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ORIGINAL ARTICLE
Year : 2022  |  Volume : 49  |  Issue : 1  |  Page : 28-34

Medical Profession in the 21st Century. Is it Still Alluring??


1 Department of Pathology, Faculty of Dental Sciences, MRIIRS, Faridabad, India
2 Department of Anatomy, Faculty of Medicine and Health Sciences, SGT University, Gurugram, Haryana, India
3 Department of Anaesthesia, Liver Transplant and GI Surgery, Medanta Hospital, Gurugram, Haryana, India
4 Department of Nephrology, Puspawati Singhania Research Institute and Hospital, New Delhi, India
5 Department of Physiology, Faculty of Medicine and Health Sciences, SGT University, Gurugram, Haryana, India

Date of Submission08-Oct-2021
Date of Acceptance10-Jan-2022
Date of Web Publication22-Apr-2022

Correspondence Address:
Prachi Saffar Aneja
Department of Anatomy, FMHS SGTU, Aster 11/1, Vatika City Sector 49 Gurugram - 122 018, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jss.jss_144_21

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  Abstract 


Introduction: The world, particularly India, is in the midst of one of the worst pandemics ever. The second wave of the COVID-19 pandemic has hit the country like a tsunami, taking a toll on life. A robust health-care industry with competent, productive, and positive manpower is needed like never before. The productivity of doctors is directly related to the fulfillment they experience in their jobs. Aims and Objectives: The study will try to explore the satisfaction level of doctors working in Haryana. It will also delve into major determinants of satisfaction and dissatisfaction. Materials and Methods: The cross-sectional survey-based analysis was conducted in FMHS SGTU on doctors employed in Haryana. The prevalidated questionnaire was administered via Google Forms. Results: A total of 515 filled pro forma were obtained. 71.6% of doctors were found to be satisfied in their chosen profession. Discussion: The discontentment among doctors is now globally acknowledged. It stems from a wide array of issues such as the growing incidents of workplace violence, lack of security measures, deteriorating doctor–patient relationship, erratic work hours, monumental workload in stressful environment, inadequate infrastructure, and pitiful pay. Conclusion: There is marked diminution in doctors' morale who regret being in this profession more and more. However, with the joint efforts of society and competent authorities, this grim situation can be rectified. Steps should be taken to build a strong doctor–patient relationship based on trust and boost infrastructure so that medical profession can be made alluring in the 21st century.

Keywords: Dissatisfaction, doctors, pay, stress, workload


How to cite this article:
Bansal S, Aneja PS, Aneja M, Bansal R, Arora J. Medical Profession in the 21st Century. Is it Still Alluring??. J Sci Soc 2022;49:28-34

How to cite this URL:
Bansal S, Aneja PS, Aneja M, Bansal R, Arora J. Medical Profession in the 21st Century. Is it Still Alluring??. J Sci Soc [serial online] 2022 [cited 2022 Nov 30];49:28-34. Available from: https://www.jscisociety.com/text.asp?2022/49/1/28/343702




  Introduction Top


Medical profession has been accorded one of the most noble professions since times immemorial.[1] Doctors are considered God's instrument, their healing powers nothing short of divine. The brightest of minds and purest of souls with an inner motivation to serve and a resolve to sacrifice their lives, enter this profession, with the singular intent to alleviate pain and misery, ill-health brings in its vogue.[2] But over the century, more so in the COVID epoch, the face of medical profession has changed, both for the beneficiary and the beneficent. It would not be wrong to say that the “terms” can even be interchanged if the perspective of a diseased person is taken into account.[3]

In the present era where success and satisfaction is measured by the luxury a person can afford, by working as less as possible, the term job satisfaction has attained a new meaning altogether.[3] It is not that jobs other than that of health-care professionals do not entail hard work and hours of toiling, but the environment of constant stress and sufferings that a doctor lives in, day in and day out and delivers his duty with precision, takes a toll on the senses.[4] The psychological impact of living in constant pain and seeing loss can never be measured in terms of money or the things it can buy. Although doctors are often considered to live a lavish life, the inner turmoil and strain can never be truly compensated for.[5],[6]

There are innumerable studies stating that for the health-care system to be efficient, the health-care professionals should be satisfied in their jobs.[7],[8] Competent and content human workforce is an asset in this resource-intensive field. The productivity and outcome of health-care providers can be said to be directly proportional to the fulfillment they experience in their jobs.

