Dermatologists in UAE - Delighted or Dismayed? Elements Linked with Occupational Satisfaction Levels

Objective:To assess the level of job satisfaction and to identify factors affecting the job satisfaction in practice of Dermatologists in United Arab Emirates.

Method:A descriptive cross-sectional study was conducted among 212 dermatologists AT United Arab Emirates. A 20-item selfadministered questionnaires were distributed to all dermatologist doctors after obtaining consent. Dermatologist should be working in United Arab Emirates were included. After obtaining response from all dermatologist doctors, we assessed level of job satisfaction with socio-demographic characteristics and assessed factors affecting job satisfaction.

Result:In present study, female predominance (73.58%) was observed with a mean age of 41.43 ± 8.6 years and majority of the doctors having 3-4 years of clinical experience. Majority of dermatologists (66.5%) were satisfied with their job. Among all satisfied dermatologists, high proportion of dermatologists (79.43%) were satisfied with their good work life balance followed by high salary (78.72%), no on-call duties (53.9%) respectively. The study revealed that mental stress (83%), was the important for job dissatisfaction followed by evening duty (54.9%), less salary (19.7%), and high patient volume (15.5%) respectively. 73.68 % of female dermatologists and 3-4-year experienced doctors (32.46%) were highly satisfied with their good work life balance. Mental stress was mostly noticed in 36-40-year aged dermatologists (44.2%) and hospital dermatologists were experienced greater mental stress than clinics.

Conclusion:Approximately 66.5 % of dermatologists were satisfied with their job. Age, years of experience, speciality and work location were essential predictors of job satisfaction. Good work-life, high salary and no on-call duties were the frequently reported satisfaction factors in the study.

Keywords:Dermatologists; Job satisfaction; Work-life balance

Physician’s job satisfaction is one of the leading elements for improving the quality of health care, and its continuity in medical system [1]. Satisfaction of Physician’s is interlinked with the quality of health care, the quality of the workforce attracted to treatment as a career, patient satisfaction with the services they receive, patient adherence, and continuity of care [2]. The incidence dissatisfaction among physicians affects patient satisfaction and can adversely influence the adherence to medical treatment which further results in a reduction of quality of care in healthcare system [3]. Physician satisfaction is a critical measure of their wellness which has been negatively associated with physicians’ burnout [4]. At individual level low level of job satisfaction and high level of job stress are threats to mental and physical health, quality of life, goal achievement and personal development. In addition, dissatisfaction can lead to increased absenteeism, lower productivity, and increased turnover, each of which raises costs to the medical system [5].

Measure of burnout among doctors often produces high figures and varies between countries, across time, specialities, or sector of work, i.e. public/private or rural/urban and this variation is due to stressors arising from work environment [6]. A study from family physicians working in rural British Columbia’s Northern and Isolation Allowance communities reported that 80% of physicians suffered from moderate to severe Emotional Exhaustion, 61% suffered from moderate to severe Depersonalisation, and 44% had moderate to low feelings of Personal Accomplishment [6]. Similarly, a more recent study of US physicians found 46% of the respondents had at least one symptom of burnout [7]. On the other hand, European General Practice Research Network Burnout Study, noticed that 12% of participants suffered from burnout in all three dimensions, 43% scored high for Emotional Exhaustion, 35% for Depersonalisation, and 32% for low Personal Accomplishment [8] Finally, an American study observed that more than half of US physicians were experienced high level of burnout in 2014 in following specialities: urology (63.6%); physical medicine and rehabilitation (63.3%); family medicine (63.0%); radiology (61.4%); orthopaedic surgery (59.6%); dermatology (56.5%); general surgery subspecialties (52.7%); pathology (52.5%); and general paediatrics (46.3%) [7].

