EVALUATION OF CAREER SATISFACTION

AMONG SURGEONS; A CROSS SECTIONAL

SURVEY TO PROFILE ETHIOPIAN SURGEONS

THESIS TO BE SUBMITTED TO DEPARTIMENT OF

SURGERY, COLLEGE OF HEALTH SCIENCES,
ADDIS ABABA UNIVERSITY IN PARTIAL
FULFILLMENT OF THE REQUIREMENTS FOR
SPECIALITY CERTIFICATE IN GENERAL
SURGERY.

NOVEMBER 2022 G.C

AA, ETHIOPA
ADDIS ABABA UNIVERSITY COLLEGE OF
HEALTH SCIENCES, DEPARTIMENT OF SURGERY

EVALUATION OF CAREER SATISFACTION

AMONG SURGEONS; A CROSS SECTIONAL
SURVEY TO PROFILE ETHIOPIAN SURGEONS

By: Dr. TEMESGEN REGASA (General Surgery Resident)

ADVISOR; Dr. ABEL SHIFEREW (MD), Assistant Professor

of Surgery)
 I

ABSTRACT
Background –A physician shortage is on the horizon, and surgeons are particularly
vulnerable due to attrition and low job satisfaction. Reduced career satisfaction leads
to increased job turnover and earlier retirement. The purpose of this study is to
delineate the risk factors that affects career satisfaction among surgeons.

Objective: - To assess the overall career satisfaction among Ethiopian Surgeons and
factors affecting satisfaction rate.

Method: - A cross-sectional survey through self-administered questionnaire was

conducted from June 26, 2022 to September 5, 2022. Respondents were grouped
into satisfied and dissatisfied using the median split. Responses were evaluated
through univariate analysis. Factors independently associated with career
satisfaction were determined using multivariable logistic regression

Result; - A total of 219 (37.7 %) surgeons responded: majority were >40 years; 80%
were men; 66.7% were married; 59.4% had children; 65.3% were general surgeons;
44.7% were in Addis Ababa; and 65.8% were in a university practice. Only 36%
were satisfied with their careers. Overall, 48.9% were considering leaving surgery
within the next 5 year. On the basis of both bivariate and multiple regression analysis
annual income, residential housing, number of children, years of service, technical
challenges, and the presence of a range of surgical cases were all strongly related to
respondents' overall career satisfaction. The majority of respondents desired
improvements in the following areas: payment (95%), well-equipped operation
theater (95%), mentorship (78%), and increased staffing (66.2%).

Conclusions and Recommendation; -The rate of career dissatisfaction was high

(64%) in this survey study of Ethiopian surgeons. The negative impact of
dissatisfaction on the lives of surgeons, patients, and their families requires further
research. Strong local, regional, and national advocacy is necessary not only to
improve career satisfaction but also to increase the tenure of current surgeons and
make the field more appealing to those considering a future in surgery.
 II

ACKNOWLEDGEMENTS

I would like to express my deepest gratitude to my advisor Dr. Abel Shiferew for his constructive
ideas and critical support in preparing this proposal paper.

I would also like to acknowledge Addis Ababa University for enabling me to be an investigator
through philosophy and for its avail in doing this research.
 III

ACRONYMS AND ABBREVIATION

A.A: Addis Ababa
GC: Gregorian calendar
FMOH: Federal Ministry of Health
PI: Principal Investigator

WHO: World Health Organization

SAO: Surgical, Anesthetic, and Obstetric providers
ETB: Ethiopian birr
Y/N: Yes or No
OR: Operation Theater
MoE: Ministry of Education
 IV

Table of Content

ABSTRACT ................................................................................................................................................... I
ACKNOWLEDGEMENTS .......................................................................................................................... II
ACRONYMS AND ABBREVIATION ...................................................................................................... III
Table of Content .......................................................................................................................................... IV
CHAPTER 1: INTRODUCTION ................................................................................................................. 1
1.1 BACKGROUND ................................................................................................................................ 1
1.2. STATEMENT OF THE PROBLEM ................................................................................................. 1
1.3: SIGNIFICANCE OF THE STUDY................................................................................................... 1
CHAPTER 2: Literature Review .................................................................................................................. 2
CHAPTER 3: OBJECTIVES ........................................................................................................................ 6
3.1 General Objective ............................................................................................................................... 6
3.2 Specific Objectives ............................................................................................................................. 6
CHAPTER 4: Methodology .......................................................................................................................... 7
4.1 Study Area and Period ........................................................................................................................ 7
4.2 The Study Design................................................................................................................................ 7
4.3. POPULATION .................................................................................................................................. 7
4.3.1. Source Population ....................................................................................................................... 7
4.3.2. Study Population ......................................................................................................................... 7
4.4 Sample Size and Sampling Technique ................................................................................................ 7
4.4.2. Sampling Technique: .................................................................................................................. 7
4.5. VARIABLES ..................................................................................................................................... 8
4.5.1. Dependent variables .................................................................................................................... 8
4.5.2 Independent variable .................................................................................................................... 8
4.6 Data Collection Tools ......................................................................................................................... 8
4.7 Data Collection and Procedures .......................................................................................................... 8
4.8Quality Control Measures .................................................................................................................... 8
4.8.1 Quality control .............................................................................. Error! Bookmark not defined.
4.9. Data processing, Analysis and Interpretation..................................................................................... 8
4.10 Operational Definitions ..................................................................................................................... 8
 V

