|Year : 2021 | Volume
| Issue : 5 | Page : 487-493
Clinical practice satisfaction and quality of life among early-career doctors in Nigeria
Olumuyiwa Folayan1, Abimbola Amoo2, Dabota Buowari3, Abdulmajid Yahya4, Kehinde Kazeem Kanmodi5, Shehu Salihu Umar6, Olayinka Stephen Ilesanmi7, Oluwatoba E Osasona8, Umar Wasinda Francis9, Oluwaseyi Ogunsuji10, Mumeen Olaitan Salihu11, Esele Fortunate Ekuaze12, Alatishe Taiwo Adedamola13, Rereloluwa N Babalola14, Iyanu Adufe15, Okhuaihesuyi Uyilawa16, Adedayo Williams17, Lawson Obazenu18, Oladimeji Adebayo19
1 Department of Pediatrics, Federal Medical Centre, Bida, Niger State, Nigeria
2 Departments of Medical Microbiology and Parasitology, University College Hospital, Ibadan, Oyo State, Nigeria
3 Department of Accident and Emergency, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
4 Department of Ear, Nose and Throat, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
5 Kebbi Medical Centre, Birni-Kebbi, Kebbi State, Nigeria
6 Department of Radiotherapy and Oncology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
7 Department of Community Medicine, Faculty of Public Health, College of Medicine, University of Ibadan, Oyo State, Nigeria
8 Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
9 Department of Internal Medicine, Federal Medical Centre, Katsina, Katsina State, Nigeria
10 Periodontology and Community Dentistry, University College Hospital, Ibadan, Oyo State, Nigeria
11 Department of Behavioural Sciences, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
12 Department of Obstetrics and Gynecology, Irrua Specialist Hospital, Irrua, Edo State, Nigeria
13 Department of Psychiatry, LAUTECH Teaching Hospital, Ogbomosho, Oyo State, Nigeria
14 Department of Surgery, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, Nigeria
15 Department of Public Health, Adeleke University, Ede, Osun State, Nigeria
16 Department of Orthopedics and Trauma, Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
17 Departments of Family Medicine, University College Hospital, Ibadan, Oyo State, Nigeria
18 Department of Surgery, Federal Medical Centre, Nguru, Yobe State, Nigeria
19 Departments of Medicine, University College Hospital, Ibadan, Oyo State, Nigeria
|Date of Submission||14-Jun-2021|
|Date of Decision||11-Jul-2021|
|Date of Acceptance||30-Jul-2021|
|Date of Web Publication||11-Oct-2021|
Dr. Oladimeji Adebayo
Department of Medicine, University College Hospital, Ibadan, Oyo State
Source of Support: None, Conflict of Interest: None
Introduction: Job satisfaction and quality of life (QOL) are critical issues among early-career doctors (ECDs) in Nigeria; however, there is a paucity of data on these two issues. This study explored job satisfaction and QOL among ECDs in Nigeria. Methods: It was a cross-sectional study that used a self-administered questionnaire to collect data on sociodemographic and job satisfaction parameters from 667 ECDs in seven Nigerian tertiary hospitals. The World Health Organisation QOL-BREF tool was used to assess their QoL. Results: Results showed that the ECDs were satisfied with their career choice; however, they were not satisfied in the areas of remuneration, workload, and work environment. Furthermore, QOL was fairly above average, with the lowest scores reported in the environmental domain and only a slight male-to-female difference in the physical domain. Conclusion: Clinical practice dissatisfaction among ECDs could negatively impact healthcare service delivery. Therefore, it is recommended that the quality of the workplace environment and infrastructure in society at large should be improved upon by various stakeholders. This will positively impact the QoL of ECDs and enhance optimal healthcare delivery to the nation's teeming population.
