academic medicine environment.
Acknowledgments: The authors thank the following individuals for numerous rich discussions about and valuable feedback on the various stages of this manuscript: Drs. Patrick O. Smith, Marian Limacher, and Jennifer Lapin, and Valerie Dandar. In addition, they are grateful to Drs. R. Kevin Grigsby and William T. Mallon for their feedback on an earlier draft. Also, the authors sincerely thank the faculty and administrators at the institutions that participated in this study. For a complete list of these institutions, see Supplemental Digital List 1 (available at http://links.lww.com/ACADMED/A87). Finally, they thank Dr. Lynn Spitzer of Spitzer Research and Consulting for her assistance with the statistical analyses in this report.
Other disclosures: None.
Ethical approval: The committee on the use of human subjects at Harvard University approved this study.
Previous presentations: Select results from this study were presented or discussed at the following meetings: the Faculty Forward User Workshop, April 2010, Washington, DC; the AAMC Group on Faculty Affairs Annual Meeting, August 2010, San Francisco, California; the Society of Academic Anesthesiology Associations Meeting, November 2010, Washington, DC; the AAMC Annual Meeting, November 2010, Washington, DC; and the AAMC Group on Faculty Affairs Annual Meeting, August 2011, Seattle, Washington.
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