4.11. Ethical Consideration ....................................................................................................................... 8

4.12 Dissemination of Findings ................................................................................................................. 9
5. RESULTS ................................................................................................................................................. 9
5.1 Sociodemographic and practices characteristics of the Respondents ................................................. 9
5.2 Satisfaction Level of Actively Practicing Ethiopian Surgeons ......................................................... 11
5.3 The determinants of study participants level of satisfaction (Regression Model Analysis) ............. 14
5.4 Intent of Leaving surgery .................................................................................................................. 16
DISCUSSION ............................................................................................................................................. 18
CONCLUSIONS......................................................................................................................................... 21
LIMITATIONS ........................................................................................................................................... 21
RECOMMENDATION .............................................................................................................................. 21
REFERENCES ........................................................................................................................................... 22
 1

CHAPTER 1: INTRODUCTION
1.1 BACKGROUND:
Physician career satisfaction has recently achieved a great attention globally 1–9 . Job satisfaction
can be defined as a pleasurable or positive emotional state, resulting from the appraisal of one’s
job or job experiences10. Recent studies from around the world have linked job dissatisfaction to
deleterious downstream consequences. These include decreased physician retention, increased job
turnover, rising healthcare costs, reduced patient satisfaction, and diminished patient safety 11–14.
Satisfaction with the professional career is one of the most important factors in the work-life
balance and consecutively in the overall quality of life. Surgery has always been considered to be
a demanding but highly respected profession. Despite significant work volume, irregular working
time, and occupational stress, the profession has always been highly rated among medical students
as a top-priority choice for future career15. Under the circumstances of a restrictive employment
and health budget policy, it is reasonable to expect a shortage of staff in the coming years. Career
dissatisfaction can make this already difficult situation worse. It is important to understand and
address factors that influence career satisfaction of surgeons to prolong tenure of existing surgeons
and understand anticipated needs of the future surgeons.

1.2. STATEMENT OF THE PROBLEM

In health sector, job satisfaction is highly positively linked with quality of services and patient
satisfaction16,17. Physician career dissatisfaction has been linked with over all lower quality of care2.
Thus far and to the best of our knowledge, no study has attempted to assess the factors associated
with Surgeons career satisfaction in Ethiopia. This study is vital as the findings will shape our
understanding of career satisfaction within the context of low-resource settings so that we will
alleviate those factors which in turn help us in achieving surgical workforces volume of 20 SAO
per 100000 population by 2030, as recommended by Lancet commission on global surgery18

1.3: SIGNIFICANCE OF THE STUDY

This study is vital as the findings will shape those who design National health Policy to understand
and address factors that influence career satisfaction of surgeons in order to prolong tenure of
existing surgeons and understand anticipated needs of the future surgeons.
 2

CHAPTER 2: Literature Review

Levels of physician’s satisfaction, specifically surgeon’s, tends to differ across the globe based on
demography of the study population. Western countries reported overall high satisfaction rate and
certain African and Asian countries reported to be low to moderate. Evidence from Norway
showed that job satisfaction among doctors was high and increasing, whereas finding from German
showed that the satisfaction of doctors increased, but that of Nurses decreased. Similarly, finding
from Saudi Arabia revealed there was a low level of job satisfaction. Different studies have shown
that many factors are responsible to affect surgeon’s career satisfaction.

Kathrin M Troppmann and her colleagues evaluated 895 USA surgeons for Career and Lifestyle
Satisfaction. Overall, 85.0% were “satisfied” with their careers. The most common reasons for
career satisfaction included the profession’s technical aspects, decisive nature, and intellectual
challenges. 15% were dissatisfied with their careers. Significant risk factors were nonuniversity
practice and dissatisfaction with reimbursement. Forty percent would not recommend a surgical
career to their own children. On multivariate analysis, significant risk factors were nonuniversity
practice and dissatisfaction with reimbursement. In all, 33.5% did not achieve work-life balance.
65.9% were dissatisfied with the amount of time available for family, and 80.8% were dissatisfied
with the amount of time available for hobbies and recreation. On multivariate analysis,
dissatisfaction with reimbursement was a significant risk factor. Respondents’ lives could be
improved by “limiting emergency call” (77%), “diminishing litigation” (92%), and “improving
reimbursement” (94%) 19

Study done by Kristie Keeton and her colleagues on Predictors of Physician Career Satisfaction,
Work–Life Balance, and Burnout showed Both women and men report being highly satisfied with
their careers (79% compared with 76% ), having moderate levels of satisfaction with work– life
balance (48% compared with 49%), and having moderate levels of emotional resilience (51%
compared with 53%). Burnout is an important predictor of career satisfaction, and control over
schedule and work hours are the most important predictors of work–life balance and burnout8
 3

Some studies showed age and workload is associated with satisfaction, and burnout. Overall,
younger surgeons were more likely than their older counterparts to meet the criteria for burnout,
to exhaust and to have lower career satisfaction rate20,21.

