|Year : 2021 | Volume
| Issue : 1 | Page : 7-12
Assessment of job satisfaction and quality of life among practicising pediatric intensivists of India: Results of a pediatric critical care physician survey
V S. V. Prasad, Anjul Dayal
Department of Pediatric Critical Care, Lotus Hospitals, Hyderabad, Telangana, India
|Date of Submission||27-Jun-2020|
|Date of Decision||24-Aug-2020|
|Date of Acceptance||14-Sep-2020|
|Date of Web Publication||08-Jan-2021|
Dr. V S. V. Prasad
Lotus Hospitals for Women and Children, 6-2-29, Lakdikapul, Hyderabad - 500 004, Telangana
Source of Support: None, Conflict of Interest: None
Introduction: Pediatric intensive care specialty is a challenging field. This exposes the pediatric intensivist to various levels of stress at different stages of their career. The various precipitating factors for stress are prolonged working hours, decreased quality time with family, unsatisfactory remuneration, and increasing medicolegal litigations and physical, psychological stress, and property damage caused by unhappy families.
Aim: The study was conducted to assess the quality of life, working patterns as well as socioeconomic wellbeing among pediatric intensivists working in Indian pediatric intensive care units (PICUs) in the private sector, public sector, and charitable institutions.
Methods: A nationwide survey was performed in 2019 among the pediatric critical care fraternity across India to ascertain and enquire about several aspects of their work, careers, and personal lives with a Google form request with preformed questions and single answer options for this survey.
Results: A total of 181 responses were received. About one-third (34%) chose this pediatric specialty for its challenging nature. Close to 40% of respondents were engaged in practice of other specialties of pediatrics apart from pediatric intensive care. Professionally, 86% of pediatric intensivists were satisfied with their work. More than half of the respondents (62%) felt that aggression against hospitals and health-care personnel was worrisome and these incidents affected their personal health with increased stress and subconscious fear.
Conclusions: This survey revealed that most pediatric intensivists are satisfied with their chosen profession. Stress has been documented as a significant issue with violence in health-care settings being one of the most worrying aspects.
Keywords: Intensive care units, job satisfaction, pediatric intensivist, questionnaires, workplace stress
|How to cite this article:|
Prasad V S, Dayal A. Assessment of job satisfaction and quality of life among practicising pediatric intensivists of India: Results of a pediatric critical care physician survey. J Pediatr Crit Care 2021;8:7-12
|How to cite this URL:|
Prasad V S, Dayal A. Assessment of job satisfaction and quality of life among practicising pediatric intensivists of India: Results of a pediatric critical care physician survey. J Pediatr Crit Care [serial online] 2021 [cited 2021 Aug 4];8:7-12. Available from: http://www.jpcc.org.in/text.asp?2021/8/1/7/306477
| Introduction|| |
The subspecialty of pediatric critical care/pediatric intensive care is a relatively new field in India. Most pediatric intensivists have long working hours, often in a stressful environment, spending over 8 h a day in hospital, with some of them performing even on-site calls overnight. Their work pattern demands their presence in the intensive care unit sometimes rushing to the unit at nights, during weekends, and public holidays. Balancing work, family and private life is quite a challenge for these professionals. This has led to job dissatisfaction which may be due to various reasons such as working in high-risk areas, limited resources, prolonged working hours, and working at odd hours.
With the onset of more intensive units coming up in private sector, including pediatric, and neonatal intensive care over the last two decades or so, new challenges confront the critical care physician. The science of critical care has grown by leaps and bounds, and our understanding of physiology and pathophysiology has revolutionized and markedly improved patient survivals.
Over the last decade, aggression of the public against hospitals and doctors has been steadily increasing with violence and damage to hospital property as well as verbal and physical abuse and assaults on physicians and other health-care professionals.
The purpose of this survey across India was to ascertain and assess the quality of life as well as standards of socioeconomic wellbeing among pediatric intensivists working in Indian pediatric intensive care units (PICUs) both in the private sector and public sector as well as in charitable institutions.
| Methods|| |
A survey was for this study was planned and ethical committee approval was obtained for designing and conducting the survey to ensure protection of the rights and welfare of human subjects of research.