We as parents always want our children to inherit our knacks and learn from our mistakes. We attempt to smoothen out their path by convincing them to avoid the ones we consider wrong. We strive to steer them toward success by helping them choose a profession which we think is appropriate. Hence, one of the parameters to gauze job satisfaction is whether the doctor wants his/her child to pursue the same life as he/she is leading or think that any profession but medical would do their child good.[4] The survey conducted has included questions which enables the doctors' to express their opinion on whether they will or will not wish their progeny to pursue the same profession as themselves (irrespective of the abilities and inclination of the child in question).

This survey attempts to assess the stance of doctors working in Haryana (state of India) toward their profession. The study will try to explore whether doctors are satisfied in their chosen profession. It (study) will also delve into the major determinants of satisfaction and dissatisfaction.

Aims and objectives

  1. To explore whether doctors in Haryana state are satisfied/regret being in medical profession
  2. To scrutinize the various reasons of such a satisfaction/regret
  3. To investigate whether doctors are willing to let their child pursue medical profession, as a gauze of their contentment.



  Materials and Methods Top


The present study is a cross-sectional survey-based analysis conducted in the Department of Anatomy, Faculty of Medicine and Health Sciences SGT University. Participants are doctors employed in Haryana state of India. The prevalidated questionnaire (to assess the content validity) was administered via Google Forms. A systematized questionnaire was developed based on the researches done by previous authors and modified to obtain information relevant for the present analysis.

The completed questionnaire was submitted by the participants in electronic format. The Google Forms was circulated on various social media platforms via Dean's office to maintain ambiguity. The participation in the survey was purely voluntary. No participant identifying information such as name, email-id, phone number, and address was acquired. The information was further anonymized and randomly coded to ensure complete delinking with any identity of the participant at source. Approval for “waiver of consent” (vide ICMR guidelines on Biomedical Research 2017, Chapter 5, Information Consent Process Box 5.2 “Conditions for granting waiver of consent”) was sought prior to circulation of Google Forms from the Registered Screening Ethics Committee of the institution (SEC/FMHS/F/13/05/20-4).

Inclusion criteria

  1. Minimum qualification-MBBS
  2. Doctor should be living and employed in Haryana state of India.


Exclusion criteria

  1. Incompletely filled forms were discarded.


Sample size

The study of Wáng et al. observed that 48.62% of participants did not regret being a doctor.[9] Taking this value as reference, the minimum required sample size with 4.5% margin of error and 5% level of significance is 474 patients. To reduce margin of error, total sample size taken is 515.

Formula used is: N ≥(p [1 − p])/(ME/zα)2

where Zα is value of Z at two sided alpha error of 5%, ME is margin of error, and P is proportion of participants not regretting being a doctor.

Calculations: N ≥ (.4862 × [1–4862])/(0.045/1.96)2 = 473.91 = 474 (approximately).

Statistical analysis

Categorical variables were presented in number and percentage (%). Qualitative variables were compared using Chi-square test/Fisher's exact test. P < 0.05 was considered statistically significant. The data were entered in MS Excel spreadsheet, and analysis was done using the Statistical Package for the Social Sciences (SPSS) version 21.0 (Armonk, NY: IBM Corp).


  Results Top


A total of 548 pro forma were obtained. The number of forms finally considered for analysis was 515. Others were discarded on the basis of inclusion and exclusion criteria mentioned in the materials and methods section.

The sample size comprised 218 females and 297 males. As far as the age groups are concerned, 264 doctors were <40 years old, 217 were in the age group of 40–60 years, and only 34 doctors were more than 60 years old. The distribution of doctors according to work profile, working in corporate hospital (with or without private practice), public sector (both government hospitals and medical colleges), private medical college, and self-employed was 78, 173, 131, and 133, respectively.

[Figure 1] depicts the reasons of why present-day doctors chose this profession in the first place. The most frequent reason was that medicine fascinated their young minds, followed by a zeal to serve the society. However, one doctor said that she became a doctor to fulfill her father's dream. She was neither forced into it, nor she liked it herself and medicine was not her family profession as well.
Figure 1: Why did you enter medical profession

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[Table 1], [Table 2], [Table 3] show how satisfied or otherwise doctors are in their chosen profession, categorized on the basis of age, job profile, and gender. Although all groups show an inclination toward satisfaction, doctors of age groups above 60 years seem to be most satisfied while the younger ones already regret their choice. Medical professionals working in corporate hospitals with or without private practice are the most content, while self-employed and those working in private hospitals are the least. However, no gender influence was observed.
Table 1: Satisfied with or regret being a doctor (on the basis of age profile)