According to Medscape Dermatology Report for 2020, dermatologists are earning more compared to other physician specialities with an average annual compensation of $411,000 which includes salary, bonus, and profit-sharing contributions. There are various Factors that can Impact the Dermatologist’s Annual Salary & Compensation like Years in practice, Skills, Location, professional reputation. Due to the lack of schedule flexibility in profession, a disconnect between ones intended practice and ones actual practice leads to burnout, stress and depression. workload is one of the immense psychological stress and mental stress apart from occupational stress, depressive symptoms, work ability. Worldwide prevalence of depression among physicians is around 28.8% (2040%) and is leading to job turnover, medical errors, and instability in the medical system [8].

Previously, a number of studies have suggested several determinants of job satisfaction, including demographic characteristics (age, gender, educational level, race, marital status), job characteristics (absolute and relative wages, number of hours worked, tenure, attitude towards work), and employer characteristics (number of staff, specialty, control over the practice environment and support from colleagues) [9-11]. Job satisfaction has been determined as a key element of healthcare quality, turnover and work performance. Previous studies noticed that physicians’ with higher level of job satisfaction are more likely to provide better performance in healthcare services than those with the lower one and which results in greater therapeutic effect on medical care system. Therefore, higher job satisfaction yields higher patient satisfaction and adherence to treatment, reduce medical costs, and increases productivity and thereby making a hospital more challenging [12].

The objective of the study was to assess the level of job satisfaction and to determine the factors affecting the job satisfaction in medical practice of Dermatologists in Dubai.

The design of the study was descriptive cross-sectional based on self-administered questionnaire. The study was conducted among dermatologist doctors practicing in United Arab Emirates from May 2020 to August 2020. A 20-item questionnaires were distributed to the dermatologist doctors of private hospitals and clinics in United Arab Emirates. Only doctors who are willing to participate in the study were given the questionnaire. The sample size was 212 dermatologist doctors with 100% response rate.

A self-administered questionnaire was used in this study. It consisted of two parts. The questions in the questionnaire were tested for structure and clarity by the physicians practicing in United Arab Emirates. After testing, a few necessary revisions were made to the questions for clarity. The first part of the questionnaire included questions regarding the socio-demographic characteristics of the dermatologist doctors in UAE. Questions on socio-demographic characteristics included age, sex, nationality, working in clinics/hospital, years of experience in clinical practice, and position in hospital. The second part of the questionnaire was the factors affecting the job satisfaction in practice of UAE and the third part of the questionnaire was the factors affecting the job dissatisfaction in practice of Dermatologists in UAE. A 20-item questionnaire was rated on scale ranging from 1 (not satisfied) to 10 (extremely satisfied). Satisfaction score of the dermatologist doctor was calculated by summing up the scale values assigned for all domains. Dermatologist doctors with satisfaction score exceeding 5 was considered satisfied. The mean score of each domain in the scale was calculated by dividing the sum of the reported scale values by the number of dermatologist doctors participating in the study

Data analysis was performed using STATA software Version 15. All characteristics were summarized descriptively. For continuous variables, data were represented using means ± SD. For categorical data, the frequencies and percentage were used in the data summaries. Chi-Square test was used to evaluate their association with satisfaction. All P values were two-tailed, and values were considered statistically significant if P is less than 0.05.

Out of the 212 dermatologist doctors participating in the study, 73.6% were female and 26.4% female. The majority (33%) of doctors were belongs to the age group 36-40 years and 20.75% aged 31-35 years and the mean age of the participants was 41.43 ± 8.6 years. In terms of nationality, higher proportion of dermatologists were Indians (46.23%) followed by Syrian (31.6%), Egyptian (16.9%), and Pakistani (3.3%) respectively, and approximately 61.79% of doctors were working in clinics and remaining were in hospital. The years of experience of the dermatologist doctors were 3-4 years in 33.9 % followed by 5-6 years in 22.6%, 7-8 years in 18.8% and 0-2 years in 11.3% respectively. As regards to position of the doctors, 88.6% were specialists and 11.3% were consultants (Table 1)

In total study population, 66.51 % of doctors were satisfied with their job/profession and 33.49 % were dissatisfied.

Table 2 represents the number of subjects according to the socio-demographic characteristics and their association with job satisfaction.

Dermatologists working in clinics were showed nearly significant satisfaction (p = 0.07) than that of hospital dermatologists. There was more statistically significant difference between years of working experience in medical practice, and age groups with satisfaction.