Study done in USA showed that out of 783 neurosurgeons more than 80% reported being at least
somewhat satisfied with their career, and 70% would choose a career in neurosurgery again;
however, only 26% of neurosurgeons believed their professional lives would improve in the future,
and 52% believed it would worsen. The overall burnout rate was 56.7%. Factors independently
associated with both burnout and career satisfaction included achieving a balance between work
and life outside the hospital and anxiety over future earnings and/or health care reform. While the
burnout rate for nonacademic neurosurgeons (62.9%) was higher than that for academic
neurosurgeons (47.7%), academicians who had practiced for over 20 years were less likely to be
satisfied with their careers4

Study done in 2014 on Career satisfaction and burnout among Ghanaian physicians showed
physicians in Ghana expressed moderate overall career satisfaction. Responding physicians having
low levels of satisfaction with resource adequacy, work-life balance and compensation.
Specifically, physicians employed in the government sector and those working longer hours were
least satisfied with their work-life balance while male physicians and physicians working longer
hours were least satisfied with their compensation. Rural physicians, on the other hand, were
particularly dissatisfied with the adequacy of resources available to them22

From gender aspect women reported lower career satisfaction 77% vs 82% and relatively more
problematic interruption of personal life owing to work 50% vs 45%. For men and women,
increasing age was significantly associated with higher career satisfaction. Insufficient time for
family owing to work was associated with lower satisfaction in both sexes. For women only, there
was a significant association between primary responsibility for at least 1 household chore and
lower career satisfaction23

A study done in South Korea (621 surgeons participated) showed considerable proportion of
surgeons that responded to this survey indicated that they would become a physician again
(64.1%). However, the percentage of a positive answer (49.4%) was decreased when they were
asked, “Would become a surgeon again”. Intriguingly, most surgeons (82.5%) do not want to
recommend their career to their child. Also, surgeons with a low career satisfaction showed a
 4

higher occupational stress level. Young age, female gender, no spouse, long working hours, high
numbers of assigned patients and frequent night duties are correlated with high occupational stress.
Among the subspecialties of surgeons, breast and endocrine surgeons had the lowest level of
occupational stress. The result is not surprising because breast and endocrine surgeons are usually
not frequently confronted with life and death events or frequent night time calls for emergencies
compared to other subspecialties.3

In study where 3,807 surgeons have participated on Practice Characteristics, Job Satisfaction, and
Reasons for Leaving Surgery have shown that 81% career satisfaction and 80% would choose
surgery over again. 26% were considering leaving surgery within the next 2 years. Stratified by
age groups 40 to 49, 50 to 59, and 60 to 69 years, the survey found that 9%, 17%, and 45% of
respondents were considering leaving surgery within the next 2 years, respectively. Thirteen
percent of surgeons less than 60 years old were considering leaving surgery, and only 49% of these
surgeons reported career satisfaction. Among surgeons less than 60 years old who were
considering leaving surgery, the top 3 reasons rated as very important were overall stress (79%),
work time demands (77%), and personal time requirements (73%).24

Research done on Why Do Surgeons Consider Leaving Practice? Showed that approximately 1 in
4 USA surgeons is considering leaving current practice for a reason other than retirement in the
near future. Personal characteristics (age, having children, age of children), practice characteristics
(method of compensation, practice setting, specialty, hours per week in the operating room), and
distress (burn-out, depression) were all independently associated with self-reported intent to
leave.25

With regard to practice setup career satisfaction among general surgeons was uniformly high, with
the majority of surgeons agreeing with statements such as “I am satisfied with my career as a
surgeon” or “If I were to choose over again, I would still become a surgeon.” Such measurements
of overall satisfaction did not differ between private and academic practice surgeons. Academic
surgeons were less likely to view their surgical colleagues as supportive of their efforts to balance
family and work responsibilities; private practice surgeons more often expressed a sense that
competition with other surgeons was a threat to financial security and that malpractice experiences
had decreased career satisfaction than did academic practice surgeons. Most surgeons (64%)
agreed that work encroached on their personal time and nearly one-half (46%) believed that their
 5

work schedules did not leave enough time for family life, but most did not feel strongly that their
career goals had been influenced by a need to maximize control of their personal time26.

Only Limited studies are available in Ethiopia addressing career satisfaction among Health
workers. A study conducted in in Harari region, eastern Ethiopia, in 20015 among 405 randomly
selected health care providers indicated that only 44.2% were satisfied with their job. Payment and
benefit, lack of training and development, poor relationship with organizational leaders, poorly
designed working environment and organizational culture and poor communication were the major
factors that decrease the satisfaction level of the health workers.27

A study conducted in Jimma University specialized hospital, southwest Ethiopia, in 2009 among
145 health workers indicated that sixty-seven (46.2%) of the health workers are dissatisfied with
their job. The major reasons reported for their dissatisfaction were lack of motivation, inadequate
salary, insufficient training opportunities and inadequate number of human resources. Only sixty
(41.4%) health professionals were satisfied with their job, the major reasons given were getting
satisfaction from helping others and professional gratification. Suggestion given by the
respondents to improve job satisfaction and increase retention rate included motivation of staff
through different incentives such us bonus, house allowance, salary increment, establishing good
administration management system and improving hospital facilities and infrastructure28