A Google form was prepared with preformed questions and single answer options for this study [Figure 1]. The Google form was disseminated through social media platforms (WhatsApp, telegram) as well as by formal E-mail to all pediatric intensivists in India with the assistance and help of the Indian Academy of Pediatrics (IAP) – pediatric intensive care chapter (PIC) and the college of pediatric critical care (CPCC), India. A request was made repeatedly for voluntary participation over a 2-week period through social media and two sets of E-mails were sent from the official E-mail address of the IAP-PIC and CPCC to all pediatric intensivists. Several gentle reminders were posted in the WhatsApp and telegram groups of the Pediatric Critical Care community to encourage physicians to participate in the survey. The participant's identity was protected, and all completed Google forms were downloaded by a digital media consultant. The consultant collated data and prepared graphs, pie charts, and shared them with the investigator.
| Observations and Results|| |
The Google form questionnaire was sent to 283 pediatric intensivist across India. A total of 182 responses were obtained over the 2-week period from May 15, 2019, to May 31, 2019. The majority of responses were received within the 1st week itself and the remaining coming in toward the middle of the 2nd week.
Of 181 responses obtained from nationwide pediatric intensivists to the first question why the pediatric intensivist chose pediatric intensive care, 63 (34%) responded as they chose this specialty because it was a challenging field, 58 (32%) chose the field due to the thrilling and rewarding nature of the specialty, 43 (23.8%) chose the field due to their love for acute care physiology and pathophysiology. Seven (3.86%) chose the field as it being a new specialty, 6 (3.3%) chose for using new technology (3.3%) and 4 (2.2%) chose the field to earn more money [Figure 1].
About 77.9% pediatric intensive care practitioners were based in private sector hospitals, 9.9% were working in trust hospitals, 8.83% were based in public hospitals, and 3.3% in central institutes.
Thirty nine percent (39%) of pediatric intensivists in India were in major large metros such as Delhi and Mumbai, and 22% of the respondents were based in smaller metro cities such as Pune, 39% were located in Tier 2 towns and cities such as Nagpur.
Thirty-six percent (36%) of practitioners were in South India, 27% in Western India, 23% in North India, 4.9% in Eastern, and 7.7% in central India.
About 34.8% of the respondents have completed fellowship in pediatric intensive care from the Indian Academy of Pediatrics, 13.2% of the respondents have done fellowship in pediatric intensive care by the National Board of examination (FNB) and 24.3% have trained abroad. 16.2% of the respondents have finished their training in various fellowship programs but have not taken the exit examinations. 9.3% of the respondents have gained knowledge in pediatric intensive care by working in well-reputed hospitals but have not gone through the structured fellowship program. 2.2% have done fellowship in pediatric intensive care given by individual hospitals.
Of the respondents working in metro cities of India, 40.2% have trained abroad, 24.3% have done fellowship form IAP, 19.5% have finished FNB, 9.75% have no formal training, but worked in well reputed hospitals, 6.1% have finished training in India but not cleared exit examination. Of the respondents working in nonmetro cities, 43% have done fellowship form IAP, 16.1% have trained abroad, 15.1% have finished training but not cleared exit exam, 11.1% have finished FNB, 11.1% have no formal training, but worked in well-reputed hospitals and 3.1% have done fellowship from individual hospitals.
Fifty percent of the respondents had duration of work expertise ranging between 10 and 15 years, while 22% were practicing for more than 15 years. 17% of the respondents had 3–5 years of practice and 11% with 1–3 years of work experience.
Seventy-two (39.7%) of the respondents were practicing both intensive care and general pediatrics. Forty-eight (26.5%) practiced intensive care, neonatology and general pediatrics, 34 (18.8%) physicians practiced purely pediatric critical care, 15 (8.2%) practiced intensive care and pulmonology, 11 (6%) were into intensive care and neonatology, and 1 (0.55%) was practicing intensive care and anesthesiology [Figure 2].
When asked about free time (leisure hours) in a day, 84 (46.4%) respondents replied they were able to avail of 2–4 h of leisure time, 59 (32.5%) got 4–6 h and 39 (21.5%) got >6 h a day of free time apart from hospital or professional work.
About 80.66% of respondents spent their leisure hours with their immediate family (spouse, children, and family). 11.09% of respondents spend time in exercise or gym, 2.7% watched cinemas, 1.6% did shopping, 2.2% indulged into hobbies, 0.55% spend time with friends, and 0.55% like to travel during the leisure time.