Among all dermatologists, 3-4-year experienced doctors were highly dissatisfied (p = 0.0003) in comparison with other groups of working experience.

Doctors aged between 36-40 years were greatly dissatisfied (p = 0.0007) than other age groups. Also, there was nearly statistically significant difference between position of the doctors and satisfaction.

Specialists were highly dissatisfied (p= 0.06) in contrast to consultants. However, no statistically significant difference was found between nationality and gender on one side and satisfaction on the other side.

Table 3 demonstrates the factors that are satisfied Dermatologists influencing their occupational satisfaction levels. In overall stratified dermatologists (141/212, 66.51%), majority of the dermatologists (79.43%) were highly satisfied with their good work life balance followed by high salary (78.72%), no on-call duties (53.9%), multiple conferences attendance (49.65 %), easy visa access for USA/ EU countries (38.30 %) and no life-threatening ill-ness in treating patients (30.50 %) respectively. As shown in Table 4, mental stress (83.1%) was the most important factor affecting job dissatisfaction among dermatologists working in UAE. There were other factors which also causes dissatisfaction in physicians. In addition to mental stress, evening duty (54.9%), less salary (19.7%), demanding patients (15.49%) and longer distance of clinic from home (12.68%) were the commonly observed factors in the study.

Table 5 presents good work life balance distribution based on gender and years of working in current practice. 73.68 % of females were satisfied with their good work life balance versus 26.32 % of males.

As regards to years of experience, 3-4-year experienced dermatologists (32.46%) were highly satisfied with their good work life balance followed by 7-8 years of experience (19.3%), 9-10 years (18.4%) and 5-6 years of experience (14.9%) respectively

Furthermore, females (77.4%) were more satisfied with No on-call duties in contrast to males (22.58%) in the study (Table 6).

Table 7 describes distribution of respondents with mental stress based on age and work location. Mental stress was mostly noticed in 36-40-year age group (44.2%) dermatologist doctors followed by 31-35 years (16.4%) and 25-30 years of age (11.48%) respectively. 40.9% of the dermatologist working in hospital were reported mental stress during their clinical practice in UAE.

Among 40.9% hospital dermatologists, dermatologists aged 36-40 years (56%) showed greater mental stress than other age groups. As shown in Table 8, evening duty was observed as a dissatisfaction factor in 41 out of 212 dermatologists.

Among 41 dermatologists, 70.73% of females were dissatisfied with their evening duty than 29.27% of males. Along with evening duty and less salary was noticed in 14 (34.15%) dermatologists. Among 14 dermatologist doctors, females (64.29 %) were highly dissatisfied with both evening duty and less salary in comparison to males.

Doctors satisfaction is an important element for increase of health care productivity, decrease of incidence of medical errors and which further results in reduced burden on healthcare system. Previous studies show that doctors’ level of job satisfaction and changes in satisfaction vary greatly among regions and according to organizational models of health care [13]. For several decades, numerous studies have attempted to classify and determine factors influencing job satisfaction. Research from both needs and content perspectives has reported a plethora of factors in relation to job satisfaction, which can be grouped into two broad categories: demographic factors and environmental factors which pertain to factors associated with the work itself or work environment such as salary, promotion and supervision [14]. Understanding the causes of physician dissatisfaction is important because dissatisfaction may have adverse effects on the cost, quality, and outcome of health care, together with its effects on physician’s mental and physical health [15]. Therefore, the aim of the present study was to estimate the level of job satisfaction and to determine the factors affecting the job satisfaction in medical practice of Dermatologists in Dubai.

Among 212 dermatologist doctors, female predominance (73.58%) was observed with a mean age of 41.43 ± 8.6 years and majority of the doctors having 3-4 years of clinical experience. In agreement with the findings of the present study, a study from Mexico dermatologists reported that 72.6% female and 27.4% male, with an average age of 45.6 and an average of 16 years of medical practice [16].