Out of 97 pharmacy professionals included in the study Assessing Job Satisfaction among
Pharmacy Professionals In South- West Ethiopia, 59 (60.8%) were satisfied and 38(39.2%) were
dissatisfied in their job. The major reasons reported for satisfaction were helping the needy
28(28.9%) and professional gratification 23 (23.7%). The major reasons identified for
dissatisfaction were inadequate salary 24 (24.75%), poor interaction with other health care team
members 15 (15.5%), lack of motivation 12 (12.4%), insufficient on service training 11 (11.34%)
and poor health institution infrastructure 10 (10.31%)29

Study done, in 2015, to know Ethiopian Anesthetist’s Job Satisfaction Level and Factors Affecting
it showed that 111(45.8%) of the anesthetists were satisfied with their job while 128(54.2%) were
dissatisfied with their job. Factors for dissatisfaction were low incentive 69(58.9%), Further
education 46(39.3%), training opportunities 117(48.3%) and insufficient resources and supplies.
 6

The major reasons given for getting satisfaction were from helping others and professional
gratification30

CHAPTER 3: OBJECTIVES

3.1 General Objective

To assess the level of career satisfaction among Ethiopian Surgeons and its associate factors.

3.2 Specific Objectives

1. To assess satisfaction across surgical specialty

2. To evaluate effect of sociodemographic factors on satisfaction rate
3. To assess whether practice setting and incentives are related to career satisfaction
4. To identify factors associated with dissatisfaction
 7

CHAPTER 4: Methodology
4.1 Study Area and Period
The study will be conducted at a national level, in Ethiopia. The study was conducted from June
26, 2022 to September 5, 2022

4.2 The Study Design

Analytical Cross-sectional study

4.3. POPULATION
4.3.1. Source Population
All Surgeons currently practicing and working in Ethiopia.

4.3.2. Study Population

Inclusion criteria:

• Surgeons who have completed their surgical training

• Surgeons who are currently working in Ethiopia and who filled the questionnaire
completely.

Exclusion criteria:

• Retired or exiled surgeons.

• Non-Ethiopian Surgeon
• Surgeons from other than Surgical Department
• Questionnaire returned with Incomplete data

4.4 Sample Size and Sampling Technique

4.4.2. Sampling Technique:

Convenience sampling method was be used.
 8

4.5. VARIABLES
4.5.1. Dependent variables:

• Overall level of career satisfaction

• Overall dissatisfaction level

4.5.2 Independent variable

4.5.2.1 Sociodemographic factors; Age, Sex, Marital status, Specialty etc.

4.5.2.2 Practice set up; Academic vs Private

4.5.2.3 Practice location; Regional states

4.5.2.4 Compensation related factors; Income, housing

4.5.2.5 Work environment; Adequacy of human power, infrastructure

4.5.2.6 Time factors; time for families, friends and leisure activities

4.6 Data Collection Tools

An online Self-administered structured questionnaire was used to collect data. The survey
questionnaire was created using Google Forms, and the link was distributed to respondents via
Telegram, Gmail, and mobile phones. Those who did not respond on the first attempt received
two non-response reminders.

4.7 Data Collection and Procedures

Data was collected by principal investigator.
 8

4.8 Quality Control Measures

A well-validated survey Questionnaires were adapted from a study conducted by S. Mahoney24
and slightly modified to make them more understandable and suitable for Ethiopian surgeons.
developed in English language. The completeness of the data was checked by the principal
investigator and stored properly.

4.9. Data processing, Analysis and Interpretation

A 5-point Likert scale with the options "Very Dissatisfied, Dissatisfied, Neutral, Satisfied, and
Very Satisfied" was used for job satisfaction questions. For analysis, results were divided into
three categories: Very Dissatisfied/Dissatisfied, Neutral, and Satisfied/Very Satisfied. For the
purposes of reporting results, responses Satisfied/Very Satisfied were considered a positive
response to an item. Surgeons who reported seriously considering leaving surgery by 2027 were
asked to rate the importance of various factors on this decision using a 5-point Likert scale
(strongly disagree, disagree, neutral, agree, and strongly agree), which was also collapsed into
three categories (agree/strongly agree, neutral, and strongly disagree/disagree).

Descriptive statistics were used to summarize categorical data. The Pearson Chi-square test was
used to determine the statistical significance of proportional comparisons. The association between
the predictors and outcome variables was assessed using binary logistic regression model. First
simple logistic regression analysis was used to look at the potential risk factors for career
dissatisfaction, and intent of leaving surgery. At this level variable with a p-value of ≤ 0.05 were
considered for the multiple logistic regression analysis. P-values < 0.05 was used to declare
statistical significance. Data was processed and analyzed using latest SPSS version 28.1.1.

4.10 Operational Definitions

Five satisfaction dimensions were used to measure the overall satisfaction rate. Each element of
satisfaction was given a 5-point scale, with 1 being the very dissatisfied and 5 being the very
satisfied. The lowest summated score was 5, while the highest was 25. Respondents with a score
of more than 12 (50%) were deemed to be satisfied with their career, those with a score of less
than 12 were considered dissatisfied with their careers, and those with a score of equal to 12 were
considered neutral.32.

