Medicolegal Issues

Are You Satisfied?


“(I can’t get no) satisfaction.”—The Rolling Stones

Do you know people who have good health, loving families, a healthy income, and a great house but who are still not satisfied? You may also know some people who seemingly have little to be thankful for, and yet they are very satisfied. There has been a great deal of research on this topic, specifically as it relates to job or career satisfaction. Some assume that the main component of job satisfaction is how much a person is paid. In study after study, however, compensation is never first and is often fourth or lower on the list of items that people identify as the key factors related to their satisfaction. So what are the other factors?

What Stimulates You?

The nature of the work is important. People must find their work stimulating. Everyone finds stimulation at different levels—for some it may involve being technically successful, whether they are reviewing contract language or hanging crown molding. Others find performing a procedure such as a cardiac catheterization or a lumbar puncture highly energizing. Or stimulation—for the master chess player, for example—may be found strictly on a mental level. Whatever the sweet spot, it is important to identify what you find motivating and challenging.

Overstimulating situations, on the other hand, are uncomfortable and dissatisfying. Some individuals thrive in a highly stressful environment, such as air traffic control, that others would find overwhelming.

One of the unique features of being a hospitalist is the need to work collaboratively across many disciplines to achieve results for our patients. The collegiality involved in the team approach can be invigorating and satisfying to many people. For others, it is simply frustrating.

In study after study … compensation is never first and is often fourth or lower on the list of items that people identify as the key factors related to their satisfaction.

Do You Feel Appreciated?

Recognition for a job well done is something everyone needs. We see this in our co-workers and in children when they try something and are praised for it. We all need recognition for doing a good job day after day. This seemed counterintuitive to me when I first learned about it. Gee whiz, I thought, why do I have to say, “Good job,” when people are just doing what they are supposed to do? It turns out that we all need to be recognized regularly in order to feel that we are valued and needed. It keeps us interested and motivated.

This reminds me of the old joke in which the wife says to her husband of 25 years, “Do you love me?” He replies, “Well, I told you so 15 years ago. Don’t you remember?”

This does not mean we need a financial reward every other day or a big bonus every month. It means that we desire recognition that is meaningful and timely. Studies have shown that unless the recognition is personalized, it can have a negative effect. For instance, if I don’t care for sports, rewarding me with tickets to a baseball game will seem depersonalized and will give me the feeling that no one took the time to know what is important to me.

By the same token, if praise in a public setting makes me uncomfortable, don’t create a reward banquet with great public fanfare. People prize small things like handwritten thank you notes, gift cards for places they like (Starbucks!), or opportunities for educational or other activities. A simple “thank you,” said with enthusiasm, does wonders. Respect is closely tied to recognition. If the hospitalist feels like a glorified resident, the sense of disrespect is pervasive—more on this below.

Are You in Control?

Autonomy and control over your work and work life remain key factors in career satisfaction. This includes having input not only when it comes to the schedule but also, and more importantly, with regard to the processes. Can you participate in design for your group or at the hospital? If you find that all your suggestions fall on deaf ears, then either the work environment needs some adjusting or you are always wrong! Small things can be important here. Just having the flexibility to participate in quality processes or to give input on a protocol creates a feeling of control over your work. Hospitalists who have decisions imposed on them experience a great deal of tension and may, ultimately, resign.

Is there an opportunity for promotion or further learning? An individual who feels boxed in and unable to make career improvements is often dissatisfied. This ties in to the need for challenge and the importance of the nature of the work.

We all have personal challenges that we would like the flexibility to address. You may have childcare or elder care issues. Perhaps you want to train for the next Ironman race. If you are unable to address these personal aspirations and goals, you may feel that you have no control over your life, much less your work life.

Are You Happy at Work?

Work environment—who knew how important this could be? Let’s say you are employed at a large organization, perhaps General Electric. GE controls the environment for all of its employees. The company makes sure that the lighting is adequate. It tries to protect its employees from hostility based on gender, race, or disability. GE controls work assignments, and there is a chain of command for any issue that needs to be addressed.

The hospitalist, as a member of the medical staff, may be in a much different setting. Often, hospitalists work in someone else’s environment. The nurses and physicians with whom they work are generally hired by others. The atmosphere in which they work can be hostile, devoid of respect. There is often no clear chain of command set up to resolve work environment issues. Some facilities are frustrating and challenging to work in, with insufficient translators or inadequate lab or X-ray support. Fellow medical staff members or administrators may not understand how hospitalists differ from other specialists, making the job of the hospitalist more difficult

An individual’s inability to affect the work environment due to the structure of the facility can be detrimental to morale. Are the committees structured so that hospitalists can participate in them and influence the decisions they make? Even seemingly small issues can have a big impact on a hospitalist’s feelings of control and autonomy.

What Do You Earn?

Finally, compensation. Everyone wants a fair wage for a reasonable work effort. It seems simple, but obviously there are tensions here. All things being equal, a person’s income should be competitive and fair. The definition of “fair” is often determined by the marketplace. In the field of hospitalist medicine, there is a great deal of competition for labor, so there are many opportunities to evaluate. But finding the work that is most satisfying involves attaining a combination of the abovementioned characteristics as well as evaluating location.

SHM’s Task Force Examines the Issue

So, what to do? As an organization, SHM has appointed a Career Satisfaction Task Force to study work satisfaction and to design processes that will address this issue specifically for the hospitalist workforce. As I mentioned above, this topic has been studied extensively in various employee environments for many years. Retention of valuable employees is a key component of an organization’s success. This applies to nonmedical as well as to medical fields. The emergency medicine field, for example, has done some work on the challenges specific to their physicians and has some interesting insights. We expect to share the work product of our own task force in the future.

Short-Term Help

But what to do now? If you are a hospitalist leader, ask your group for feedback. Are they finding satisfaction in the areas described above? Find ways to develop control and autonomy for your group. Encourage them to participate in shaping their own careers and futures. Recognize, recognize, recognize. You can’t say “Thank you” or “Good job” too often. Learn how your group members prefer to be recognized and try to personalize what you do for them. Remember this line from The One Minute Manager, by Kenneth Blanchard, PhD, and Spencer Johnson, MD: “Catch them doing something right.” It happens around us all day, but we take performance for granted and fail to praise and recognize.

If you are a hospitalist, help shape your own destiny. Participate, ask questions, and devise solutions. And recognize the nurses, the social worker, and your group leader.

Together we can create career satisfaction and lifelong, fulfilling work. Unlike Mick Jagger, we will then get some satisfaction! TH

Dr. Gorman is the president of SHM.

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