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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 2  |  Issue : 3  |  Page : 153-163

The effect of alternating shifts on the quality of life and career satisfaction of emergency physicians in Saudi Arabia: A survey study


1 Medical Intern, College of Medicine, University of Almaarefa, Riyadh, Saudi Arabia
2 Department of Emergency Medicine, College of Medicine, University Medical City, King Saud University, Riyadh, Saudi Arabia

Date of Web Publication1-Jul-2019

Correspondence Address:
Najla S Ewain
Intern/Student, College of Medicine, University of Almaarefa, Riyadh
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JNSM.JNSM_57_18

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  Abstract 


Background: The Department of Emergency Medicine (EM) provides critical medical care to patients at all times. Providing medical care, especially at night, has led physicians to work in alternating shifts. Objective: The objective of this study was to determine the effect of alternating shifts on the quality of life and career satisfaction among emergency physicians (EP). Design: This was a multicenter, observational, cross-sectional study. Settings: EM departments of major government and private hospitals in Saudi Arabia. Methods: An e-survey-based study using a structured questionnaire was conducted on 234 board-certified EP in 2017. Data were analyzed using the Statistical Package for the Social Sciences software. Results: Most EM physicians (59.4%) were either satisfied or very satisfied in their career, with a majority (39.7%) admitting that shift alternations influenced their job satisfaction. While 52.6% of the physicians denied that shift alternations caused them to think about leaving EM, about 15% admitted that it is a major factor. Approximately, 40.6% of participating physicians believed that shift alternations moderately impacted their social and family life. About 88.1% of physicians believed that one or more medical conditions are primarily caused or aggravated by shift alternations; only 11.9% reported no direct impact on their health. Female physicians; singles; physicians with children, evening shifts, and higher number of shifts; and physicians with less years of experience reported less satisfaction. Physicians with equal distribution of shift times, older age, and more nonclinical hours or with part-time jobs showed more satisfaction. Conclusions: EM physicians report a moderate-to-major negative impact on their social, family, and healthy life due to the constant alternation of shifts. However, the effect did not cause them to think about leaving EM and most of them had high career satisfaction.

Keywords: Emergency medicine, job satisfaction, physicians, rotating shift work


How to cite this article:
Ewain NS, Khan AA. The effect of alternating shifts on the quality of life and career satisfaction of emergency physicians in Saudi Arabia: A survey study. J Nat Sci Med 2019;2:153-63

How to cite this URL:
Ewain NS, Khan AA. The effect of alternating shifts on the quality of life and career satisfaction of emergency physicians in Saudi Arabia: A survey study. J Nat Sci Med [serial online] 2019 [cited 2019 Jul 16];2:153-63. Available from: http://www.jnsmonline.org/text.asp?2019/2/3/153/254482




  Introduction Top


Medical practice has been always associated with providing health care to patients round the clock. Providing medical care, especially at night, has become a basic component of emergency medicine (EM). This has led physicians to work in a shift manner providing coverage at all times; morning, evening, and night. However, evidence indicates that alternating shifts can lead to circadian disruption and desynchronosis that eventually leads to adverse health effects among the EM physicians.[1] Moreover, the effects of constantly rotating shifts are cumulative and represent one of the most important reasons physicians leave the specialty.[2] On the other hand, “the American Board of EM longitudinal study of Emergency Physicians (EP)” reported that 65% of EP had high levels of career satisfaction, and 77% stated that EM met or exceeded their career expectations. Factors that contribute to high levels of career satisfaction in EM included patient variety, job excitement, proficient use of skills, member of an effective team, opportunities for leadership, teaching, and high salary.[3]

The current study was conducted to estimate the effect of alternating morning, evening, and night shifts on career satisfaction, decision to leave EM, health, and social life of EM physicians working in Saudi Arabia. It also aimed to measure the factors contributing to higher levels of career satisfaction on those physicians. It is the first study conducted in the region intended to measure these parameters. The findings of this study provided us with an insight into the current situation and will allow us to give recommendations for future work in this field.


  Methods Top


Study design and setting

This was a multicenter, observational, cross-sectional study based on a structured questionnaire. The data collection tool (questionnaire) targeted board-certified EP and was composed of 13 questions (apart from the demographic profile of the respondents) relating to the satisfaction, alternating shifts' influence on job satisfaction, causes of job dissatisfaction, details about switching shifts, decisions about leaving EM, and the impact of alternating shifts on social life and family time. Rating scales obtained from Likert-Type scale[4] [Appendix A].