4.11. Ethical Consideration

Name of the participants will not be indicated. Ethical clearance will be obtained from Research
and Publication Committee, department of surgery and Letter of permission will be used to
concerned officials.
 9

4.12 Dissemination of Findings: Finally, the finding will be communicated to potential

stakeholders: To Addis Ababa University, FMOH, MoE and reader who will need it.

5. RESULTS

5.1 Sociodemographic and practices characteristics of the Respondents

Of the 581 eligible surgeons, 219 responded to the survey making a response rate of 37.7%. In
general, Male and General surgeons were more likely to respond. Majority of the respondents were
male (88.1%) and General surgeons (65.3%) with the remaining being sub-specialty surgeons. Of
all respondents, 88.1% were <40 years of age. 66.7% are married and 89% of them had no children.
With regard to Residential housing, 53% lived in rented buildings, 36.1% were managed by
medical facilities, and only 4.6% owned their own apartments. Considering practice
characteristics, 55% of surgeons work out of Addis Ababa, 77.2% were in a government hospital,
2.3% of surgeons were dedicated to private institutions, and 65.8% worked at universities.

The majority (82.2%) of the participants had an annual income of less than five hundred thousand
birr and 76.5% of the respondents had less than 5 years of work experience. Thirty-seven percent
of the participants had 5 to 10 nights on calls per month. With regard to social habit, 1.4% of
respondents were smokers and two-third of the responded surgeons drank alcohol occasionally.
 10

Table 1. The sociodemographic characteristics of the study participants whose profession of

surgeon.

Variable Category frequency Percent

Sex of the study Male 193 88.1
participants Female 26 11.9
Age of the study ≤40 193 88.1
participants 40-50 17 7.8
50-60 8 3.7
≥60 1 0.5
Marital status of the Single 68 31.1
study participants Married 146 66.7
Divorced 3 1.4
Stable life partner 1 .5
Widowed 1 .5
Number of 0 89 40.6
Children ≤2 91 41.6
>2 39 17.8
Specialty General surgeons 143 65.3
Neurosurgeons 15 6.8
Cardiothoracic surgeons 6 2.7
Pediatrics surgeons 12 5.5
Colorectal surgeons 3 1.4
Urology surgeons 17 7.8
Vascular surgeons 4 1.8
Endocrine surgeon 2 .9
Plastic and Reconstructive surgery 9 4.1
Hepatobiliary and Pancreatic Surgery 8 3.7
Residential houses Own 10 4.6
Rented 116 53.0
Provided by health facility 79 36.1
Lives in Relative’s/Friend’s/Parent’s 14 6.4
Practice region Addis Ababa 98 44.7
Out of Addis Ababa 121 55.3
Practice institutions Non university 75 34.2
University 144 65.8
 11

Practice setup Private 5 2.3

Academic (Government) 169 77.2
Both 45 20.5

Table 2. the study participants characteristics on Income, Experience, Duties and social Habits

Variable Category Frequency Percent

Average Yearly income in birr < 500,000 180 82.2
500,000 – 1,000,000 23 10.5
1,000,000 – 1,500,000 8 3.7
>1,500,000 8 3.7
Average monthly expenditure in < 10,000 9 4.1
birr 10,000 - 15,000 48 21.9
15,000 - 20,000 63 28.8
<20,000 99 45.2

Year of experience as a surgeon ≤5 168 76.7

5 -10 28 12.8
10 - 15 8 3.7
15 - 20 9 4.1
> 20 6 2.7
Average Nights on call per month ≤5 65 29.7
5 - 10 82 37.4
10 - 15 44 20.1
> 15 28 12.8
Smoking Yes 3 1.4
No 212 96.8
Maybe 4 1.8
Drinking Never 74 33.8
Occasional 143 65.3
Binge drinking 2 .9

5.2 Satisfaction Level of Actively Practicing Ethiopian Surgeons

The overall satisfaction of surgeons with their career is about 36% (Figure 1). Only 3.2% of
surgeons believe they are adequately compensated financially. The majority of surgeons report
negatively on surgical career time commitment, with 69.9% of surgeons reporting insufficient time
for family, hobbies and interests. 24.7% of surgeons see competition with other surgeons as a threat
to their financial security. 50.2% are dissatisfied with residents and support staff when it comes to
 12

reliably carrying out the clinical instructions given to them. In terms of career recommendation,
23.3% of surgeons said they would not recommend surgery or medicine as a career for their
children. Despite the low level of job satisfaction, 71.6% of respondents agreed or strongly agreed
that they would choose to return to being a surgeon. Sources of surgeon satisfaction include the
technical difficulties of the cases provided to them (68.5%) and the variety of cases (58.4%).