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Table 2: Satisfied with or regret being a doctor (on the basis of job profile)

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Table 3: Satisfied with or regret being a doctor (gender-wise)

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[Table 4] and [Table 5] depict the level of satisfaction of doctors in pre- and paraclinical and clinical branches, respectively. Medical professionals working in private sector (both medical colleges and hospitals) are less satisfied. [Figure 2] lists the reasons for dissatisfaction. Foremost among them is the increase in episodes of violence against the medical professionals and lack of security.
Table 4: Doctors in preclinical/paraclinical branches

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Table 5: Doctors in clinical branches

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Figure 2: Reasons you regret being a doctor

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[Table 6], [Table 7], [Table 8] portray the views of doctors on their earnings. [Table 6] categorizes the doctors on the basis of job profile. [Table 7] illustrates views of pre- and paraclinical doctors (male and female) working in private and public sectors. [Table 8] illustrates views of clinicians (male and female) working in private and public sectors. More than 58% of respondents feel that they earn less than their counterparts. Only 10% of participants feel that their counterparts earn less.
Table 6: Comparison with earnings of counterparts in other professions

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Table 7: Comparison of earnings of doctors (in pre- and paraclinical branches) with earnings of counterparts in other professions

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Table 8: Comparison of earnings of doctors (in clinical branches) with earnings of counterparts in other professions

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More than 56% of medicos feel that they do not want their progeny to purse medical profession. [Figure 3] depicts the reasons for such a feeling. The basic reason doctors do not want their child to pursue this career is again the same, i.e., increase in episodes of violence against the medical professionals and lack of security of life. The other listed reasons include perpetual environment of stress and more course duration. However, 44% of doctors feel that this profession is good for their child. [Figure 4] shows why doctors still recommend this profession for their child. They opine that it is a noble way to serve the society and accords respect of common man. For 95% (P = 0.006) of the respondents, the choice of profession of their child is independent of the said child's gender.
Figure 3: Reasons of why medical profession is NOT a good option for your child

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Figure 4: Distribution of why do you think medical profession is good for your child of study subjects

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More than 82% feel that medical profession has lost its sheen over the years. 61% (P = −0.029) feel that the profession has lost more value over the years than its counterparts like judiciary system, Indian police force, and teachers.


  Discussion Top


The world, particularly India, is in the midst of one of the worst pandemics ever. The second wave of the COVID-19 pandemic has hit the country like a tsunami, taking a toll on life and property. A robust health-care industry is needed like never before. One of the key elements of this industry is the health-care professionals. It is a well-established fact that for the industry to flourish, competent, productive and positive manpower is dispensable. Many studies are conducted from time to time all over the world to determine the level of job satisfaction among doctors. Different parameters are employed to ascertain the level of job satisfaction so as to measure its bearing on the work outcome.[10]

There are many reasons as to why the youth has always been inclined toward medicine as a career opportunity. A few of them, consistent with our findings are, first and the foremost, the fascinating nature of medicine with its wide array of subspecialties. Second, the fulfilment one feels in being able to help others in need and change their lives for the better. Respect and honour the profession brings in its vogue and lastly, the financial security along with the high social status it accords.[11],[12],[13],[14]

The overall satisfaction rate in the present study was approximately 72%. Similar results were seen in studies done in Pakistan and India where 26% in each were dissatisfied.[1],[15] A few studies reported better satisfaction results such as one done in Australia (85.7% satisfied).[16] However, overall satisfaction of doctors in this study was higher than certain studies done in Ethiopia (satisfaction level of 54%),[17] China (satisfaction level of 48.6%),[9] and India (satisfaction level of 50% and 69.5%, respectively).[18],[19] The study results show that the level of job satisfaction increases with age. A plausible reason for this increase is the decrease in workload and better income with increasing age. Corporate hospital doctors with or without private practice were better adapted and satisfied with their profession. However, no gender variation was observed as seen in a study conducted in Turkey.[7] Doctors of pre- and paraclinical branches were more satisfied in public sector jobs. A significant difference was recorded with 78% satisfaction level in those employed in government medical colleges as against 60% in those working in private medical colleges. In contrast to this, the level of satisfaction did not vary much in the case of clinicians working in these two sectors.