Few previous studies were conducted across different countries identified personal characteristics and job attributes that are associated with the elements of work satisfaction among different medical specializations. A study conducted in Pakistan reported that about 26% of clinicians were dissatisfied with their profession [17]. In India 26% [18] and in Australia 14.3% of the doctors were dissatisfied about their job [19]. Compared with our results, a higher percentage of dissatisfied dermatologists (33.49%) was encountered.

Another important finding in this study was the high level of job satisfaction among dermatologist doctors practicing in United Arab Emirates as 66.5 % of doctors were satisfied with their job. The high level of job satisfaction in this study was comparable to a study conducted in Egypt as 62.7 % of resident doctors at Assiut University Hospitals were highly satisfied with their job [20]. This was greater than that reported among physicians from the Egyptian Ministry of Health and Population as 38.7 % of the participated physicians have expressed overall satisfaction with their job [21]. Our results show that age, years of experience, working location and speciality were the most important predictors of job satisfaction. In present study, compared to hospital location, dermatologists working in clinics were showed nearly significant satisfaction (p = 0.07). Our results suggest that females were highly satisfied than males. This finding was similar to a study in Scottish general practitioners found that women reported higher levels of job satisfaction and lower levels of stress than men and this was explained by the author as “women were more likely to work part-time” [5].

Age of the dermatologists and years of experience in clinical practice were significantly associated with job dissatisfaction in this study. However previous studies reported that doctor’s age and years of experience were significantly associated with overall job satisfaction [22-24]. These studies suggested that older doctors are more generally satisfied with their job than young doctors [24]. It is possible that the young physicians have greater demands and, as age advances, the possibility to adapt increases.

The present study findings show that good work life balance, high salary, no on-call duties, multiple conferences attendance were the important predictors of job satisfaction. Approximately 79.43 % of dermatologists were satisfied with their work-life balance following 78.72% were satisfied with high salary. In similar to our study findings a study conducted in US physicians [25] showed high level of satisfaction with work-life balance among physicians practicing in dermatology, general paediatrics, and preventive medicine including occupational health and environmental medicine. A study from conducted by Leigh et al. [26] found that physicians with high income were significantly more satisfied than physicians who earn less. Physicians especially practicing in geriatric internal medicine, neonatal-perinatal medicine, dermatology showed significantly greater satisfaction with high salary [26]. Similar findings have been reported by Qian et al. [27].

Our results show that mental stress (83%), evening duty (54.9%), less salary (19.7%), and high patients demand (15.5%) were plays a dominant role in job dissatisfaction. A national survey conducted in Turkey dermatologists suggest that higher number of shifts, lower monthly salary, longer working hours, high patient volume, and stressful relationships with supervisors were might results higher levels of dissatisfaction [28].

With regards to good work-life balance, females (73.68%) were more likely satisfied than males and dermatologists with 3-4 years of experience were also showed higher satisfaction levels with good work-life balance. A study conducted in Texas among female dermatologists showed similar results [29]. In addition to above study, other two studies have shown that female physicians have higher job satisfaction than male physicians [27,30]. However, a study done by McMurray et al., [31] found that women were more likely to be dissatisfied than men. In our study, about 77.42% of female were stratified with no on-call duties during their practice in comparison to males.

Mental stress had a great influence on job dissatisfaction; our data showed that 36-40 years of dermatologists tended to be more dissatisfied due to mental stress than other age groups and dermatologists practicing in hospital (40.9%) had reported high level of mental stress. In comparison to our study, a study conducted by Ozkur et al., [28] reported a negative correlation between personal accomplishment and age. In present study, females were highly dissatisfied with evening duties and less salary in contrast to males.

The study explored job satisfaction among dermatologist doctors practicing in United Arab Emirates and identified factors that affect satisfaction. About 66.5% of dermatologists were satisfied with their job. Age, years of experience, speciality and work location were essential predictors of job satisfaction. It is concluded that good work life balance, high salary and no on-call duties were the frequently reported satisfaction factors in the study. As regards to dissatisfaction, mental stress, evening duty, less salary and high patient volume plays a vital role in job dissatisfaction.