68.5% of the respondents were staying in their own houses and 31.4% were staying in rented houses. Of the lot, owning their house, 47.58% were staying in 3-bedroom apartments, 31.4% in 2-bedroom apartment, and 20.9% in 4-bedroom apartments.
70.71% owned one car, 18.7% owned 2 cars and 3.86% owned 3 cars. 6.62% owned a 2-wheeler.
75.69% of the respondents sent their children to private schools, 12.1% send their children to private schools with international board curriculum, 5.5% send their children to government run schools and 0.55% sends their children to overseas international school. 2.7% of the respondents send their children to government college and 2.7% send their children to private universities in India.
51% of the respondents had financial savings and investments to last a few months (3–6 months), whereas 24% had substantial savings and investments, 11% had planned and had consistent savings for retirement, 14% responded having minimal savings and their dependence on a steady monthly income only with no significant financial backup or contingency funds being available.
When asked to self-assess the quality of life they were leading, 3% said that they are extremely satisfied and could not wish for more, 8% said that they are truly blessed and have gotten more than they ever wished for, 27% said that they were quite satisfied with their lives and have no worries, 48% said they are somewhat satisfied and hope to do better in future and 14% said that they are not satisfied with the quality of life they are leading.
When asked about professional satisfaction, 59.76% said that they are very satisfied with their work, 32% were somewhat satisfied, 4.41% were happier than they imagined in this profession, and 3.86% were not satisfied with their work.
When asked about the major stress factors in life worrying them, 62.9% responded that public violence against hospitals and medical professionals worries them, 20.99% felt it was feeling bad for children taken DAMA for financial reasons, 8.28% felt something can be done from their hospital management to help poorer patients and 7.7% thought of quitting pediatric intensive care and choosing a low risk field and practice safe general pediatrics [Figure 3].
The question posed regarding future aspirations of the intensivists, the response chosen were that 46.4% felt that they wish to do well in academics as well as earn a good amount of money, 30% felt that academics – teaching and participation in seminars, CMEs, conferences as faculty is their prime interest, 16% felt that research is their forte, comfortable, and stable income just enough to sustain their family is enough for them and 6.6% felt that monetary gains and their income were of paramount importance.
| Discussion|| |
This survey amongst pediatric intensivist practicing in India, highlighted many facets of their professional and personal lives. The respondents in the survey were almost equally distributed among the metro cities and smaller cities (45.30% vs. 54.69%). However, the interesting point highlighted in the survey was that majority of the intensivists from the metro cities were trained abroad (40%), whereas majority of the respondents from the smaller cities have finished fellowship awarded by IAP. This highlights the success of fellowship program of IAP, which aims to improve the quality of critical care across India.
The formal fellowship training program in pediatric intensive care, accredited by IAP have shown that a lot of young pediatric intensivist have come out of these courses, with majority of respondents (81%) who have are practicing for 5 years or less have fellowship from IAP. This again shows that a lot of young pediatric pass outs are opting for IAP fellowship program, which probably is linked with the robust academic content of the fellowship program.
Most of the respondents of the survey, were the intensivists, who had a substantial work experience in the field of pediatric intensive care, with more than two-third of the respondents had more than 10 years of experience and more so almost one-third of this lot had experience of 15 years and more, this has led to a lot of credence to the answers obtained especially pertaining to quality of life and work satisfaction.
One of the interesting points brought out by the survey was that unlike in the developed world where pediatric intensivists devote their professional time wholly to their specialty, the survey revealed only a small fraction (18.7%) of the respondents, practiced pediatric intensive care as the sole specialty. More than two-third of the respondents were into the other pediatric fields as well with majority practicing general pediatrics along with intensive care. The other branches practiced by the respondents were neonatology, pulmonology, and anesthesia. The reasons for this observation may have been financial compulsions as income purely from their specialty would not have been sufficient to lead a comfortable lifestyle. The other reasons for the intensivists indulging into other branches may be the compulsion of work of corporate hospitals, for the follow-up of the patients discharged from the intensive care unit and a bonding with patient and families that develops a faith in the doctor.
The fact that almost 98% of the respondents have chosen the specialty of pediatric intensive care for the challenges, love for acute physiology, use of technology shows that the dedication toward the job is high among the intensivists. Only 2% of the respondents have chosen the branch for money. The passion for the specialty always reduces the stress factor in the job.