Table 3. The study participants response on general aspects of satisfaction

Variable Frequency Percent

Would become a surgeon again
Agree 157 71.7
Disagree 37 16.9
Neutral 25 11.4
My surgical colleagues support my effort to balance my work and family responsibility
Agree 87 39.7
Disagree 66 30.1
Neutral 66 30.1
Satisfied with Technical challenges and case variety
Agree 145 66.2
Disagree 32 14.6
Neutral 42 19.2
Overwhelmed by cases coming to me
Agree 64 29.2
Disagree 91 41.6
Neutral 64 29.2
Have enough time for family, hobbies and leisure activities
Agree 66 30.1
Disagree 108 49.3
Neutral 45 20.5
Career Recommendation
Agree 52 23.7
Disagree 113 51.6
Neutral 54 24.7
 13

The over all level of surgeon career

satisfaction

78, 36%

Satisfied
141, 64%
Dissatisfied

Figure 1. The overall level of surgeon career satisfaction

In terms of specific satisfaction measures, 89% and 66.6% were dissatisfied and/or very
dissatisfied with the salary they received and opportunities for career advancement respectively.
2/3 of the participants were satisfied with the teamwork. 79% are very dissatisfied or dissatisfied
with the availability of infrastructure in the operating room (Table 4).

Table 3; Reported Job Satisfaction of Actively Practicing Ethiopian Surgeons

Very Satisfied Neutral Dissatisfied Very

variable Satisfied Dissatisfied

Satisfied with Salary 7(3.2%) 17(7.8%) 56(25.6%) 139(63.5%)

satisfied with Opportunity for further 6(2.7%) 25(11.4%) 38(17.4%) 97(44.3%) 53(24.3%)
career advancement.
Infrastructures availability in the OR 3(1.4%) 21(9.6%) 22(10%) 74(33.8%) 99)(45.2%)
(like Appropriate instruments, Sterile
drapes, Electricity and Running
water)
Satisfied with Teamwork 15(6.8%) 76(34.7%) 63(28.8%) 46(21%) 19(8.7%)
Satisfaction with career 7(3.2%) 65(29.7%) 51(23.3%) 71(32.4%) 25(11.4%)
 14

5.3 The determinants of study participants level of satisfaction (Regression

Model Analysis)

The strength of association between independent variables and career satisfaction was measured
with bivariate and multivariate logistic regression using 95% CIs and odds ratios. Participants with
two or more children were therefore 1.8 times happier than those without children (AOR = 1.8,
95% CI = 1.28, 2.28). Surgeons living in rented apartments reported 62% lower satisfaction scores
(AOR=0.38, 95% CI=0.07, 0.77), while surgeons living in relatives' homes reported a 45% lower
satisfaction scores (AOR=0.55, 95% CI=0.07, 0.77). % CI). =0.25, 0.88) than those living in their
own home.

Surgeons earning over 1.5 million birr a year were 2.8 times more satisfied with their careers than
those earning less than 500,000 birr a year (AOR = 2.8, 95% CI = 1.54, 14.40) and those with >
20 years of work experience are 7.8 times more satisfied than those with < 5 years of work
experience (AOR = 7.8, 95% CI = 2.64, 96.03

The report of adjusted odd ratio showed that, participant with no intent of becoming surgeon again
if to choose over again were 75% less likely to be satisfied with their career (AOR=0.25,
95%CI=0.08, 0.76) and participant who were not satisfied on technical challenges and case variety
are 83% less satisfied (AOR=0.17, 95%CI=0.04, 0.70). Career satisfaction was 63% lower in
career non-recommendation (AOR=0.37, 95%CI=0.15, 0.89)
 15

Table 4. The Bivariate and Multivariate logistic regression of association between some of the
independent variables and dependent variable.

Variable Satisfaction level (N) Sig. COR with Sig. AOR with 95%CI
Satisfied Dissatisfied 95%CI
Sex
Male 69 124 1 1
Female 9 17 0.910 0.95(0.40, 2.25) 0.778 1.2(0.44, 3.02)
Number of children
O 31 58 1 1
≤2 28 63 0.562 0.83(0.45, 1.55) 0.191 0.62(0.29, 1.27)
>2 19 20 0.140 1.8(0.83, 3.82) 0.045 1.8(1.28, 2.28)
Residential house
Own 7 3 1 1
Rented 40 76 0.038 0.23(0.06, 0.92) 0.024 0.38(0.07, 0.77)
Provided by Health 27 52 0.039 0.22(0.05, 0.93) 0.377 0.45(0.08, 2.65)
facility
With relatives 4 10 0.052 0.17(0.03, 1.02) 0.04 0.55(0.25, 0.88)
Practice region
Addis Ababa 43 55 1 1
Out of Addis Ababa 35 86 0.022 0.52(0.29, 0.91) 0.144 0.55(0.24, 1.23)
Practice setup
Private 5 0
Academic 54 115 0.019 0.064(0.33, 0.970 0.98(0.44, 2.21)
0.76)
Both 19 26 1
Average yearly income in Birr
<500, 000 58 122 1 1
500, 000-1, 000,000 12 11 0.063 2.3(0.96, 5.51) 0.343 1.7(0.58, 4.82)
1, 000, 000- 1,500, 000 3 5 0.756 1.3(0.29, 5.46) 0.381 0.42(0.06, 2.96)
>1, 500, 000 5 3 0.093 3.5(0.81, 15.17) 0.022 2.8(1.54, 14.40)
Year of experience as a surgeon
≤5 50 118 1 1
5 -10 16 12 0.006 3.1(1.38, 7.13) 0.017 3.1(1.22, 7.83)
10 – 15 3 5 0.643 1.4(0.33, 6.15) 0.849 1.2(0.22, 6.21)
15 – 20 4 5 0.358 1.9(0.48, 7.33) 0.712 1.4(0.24, 8.22)
> 20 5 1 0.026 11.8(1.34, 0.002 7.8(2.64, 96.03)
103.6)
 16

5.4 Intent of Leaving surgery

Overall, 48.9% of surgeons reported they are considering leaving the clinical practice of surgery
by 2027. 3.2% of this will definitely leave surgery while majority of the intention is either slight
or moderate intentions (80.4%).