There are several determinants of job satisfaction. Job dissatisfaction is multifactorial and there is a critical interplay between the individual factors. Of the many factors listed, the most important were the increasing episodes of violence against doctors (affirmed by 41% of respondents who regret being in this profession) and poor security measures (stated by 35% of stakeholders) to ensure that the incidences are not repeated. Episodes of workplace violence against health-care professionals have become rampant worldwide more so in developing countries.[20] A previous study conducted in Uttar Pradesh brought forth a shocking revelation, where a whopping 87% of participants admitted to facing violence at workplace ranging from verbal abuse to physical violence.[21] The problem is further deepened by the fact that doctors feel that proper security measures are still lacking to address this issue.[20] Working in an environment of constant stress associated with disease and a need to make crucial decisions compounded by a sense of insecurity of life has led to marked diminution in the morale of health-care professionals.[22]

A stark discrepancy between workload and pay is also a major contributing factor.[23],[24],[25] 57.5% of respondents in this study feel that their counterparts earn more. The study clearly shows that females, employed both in private and public sectors and belonging to any specialty preclinical, paraclinical, or clinical, feel they earn less than their counterparts in other professions. There is enormous literature to support that the salaries of doctors do not justify the work they put in, in terms of number of working hours.[23],[24],[25] Doctors often complain of sleep deprivation (especially the junior and resident doctors) and inability to maintain work-personal life imbalance.

Other contributory factors for the growing discontent among doctors are poor workplace environment and infrastructure, stress, and poor doctor–patient relationship. Evidence suggests the growing expectations of public, and lack of adequate infrastructure leads to frustration in health professionals.[21] Bringing the doctor under the Consumer Protection Act has made matters worse. With increasing litigation charges, doctors now take a more prudent approach in diagnosis and treatment. Ordering laboratory investigations to be doubly sure of diagnosis before prescribing drugs has become essential, but more often than not, it increases the cost of treatment. This leads to displeasure and further deterioration of the already precarious doctor–patient relationship.[3]

One of the parameters to gauze satisfaction levels was whether the participants consider medical profession good for their children. 56% of partakers felt that medical profession is not good for their child. Although, for 95% of respondents, the choice was irrespective of the gender of the child in question. In similar studies conducted in Korea[4] and China,[9] 82.5% and 72.6% of respondents did not want their child to pursue this profession. In another study conducted in China,[22] 88% of respondents did not recommend medical profession for their children. A number of reasons were enlisted for such an opinion, the foremost among them being long working hours and stressful work environment, deteriorating doctor–patient relationships, and poor pay scales.[9],[22] In the present study, the most negative factor cited by doctors for their decision was increasing episodes of violence and lack of security arrangement for doctors. Doctors feel threatened and have lost trust in security arrangements. This has been reflected in their choice of profession for their progeny. Those who are comfortable with their progeny pursuing medical career said that it is one of the best professions to take up, to serve the society. Moreover, doctors accord respect and high stature in the society. 20% said that their decision stems from the fact that they are ignorant about other professions. Since they can guide their child in this branch, it is a rational choice.

Medical profession has lost its sheen advocated 82% of respondents (85% of females and 80% of males). 60% of respondents (58% of females and 62% of males) further opinionated that medical profession has lost more sheen over the years than other professions such as law and police services.


  Conclusion Top


The citizens of India need a robust and effective health-care industry. This awareness has further deepened with the outbreak of COVID pandemic, where each and every one of us has realized that for a healthy nation, the health-care services of the country have to be strengthened. India spends as little as 3.6% share of gross domestic product on the health sector as against 16.9% spent by the USA.[26] Health-care professionals form an integral part of this industry, so for it to flourish, competent, productive, and positive doctors are of utmost importance. The dissatisfaction among doctors is now globally acknowledged. The discontentment stems from a wide array of issues such as the growing incidents of workplace violence, lack of measures taken to strengthen the security, pitiful pay, erratic work hours, monumental workload, stressful environment, inadequate infrastructure, and deteriorating doctor–patient relationship. This has led to marked diminution in doctors' morale who regret being in this profession more and more. Many do not even consider this a suitable profession for their progeny. It is evident from the study that the medical profession does not enjoy the glory and stature it used to.

However, with the joint efforts of society and competent authorities, this grim situation can be rectified. First and foremost step is building a strong doctor–patient relationship based on trust. Furthermore, steps should be taken to boost infrastructure, reduce workload by increasing trained manpower, and provide doctors their rightful respect in society so that medical profession can be made alluring in the 21st century.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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