The professional demands of this specialty are quite overwhelming worldwide, but the situation on ground in our country is quite different from the developed world. Traditional working hours of 8 h a day with a 2-day weekend are a distant dream in India and a dream to be practiced in PICUs in India. Clinical time as well as attending to emergencies in the PICU, and balancing other responsibilities is often a challenge.
Almost two-third of the respondents got <6 h of leisure time a day. This is a worrying fact and one of the parameters of job satisfaction is the free time away from the job.
Although the leisure time over the week is less for most of the pediatric intensivists, the interesting part that came out in the survey was that most of the respondents (81%) prefer to spend their time with their families. This is a good practice to formulate a smooth work-life balance.
Heartening facts that apart from spending time with family, the other major activity that the respondents indulged into was exercise, with few of them (20%) prefer to exercise or spend time in the gymnasium. This keeps a check on abnormal eating behavior and stress.
Leisure time is crucial to the overall wellbeing of the practicing intensivist. Time well spent in leisure activities recharge and relax an individual giving him/her a much needed break from the stress of hospital work. One should perceive negative impact of stress and adopt lifestyle changes to reduce its impact. In a study done on adult intensivists in Brazil, around 64.21% spend time with family to vanquish stress while others practice meditation/yoga, exercise, watch television, and indulge in eating.
The professional life of a doctor, particularly, a pediatrician who chooses voluntarily to become a specialist in intensive care starts only after the training period of a fellowship/specific degree to acquire the necessary knowledge base and skill sets. A period of learning (the learning curve) usually ensues before the young pediatric intensivist actually is on his/her own. During this period, they usually work for a few years in a well-reputed center under the guidance of a senior consultant to learn the finer nuances of care, particularly counseling skills of parents as well as administrative responsibilities. Most pediatric intensivists are in their mid to late thirties before “settling down” in a location or hospital setting of their choice to develop a career and reputation. This prolonged time span may impact the timeline for the pediatric intensivist to acquire the decent standard of living.
The survey showed that almost two-third of the respondents own their own houses (68.5%) and of this lot almost two-third again stayed mostly in 3 or 4 bedroom hall kitchen apartments, which is a mark of a decent living in Indian society.
The other markers of decent living standards like owning a car, almost all the respondents (93%) of respondents have that luxury and sending children to good schools, which almost all of the respondents (95%), were sending their children in good private schools or universities.
When inquired about their financial security, majority of the intensivists (86%) had a good financial reserve and only a small number (14%) reported having minimal saving. This was a heterogeneous group and the young intensivist who are upcoming in their carriers were not very sound in financial reserve, but overall, the respondents were doing well financially. Although being financially sound does not improve emotional wellbeing, it reduces the mental stress.
The survey reflected a positive mindset of pediatric intensivist with a willingness to participate in academic activity and become financially comfortable. The vast majority wished to perform better academically as well as earn a decent income. Less than 10% of respondents had financial interests as their sole aim of practice, whereas a third of practitioners wished a balance of professional work, academics, and income, with a small fraction opting only for research and academics as their forte.
This survey revealed a good standard of living of most pediatric intensivists in the country. The overall quality of life of practicing pediatric intensivists reflected their overall status with majority of the intensivists (almost 86%) reported being satisfied with the profession that they have chosen. In fact, there were few of them (11%), who felt that they have a better quality of life than they expected.
An encouraging and nurturing work environment with good interpersonal relationships with their peers as well as support staff with a high quality of the work ensures mental and psychosocial wellbeing for pediatric intensivists and other professionals. Wellbeing is physical, mental, and social and is essential to lead a healthy and productive life. In our survey, professionally, over two-third of pediatric intensivists were satisfied with their work.
Over the last decade, aggression of the public against hospitals and doctors has been steadily increasing with violence and damage to hospital property as well as verbal and physical abuse and assaults on physicians and other health-care professionals. In this survey also the major concern for most of the pediatric intensivist was the violence against their fellow colleagues.