Keywords: Domains, early-career doctors, quality of life, resident doctors, satisfaction, World Health Organisation Quality of Life-BREF
|How to cite this article:|
Folayan O, Amoo A, Buowari D, Yahya A, Kanmodi KK, Umar SS, Ilesanmi OS, Osasona OE, Francis UW, Ogunsuji O, Salihu MO, Ekuaze EF, Adedamola AT, Babalola RN, Adufe I, Uyilawa O, Williams A, Obazenu L, Adebayo O. Clinical practice satisfaction and quality of life among early-career doctors in Nigeria. Niger J Med 2021;30:487-93
|How to cite this URL:|
Folayan O, Amoo A, Buowari D, Yahya A, Kanmodi KK, Umar SS, Ilesanmi OS, Osasona OE, Francis UW, Ogunsuji O, Salihu MO, Ekuaze EF, Adedamola AT, Babalola RN, Adufe I, Uyilawa O, Williams A, Obazenu L, Adebayo O. Clinical practice satisfaction and quality of life among early-career doctors in Nigeria. Niger J Med [serial online] 2021 [cited 2021 Dec 5];30:487-93. Available from: http://www.njmonline.org/text.asp?2021/30/5/487/327945
| Introduction|| |
The measure of workers' contentedness on their daily engagement at the workplace is topical as work is a large subset of daily life. An average employee spends a third of their lifetime in the workplace; therefore, the appraisal of this period may give an insight into their quality of life (QOL). QOL, as defined by the World Health Organization, is the perception a person has of their position in life, in the context of the culture and value systems in which they live, and about their goals, expectations, standards, and concerns. It can also be defined as an individual's sense of well-being based on their satisfaction from the aspects of life they consider important. These definitions bring to fore the close interplay between workplace satisfaction and an individual's QOL.
Early career doctors (ECDs) in Nigeria are medical or dental practitioners in the early phase of their professional career postgraduation. These include house officers, resident doctors, and medical/dental officers below the rank of principal medical/dental officer (PMO/PDO). The early career period spans the start of a career to about 15 years after, depending on the path chosen for professional development. It is also characterized by job schedules that require clinical management of patients, academic engagements, research, and administrative roles in proportions appropriate for each cadre. This group of doctors encounters different challenges in their daily work that borders on contentment with what they do and the quality of their lives. These challenges have ripple effects on the quality of patient care they offer and their relationships at work. Issues bordering on job satisfaction and QOL may also be important factors influencing migration of ECDs in the background of an inadequate health workforce in Nigeria.
An insecure work environment, socio-cultural status, overwhelming workload, lack of career advancement and progression, lack of recognition, long working hours, work stress, and physical/verbal violence against medical workers have been reported to be leading causes of job dissatisfaction in clinical practice.
Floch et al. reviewed issues relating to work satisfaction among general practitioners and concluded that policymakers in Europe should be aware of the balance between workload and income, job flexibility, and a robust social support system as important determinants of satisfaction.
In China, Chen et al. and Liang et al. both agreed on doctors' poor QOL and working conditions, especially in rural China, and recommended continuing education opportunities and improved working conditions to help the rural areas retain their doctors.
In Tropical Africa, Suliman et al. studied the factors affecting job satisfaction among 94 junior doctors in a teaching Hospital in Sudan over three months and obtained information on job satisfaction factors such as working conditions, workload, payment, and promotion. They found that most of their respondents, who were unmarried male doctors in their third decade of life and had two to three years of clinical experience, were dissatisfied with their job. The major reasons were work conditions (27%), lack of training (23%), inadequate pay (21.7%), workload (19.8%), social relationship (4.7%), and autonomy (3.6%).
In Nigeria, our literature search revealed more reported studies on job satisfaction than there were on doctors' QOL. Bello et al. in Southern Nigeria found that the determinants of overall job satisfaction among physicians in public hospitals included remuneration, contingent reward, operating procedures, communication, job autonomy, and being married. This was similar to the report on job satisfaction among healthcare workers in a Nigerian tertiary hospital by Lasebikan et al.
In 2002, Ofili et al. in Benin, South-South Nigeria, while investigating the level of job satisfaction and its relationship with psychological disorders among 190 doctors, found a high level of job dissatisfaction in their study as compared to their European counterparts. Yakasai et al. reported a high level of job satisfaction among resident doctors in Northern Nigeria. Another Nigerian study found a significant negative correlation between duty hours and QoL among ECDs, with the more junior cadre doctors had lower QoL scores than their senior colleagues.
This study aimed to investigate clinical practice satisfaction and the QOL among early-career doctors (ECDs) in Nigeria. There is a dearth of studies on the subject matter in Nigeria, and objective decision-making is needed in improving the QOL among the country's healthcare workforce.
| Methodology|| |
Nature of study
This study was a part of the Challenges of Residency Training and Early Career Doctors in Nigeria (CHARTING) study.,,
The ECDs comprised house officers, registrars, senior registrars, and medical/dental officers below the rank of a PMO/PDO. House officers are fresh medical and dental surgery graduates undergoing compulsory one-year training to obtain a permanent medical/dental practising license. Doctors in the early and later phases of postgraduate professional training are referred to as registrars and senior registrars, respectively. Medical/dental officers are doctors who are not undergoing the postgraduate medical training of the postgraduate medical colleges and are below the rank of Principal Medical/Dental Officer.