Majority of the respondents with positive response ages less than 40years. Single marital status
found to have a higher intention for leaving surgery as compared to married ones (55% vs 45%)

The intent of leaving in surgery in the coming 5

years
120 51.1%

100

80

60

15.1% 16.4%
40 142%1

20
3.2%
0
none slight moderate likely definate

Figure 2. The intent of study participants Leaving surgery in the coming 5 years

Regarding potential reasons for leaving surgery, 91.6% to insufficient payments, 50.5% to general
stress, 57% to a lack of sufficient time for family, 23.4% were related to retirement plans, and
37.3% were agree on the inadequate opportunity for career advancement. When inadequate
compensation is taken into account, women are more likely to quit surgery (100% vs. 71%),
whereas men are more likely to do so from changing career interests (30.7% vs. 61%). The
intention to leave surgery was found to be negatively correlated with median annual income, job
satisfaction, and marital status. Government hospital surgeons are 36% more likely to quit surgery
(P = 0.033), and surgeons with 5 to 10 years of experience are 2.482 times more likely to leave
 17

practicing surgery (P = 0.042 OR = 2.482). When compared to surgeons who are willing to
continue their surgical professions, those who are likely to leave surgery reported being 65% less
satisfied (AOR=0.35, 95%CI=0.10, 0.87).

Table 5. The Surgeons intent of Leaving surgery

Reason to intent leave from surgery Response

(n=107) SD D N A SA

Retirement plan 43(40.2%) 21(19.6%) 18(16.8%) 20(18.7%) 5(4.7%)

Inadequate Payment 3(2.8%) 6(5.6%) 38(35.5%) 60(56.1%)
Surgery is a demanding profession 19(17.8%) 19(17.8%) 23(21.5%) 34(31.8%) 12(11.2%)
Overall stress 10(9.3%) 20(18.7%) 23(21.5%) 36(33.6%) 18(16.8%)
Fear of malpractice 23(21.5%) 41(38.3%) 25(23.4%) 14(13.1%) 4(3.7%)
Lack of time for family 4(3.7%) 13(12.1%) 29(27.1%) 40(37.4%) 21(19.6%)
Inadequate opportunity for career 11(10.3%) 25(23.4%) 31(29%) 30(28%) 10(9.3%)
advancement
Changing career interests 15(14%) 21(19.6%) 33(15.1%) 28(26.2%) 10(9.3%)
SD: strongly Disagree, D: disagree, N: Neutral, A: Agree, SD: Strongly Agree

This study also tried to assess for specific areas which may need improvement in order that
Ethiopian surgeons must be improved. When asked what has got to be improved, our study
participants most often cited better reimbursement (95.4%), better OR setup (95%), and
implementation of mentorship program (78.1%). 66.2%of surgeons showed positive feeling
towards increasing number of staffs. Only 18.1% felt that they're overwhelmed with number of
night calls and wanted it to be more reduced
 18

Figure 3: The study participants level of agreement on areas of improvement

The level of agreement to be improved in the working enviroment

200

180 N = 219
173 174
160

140

120

100

93
80 89
80 78
60
61
56
40 49
42
36 38
34 33
20
10 19 6 9 2 7 5 1
0
Improve reimbursement increase number of ensure surgical practice minimize emergency Mentorship
staffs(Team) infrastructure call

Strongly Aagree Agree Neutral Disagree Strongly Disagree

DISCUSSION
We report here the results of a national study of satisfaction with career choice among surgeons
and intent of leaving surgery within the coming 5 years. To our knowledge, this study is the first
to examine career satisfaction among Ethiopian surgeons.

According to the results of this survey, only 36% of Ethiopian surgeons are satisfied with their
jobs. This result was lower than that of a study conducted in the United States, which revealed a
high level of satisfaction of 81%24 , Kristie Keeton8 , Kathrin M Troppmann (85%)19. A study
conducted in South Korea also revealed a higher level of job satisfaction of 49.4%3. We discovered
that the majority of the dissatisfaction stemmed from inadequate pay, limited opportunities for
further career advancement, and a lack of electricity, running water, surgical drapes, and
instruments required to perform surgical procedures within the operating room. Inadequate time
 19

for family and leisure activities, as well as a lack of mentorship programs, were found to be
associated with a lower level of satisfaction.

Inadequate pay is the most frequently cited source of dissatisfaction in this survey. 90.1% of
surgeons are dissatisfied or very dissatisfied with the income they received, with only 3.2% of
them believing they are sufficiently compensated monetarily. This is consistent regardless of age,
gender, practice setup (Academic vs Private, University vs non-university), specialty, or service
years of the respondents. When asked about the availability of infrastructure in the OR (such as
appropriate instruments, sterile drapes, electricity, and running water), 79% of respondents felt it
was insufficient.