Strengths and limitations of the survey
This survey highlighted many facets of professional and personal lives of the practicing pediatric intensivists all over the India. The major limitation of this study was the essentially small number of participants. As it was a voluntary survey it might not be the correct representative of the pediatric intensivists across India. In addition, some other factors that are associated with self-reporting studies such as personal bias could also have affected the results of this study in some ways.
| Conclusions|| |
Pediatric intensivists are facing several challenges in delivering contemporary state of art, quality care in India. This survey revealed a good standard of living of most pediatric intensivists in the country. The overall job satisfaction among the pediatric intensivist was present in around two-third of the respondents. The survey also brought forward the importance to fellowship program, which has helped to promote pediatric intensive care in small metros and tier II cities of India. Probably, the leisure time available for intensivist is less, but overall satisfaction with the job is high. Violence in health-care settings is citied to be one of the most worrying aspects for intensivist. Of an encouraging viewpoint, most practitioners were interested in academics as well as practice.
- Overall pediatric intensivist has good satisfaction with the job
- Fellowship program has successfully spread pediatric intensive care across India
- Most of the pediatric intensivist felt that quality of life is good
- Violence in health care a worrying factor for most of the pediatric intensivists.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Bhalala U, Khilnani P. Pediatric critical care medicine training in India: Past, present, and future. Front Pediatr 2018;6:34.
Wheeler DS, Dewan M, Maxwell A, Riley CL, Stalets EL. Staffing and workforce issues in the pediatric intensive care unit. Transl Pediatr 2018;7:275-83.
Pastores SM, Kvetan V, Coopersmith CM, Farmer JC, Sessler C, Christman JW, et al
. Workforce, workload, and burnout among intensivists and advanced practice providers: A narrative review. Crit Care Med 2019;47:550-7.
Govil YC. Pediatric intensive care in India: time for introspection and intensification. Indian Pediatr 2006;43:675-8.
Shastri D. Violence against doctors. Indian Pediatr 2019;56:629-31.
Bhalala U, Bansal A, Chugh K. Advances in pediatric critical care research in India. Front Pediatr 2018;6:150.
Odetola FO, Clark SJ, Freed GL, Bratton SL, Davis MM. A national survey of pediatric critical care resources in the United States. Pediatrics 2005;115:e382-6.
Teixeira C, Ribeiro O, Fonseca AM, Carvalho AS. Burnout in intensive care units-a consideration of the possible prevalence and frequency of new risk factors: A descriptive correlational multicentre study. BMC Anesthesiol 2013;13:38.
Muula AS. Medicine and money: friends or foe? Mens Sana Monogr 2006;4:78-88.
] [Full text]
Saari LM, Judge TA. Employee attitudes and job satisfaction. Hum Resour Manage 2004;43:395-407.
Kimura D. Work and life balance “If we are not happy both in work and out of work, we cannot provide happiness to others.” Front Pediatr 2016;4:9.
Schwingshackl A. The fallacy of chasing after work-life balance. Front Pediatr 2014;2:26.
Sominsky L, Spencer SJ. Eating behavior and stress: a pathway to obesity. Front Psychol 2014;5:434.
Nassar Junior AP, Azevedo LC. Factors associated with job and personal satisfaction in adult Brazilian intensivists. Rev Bras Ter Intensiva 2016;28:107-13.
Lacerda JC, Barbosa AP, Cunha AJ. Professional profile of pediatric intensivists in Rio de Janeiro, southeastern Brazil. Rev Bras Ter Intensiva 2011;23:462-9.
Sarnaik A. Lessons learned in the life of a pediatric intensivist. Pediatr Crit Care Med 2009;10:239-41.
Rao ND, Min J. Decent living standards: Material prerequisites for human wellbeing. Soc Indic Res 2018;138:225-44.
Kahneman D, Deaton A. High income improves evaluation of life but not emotional well-being. Proc Natl Acad Sci U S A 2010;107:16489-93.
McMurray JE, Linzer M, Konrad TR, Douglas J, Shugerman R, Nelson K. The work lives of women physicians results from the physician work life study. The SGIM Career Satisfaction Study Group. J Gen Intern Med 2000;15:372-80.
Torres AR, Ruiz T, Müller SS, Lima MC. Quality of life, physical and mental health of physicians: a self-evaluation by graduates from the Botucatu Medical School-UNESP. Rev Bras Epidemiol 2011;14:264-75.
Leigh JP, Tancredi DJ, Kravitz RL. Physician career satisfaction within specialties. BMC Health Serv Res 2009;9:166.
[Figure 1], [Figure 2], [Figure 3]