The ECDs who gave consent to participate and work in centers with the National Association of Resident Doctors' established presence were included in the study. Doctors and centers that did not meet these criteria were excluded.
It was a cross-sectional multi-center and multidisciplinary study that included 667 ECDs from seven Nigerian tertiary hospitals and explored issues affecting them. The protocol for the CHARTING study had been previously published.
Self-administered, structured questionnaires were used to obtain information on sociodemographic data, income, years of training, sleeping hours per day, job satisfaction, working conditions, and job dissatisfaction. QOL was measured with a prevalidated World Health Organization QOL (WHOQOL-BREF) tool, a 26-item Likert scale questionnaire that assesses the QOL in four domains, namely physical health, psychological, social relationships, and environment.
Data management and statistical analysis
Data from the questionnaire were cleaned and computed into IBM SPSS statistics for windows version 23 (IBM Corp, Armonk, N.Y., USA). The normality of the data distribution was determined using the Shapiro–Wilk test, and the frequency distributions of all variables were determined. Continuous variables were summarized as mean, median, and standard deviation, while the categorical variables were summarized as proportion and frequencies. Chi-square test was used to determine associations between the outcome variables of interest (job satisfaction and QOL) and other categorical independent variables of interest at a 5% level of significance (P < 0.05).
Ethical clearance and institutional approval to conduct the study were obtained from the National Ethics Review Committee, Federal Ministry of Health (FMoH), Nigeria (NHREC Approval Number NHREC/01/01/2007-26/06/2019) and from the seven study centers, respectively. Informed consent (written and verbal) was obtained from all participants before they participated in the study. All information obtained from participants was treated with confidentiality.
| Results|| |
The mean (± standard deviation) age of respondents was 33.2 (±5.54) years. The male to female ratio was 2:1, 62% (414) were married; Of these married respondents, 99.8% (413) were in monogamous marriages, and many (67%) had ≤4 dependents. The distribution of the respondents based on cadre in descending order were 35%, 32%, 25%, and 8% for registrars, senior registrars, house officers, and medical officers, respectively [Table 1].
|Table 1: Sociodemographic characteristics of early-career doctors in selected Nigerian tertiary hospitals|
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The majority of respondents (92.7%) had no postgraduate academic degree, 67.2% were in residency programs at various training centers, and 77% (476) spent more than 40 h/week on resident duty. Approximately 63% (405) had more than seven days of calls per month, and 92% (593) had <7 h of sleep per day. Those who spent <7 h daily on educational and research activities accounted for 69% (394) and 93% (259), respectively. In the income category, 68% (435) of ECDs earn <833 US dollars monthly [Table 2].
There was a high level of satisfaction on career choice, professional fulfillment, and work enthusiasm among all ECD cadres, with a median score of 4.00. However, the median scores showed a strong desire to practice the medical profession in another country (median score 5.00). The level of satisfaction was generally low (median score 2.00) with the comfort of the workplace environment, the current salary of the surveyed ECDs, and the capacity of the workplace facility to cater for the health needs of patients [Table 3].
There was a statistical significance in the median scores of all cadre of ECDs in the decision to opt for the medical profession and the dissatisfaction their choice has offered them [Table 4]. The least satisfaction median scores of 2.0 were recorded in remuneration and access to extracurricular activities [Table 4].
Low workplace satisfaction was expressed by all caders of ECDs, and this was the same for job security and availability of facilities to work with. The inadequacy of the workplace to cater for the career needs of the ECDs and the health needs of the patients were statistically significant [Table 5].
All cadres considered their relationship with their patients satisfactory, although this was not statistically significant. ECDs in the senior registrar cader had the highest median satisfaction scores for administrative function. There was, however, a low score for adequate career opportunities across all ECD caders [Table 6].
The median score of all ECDs in the WHOQoL-BREF domains transformed to WHOQoL-100 scores and expressed as percentages showed the highest scores in the social domain [Figure 1].
Female ECDs had lower median scores in the physical domain compared to males [Figure 2].