The majority of surgeons express dissatisfaction with the time commitment required for a surgical
career; 69.9% of surgeons say they don't have enough time for their families, hobbies, or other
interests, and hence unable to achieve work-life balance. The financial stability of 24.7% of
surgeons is threatened by competition from other surgeons. When it comes to residents and support
personnel reliably following the clinical instructions given to them, 50.2% of surgeons are
dissatisfied.

Despite lower job satisfaction, approximately 71.6% of respondents agreed or strongly agreed that
they would choose surgery again. Technical challenges and case variety were cited as the top
sources of satisfaction in this survey. 68.5% of respondents were pleased with the abundance of
technical challenges provided by the case, and 58.4% were pleased with the variety of cases
provided by their current referral base. When asked about career recommendations, 76.7% do not
recommend surgery as a specialty to their children, and 51.2% do not want their children to work
in the field of medical. These findings are comparable with the results of studies done
elsewhere31,34

On the basis of both bivariate and multiple regression analysis annual salaries, residential housing,
having children, years of service, technical challenges, and the presence of a range of surgical
cases were all strongly related to respondents' overall career satisfaction. Compared to surgeons
without children, those who had more than two children reported being 1.8 times more satisfied
(AOR=1.8, 95%CI=1.28, 2.28). This may be because the surgeons' contentment rises as they
become more stable when they have a family, but the lack of children can be explained by a
 20

surgeon's worry of providing insufficient family support due to poor reimbursement (Needs further
study).

Surgeons who lived in a leased housing were 62% less likely to be satisfied with their jobs than
those who lived in their own homes (95%CI=0.07, 0.77). When looking at yearly income, it was
discovered that surgeons who earned more than 1.5 million birr were 2.8 times more satisfied with
their careers than those who earned less than 500,000 birr (p=0.022)

Career satisfaction is significantly correlated with years of service. In this study, we discovered
that surgeons with more than 20 years of professional experience reported being 7.8 times more
satisfied than those with less than 5 years of experience (p=0.002). Respondents who were
dissatisfied with technical challenges and case variety were 83% less likely to be satisfied with
their jobs than those who were (AOR=0.17, 95%CI=0.04, 0.70).

A frightening 48.9% of surgeons said they were thinking about retiring from clinical practice of
surgery by the year 2027. 3.2% will undoubtedly opt out of surgery, 16.4% are likely to do so, and
the rest (61.2%) have slight or moderate intentions. Majority of them were less than 40 years or
Single (See Result above). Major reasons given by respondents for leaving surgery included
inadequate payments (91.6%), retirement plan (23.4%), overall stress (50.5%), insufficient family
time (57%), and insufficient opportunities for career progression (37.3%). While 26% of surgeons
admitted to seriously considering quitting surgery the top reasons given by surgeons in the USA
were: Retirement plans, a lack of personal time, and the overall time demands of the job24. Females
are more likely to leave surgery from inadequate payment (100% vs 71%) while males consider
more of changing career interests (30.7% vs 61%). In this survey intention to leave surgery has a
negative relationship with average annual income, career satisfaction, and marital status. Surgeons
from government hospitals (P = 0.033) and surgeons who have an experience of 5-10 years are
2.482 times more likely to leave surgery. Those who intended to leave surgery were 65% less
satisfied than those who had no intention of leaving surgery, indicating that job satisfaction is
critical for surgeons to remain in the field of surgery.

finally, we considered the components that surgeons actually like to see improved. Our study
participants most frequently mentioned better payment (95.4%), better OR setup (95%), and
 21

introduction of mentorship program (78.1%) when asked what needed to be addressed. 66.2% of
surgeons felt that hiring more personnel was necessary. 18.1% of people said they were
overwhelmed by the volume of night calls and wished they were reduced. These findings didn’t
vary across sociodemographic factors

CONCLUSIONS

In this study the overall career satisfaction of the study participants was low, which is 36%. And a
significant number of surgeons planned to leave surgery, which will have a serious impact on
surgical care delivery, which is already hampered by a shortage of surgeons. The determinant of
study participants (surgeons) career satisfaction was number of children, status of the residential
house, annual income, professional experience, participant proudness of a surgeon, technical
challenges and case variety

LIMITATIONS
This study has some limitations. First, the response rate cannot be accurately calculated as the
complete data was unavailable. This study relies almost entirely on self-reported data. It was
impossible to involve the war affected parts of the country and to extremely remote areas (i.e.
Tigray, Benishangul Gumuz and Gambella regions) due to telecommunications problems. Despite
these limitations, this study is the first in its kind in Ethiopia and will definitely paves the way for
future studies.

RECOMMENDATION

We emphasize the value of targeted advocacy by surgical professionals and their organizations.
The practice of professional advocacy is required both locally and nationally. Individual surgeons
should discuss these issues with their federal politicians, and professional surgical organizations
should continue to intervene, as part of national lobbying efforts. All of these steps would increase
career satisfaction and retention rates for surgeons who are currently in practice and may also make
surgery more appealing to those considering a career in surgery, assuring a steady supply of well
trained and motivated doctors.
 22

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