Family medicine residency educational characteristics and career satisfaction in recent graduates

Richard Young, M.D.
Anita Webb, Ph.D.
Nuha Lackan, Ph.D.
Lucille Marchand, M.D., B.S.N.

Background

Studies at the state, national and international levels have documented declining job satisfaction among physicians. With regard to family medicine, the American Academy of Family Physicians conducts an annual national survey inquiring: “If you had to do it over, would you still choose to be a family physician?” Their most recent survey found that 70 percent of family physicians said that they “agree/strongly agree” that they “would do it over again.” This represents a 4-percent decline compared to 2001, and a 9-percent decline compared to 1995.

Another national survey of primary care physicians asked “Are you sorry you went into primary care?” Although this was not a scientific survey, 73 percent of respondents answered that they were sorry that they went into primary care.

We could find no studies that directly measured characteristics of residency training and their association with job or career satisfaction. The purpose of this study was to examine the relationship between current family medicine career satisfaction, current physician practice characteristics and residency training characteristics in family physicians who were less than 10 years out of their residency.

Methods

A series of pilot survey instruments was used to develop our final survey instrument. We received permission to use three scales from a previously existing instrument called the Physicians Worklife Study (PWS): Global Job Satisfaction, Global Career Satisfaction, and Global Specialty Satisfaction.

Our final survey instrument was then mailed to 1,000 practicing family physicians across the United States who graduated from residencies within the last 10 years. This time frame was chosen to balance the need to have a diverse study population, but to include physicians who would have reasonably accurate memories of their residency experience. Approval for this project was granted by the JPS Health Network Institutional Review Board.

Our primary outcome variable was a composite score of the specialty-specific job satisfaction scale from the PWS. We performed bivariate and multivariate analysis to determine which factors were associated with family medicine career satisfaction.

We received 560 surveys, subtracting two that were not usable, for an overall response rate of 55.8 percent.

Results

Overall, only 50.5 percent of respondents answered “strongly agree” or “agree” to the question: “If I were to start my career over again, I would choose to be a family physician.” There was no association of career satisfaction with many demographics and current practice features, including income, race, gender, practice location, practice setting, full-time or part-time status, or use of an electronic health record.

Exploratory factor analysis showed three significant factor loadings: overall work life, rigorous residency training, and current work environment and demographics. The final regression results are shown in Table 1. The final model explained 55 percent of the variance in the family medicine composite score. Multivariate analysis found that training that was exceptionally broad and in-depth was independently associated with career satisfaction (beta = 0.092, P = 0.003). The factors with the largest association with family medicine career satisfaction were medical career composite score (ß = 0.479, P < 0.001) and job satisfaction composite score (ß = 0.196, P < 0.001). There was a negative correlation with income—respondents with higher incomes were less likely to be satisfied (ß = -0.140, P < 0.001).

Discussion

Our findings suggest that some characteristics of residency education are associated with early career satisfaction. Those characteristics reflected rigorous training that included hands-on procedural experience, breadth of experiences with patients and illness, a wide range of pathology and care for complex hospitalized patients.

Our results revealed a much lower satisfaction with family medicine than AAFP surveys, with 50.5 percent versus 70 percent answering that they would choose a family medicine career again. Our survey population was early in their career—average graduation year 2001—and other studies have found that younger physicians are more dissatisfied.

A notable finding was that income was negatively associated with career satisfaction, which had not been reported previously. This might reflect difficulty with a work/life balance: some physicians are working more intensely than they would prefer, which results in a higher income, but decreased job satisfaction.

Another surprising finding was that relationships with residency faculty and resident colleagues were not independently associated with career satisfaction in the multivariate analysis. Previous research showed the importance of relationships in job and career satisfaction. Perhaps the influence of relationships during the residency years does not carry over to the practice years.

Current practice characteristics were associated with career satisfaction in our survey. Physicians who care for obstetrical/maternity patients and pediatric patients were more likely to have high job satisfaction. Respondents of Asian descent were slightly more likely to be satisfied than other ethnicities. Gender and age were not significantly associated with job satisfaction.

Our study had many limitations. The cross-sectional nature of our study does not allow us to make conclusions about causality in our findings. Does rigorous training result in positive influences on residents during residency or do medical students who seek out rigorous residencies come equipped with personality traits and tools that independently contribute to later career satisfaction? Other limitations will be listed in the final published manuscript.

Our findings imply that a rigorous residency experience may help family medicine residencies equip their residents with a multitude of skills and capabilities to prepare them to care for a wide variety of patients. In the absence of other data to the contrary, family medicine residencies should work toward providing broad, comprehensive training to their residents. Movements toward limiting family medicine training to only the outpatient setting, with a focus on prevention and well-person care, may be a mistake.

The biggest contributor to career satisfaction in our survey was the global medical climate. Family medicine organizations should continue to work toward improving the working conditions of all family physicians.

This study was funded in part by a research grant from the Texas Academy of Family Physicians Foundation.