The median WHOQoL domain transformed score was least (≤50) in the environmental domain for all cadres [Table 7]. The scores in all four domains for all cadres were statistically significant (P = 0.00).
| Discussion|| |
Work is an integral part of life; an average employee spends about one-third of their lifetime in the workplace, making the time spent at work a factor worth considering when evaluating the QOL. Satisfaction in the workplace refers to a positive emotional state resulting from an individual's appraisal of his or her job. This appraisal was investigated among ECDs in our study and classified into career choice, income, work schedule, work environment, and effect of work on health.
Our study found that most ECDs were satisfied with their career choice and showed enthusiasm in their work. They, however, frequently entertained the thought of leaving the profession in Nigeria to practice in other countries. This implies that the practice of the profession in Nigeria and not the demands of the medical profession may be a reason why job satisfaction is low. Dissatisfaction with workload and remuneration was common across all cadres of ECDs surveyed in our study. Dissatisfaction with one's salary will adversely affect the motivation to put in one's best at the workplace; a positively motivated workforce is a vital component of health services delivery. Mohebbifar et al. reported that good wages ranked first among employee's viewpoints of motivational factors for quality healthcare service delivery. Our findings were also congruent with the findings from reports on dissatisfaction with pay and benefits among health workers in North-Eastern Nigeria and young clinical doctors in China.
Good patient outcomes play an important role in physician satisfaction, and provision of work tools help to achieve both good outcome and appropriate job satisfaction. This study found that the inadequacy of health facilities to cater for patients' health needs might affect ECDs' career fulfillment. The dependence on out-of-pocket patient-consumables needed for care hinders the smooth flow of work, making the work environment suboptimal for adequate patient care and non-fulfilling for the ECD. This was also highlighted by Martins et al. in their evaluation of job satisfaction among health workers in a Nigerian tertiary hospital.
Sleep is essential for good health and optimal function at work. An average sleep time of 7–9 h is recommended for the age category of our respondents, but all caders of ECDs in this study had low median scores for sleep hours as a result of the demands of work. Ogunsuji et al., in their study on work hours and QoL in ECDs, reported sub-optimal sleep hours among ECDs, and better physical health in those that had additional sleep hours.
A person's QOL can be defined as a sense of well-being based on the person's satisfaction from the aspects of life that he/she considers necessary. Our study found that the environmental domain had the lowest QOL score among our study respondents. Most ECDs are not satisfied with their physical safety, security, available healthcare services, home/physical environment, recreation activities, and transport facilities. The recent spate of kidnapping and banditry with demand for huge ransoms and the constant dilapidating social amenities affecting the country also trickles to this subset of individuals, and these may be part of the reasons among others for the emigration of ECDs despite the suboptimal health workforce in Nigeria.
The QOL in the physical domain was slightly lower for females when compared with their male colleagues. Most of our respondents were married and had dependents; therefore, the task of keeping the home combined with the rigors of the profession may have accounted for a lower QOL in the physical domain for female ECDs. Women also tend to get more fatigued from much work demand and may not have enough energy capacity that can match their male counterparts. The findings on QOL were comparable to the report on the QOL among Doctors in urban China. The reasons for low scores in the Chinese study included frequent violence against medical workers, tense doctor-patient relationships, anxiety, burnout, and exhaustion.
This study is a descriptive cross-sectional study; therefore, a causal relationship between job satisfaction and QOL among ECDs cannot be established. However, the WHOQOL BREF used is a standardized instrument that has been validated among the local population. Its use in this study allows for comparison with other related international studies.
The tertiary hospitals across Nigeria offer a wide range of specialty training; hence, most ECDs in training are found in these centers. This study recruited a large sample population of ECDs selected from tertiary hospitals spread across the six geopolitical zones in Nigeria; hence the findings can be generalized among ECDs across the country.
| Conclusion|| |
ECDs in Nigeria have a passion for the profession but are dissatisfied mainly with practising the profession in the country. An overwhelming workload, poor remuneration, workplace safety, and unavailability of work tools were common reasons for job dissatisfaction. The QOL of ECDs in Nigeria is fairly above average; however environmental factors have a significant negative impact on this.
We recommend that various stakeholders upgrade the workplace environment infrastructure in the healthcare sector and society at large in a bid to improve the QOL of ECDs and optimize their satisfaction at the workplace for the delivery of optimal healthcare services that guarantee patient safety and satisfaction.
Financial support and sponsorship
Nigeria association of resident doctors.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]