The study was conducted in the EM departments of major government and private hospitals in Saudi Arabia in the year 2017. All board-certified EPs were invited to join the study. Invitations were sent through social media, together with the consent to participate in the study. The main outcome measures the level of satisfaction, factors contributing to the level of satisfaction, and the extent of the effect on the social, family, and healthy life. The sample size included 234 board-certified EPs. Responses received from different hospitals and major regions of the kingdom, including the central, Western, Eastern, and Southern regions. The study was approved by the King Saud University Institutional Review Board Committee, and permission from the hospital and emergency department was taken before survey distribution. Privacy and confidentiality of all participants were maintained.

Data collection and analysis

Data collection was completed through a survey questionnaire as mentioned earlier. The questionnaire was designed with closed-ended questions delivered to targeted physicians using e-survey through social media (validity was tested to check the accuracy of the questionnaire to make sure that each question is understandable, and that it correctly measures what needs to be measured. A pilot trial has been conducted to assure that questions were clear and data are meaningful). Reliability was tested to make sure that each question gives the same answer from the same person at different times, stable and with consistent results. Clearance was performed to take out the invalid or uncompleted responses. Data were analyzed using the Statistical Package for the Social Sciences (SPSS 22; IBM Corp., New York, NY, USA). Data were expressed as mean ± standard deviation and percentages. T-test and Chi-square test were used for analyses of different variables. Univariate logistic regression analysis was used to assess the risk factors for low career satisfaction. P < 0.05 was considered statistically significant.


  Results Top


A total of 234 EM physicians (males: 84.2%; mean age: 38.6 years) participated in the study [Table 1]. Most of the participants were married (90.6%), with children (79.5%), and with an average number of 16.21 clinical shits per month at their primary hospital. A majority of the EM physicians (66%) had an experience of 0–10 years, and only 8.98% had nonclinical hours.
Table 1: Demographic and professional characteristics of the study sample (n=234)

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Most of the participants (42.3%) were working more often in evening shifts. The majority of the total participants (59.4%) were either satisfied or very satisfied in their EM career. A considerable fraction of the physicians (37%) admitted that shift alternation negatively influenced their job satisfaction. However, 52.6% of them denied that shift alternation caused them to think about leaving EM, and only 15% admitted that it is a major factor. Interestingly, (72%) EM physicians reported that shift alternations had a moderate-to-major impact on their social and family life, and only 11.9% believed that shift alternations had no direct impact on their health. Moreover, 88.1% believed that shift alternation primarily caused or aggravated one or more medical condition such as hypertension (2.6%), headache (7.7%), fatigue (15.0%), insomnia (13.7%), smoking (1.3%), others (3.8%), and (44.0%) believed they were affected by more than one of the mentioned conditions [Table 2].
Table 2: Quality of life and career satisfaction of emergency physicians

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Male physicians were more satisfied in their EM career than females [Table 3]. The female participants in our study were involved more in evening shifts and less in night shifts. Most of the males admitted that shift alternation had a moderate impact on their social and family life, while most of the females believed it had a major impact. Compared to females (54%), a lesser number of males (42%) reported to be affected by more than one health conditions. Around 12.7% of the males believed that shift alternations did not primarily impact their health, while only 5.4% of the females believed so.
Table 3: Quality of life and career satisfaction of emergency physicians by gender

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Logistic regression analyses indicated that female gender (P = 0.009), singles, physicians with children, evening shift workers, higher number of shifts (P = 0.006), and less years of experience are linked to less job satisfaction more than their opposite [Table 4]. Physicians with equal distribution among morning, evening, and night shifts; physicians with higher nonclinical hours; physicians with part-time jobs in other hospitals; and older physicians showed a higher rate of satisfaction.
Table 4: Univariate logistic regression for participants' characteristics and low career satisfaction

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  Discussion Top


The current study estimated the effect of alternating shifts on the quality of life (QoL) and career satisfaction among EM physicians working in Saudi Arabia. It measured parameters that were not studied before in the region with the aim to provide us with an insight into the current situation. Earlier international studies suggest that a majority of EM physicians (>60%) were satisfied with their career,[3],[5],[6],[7] although a negative influence on their general health and QoL were reported.[5],[6],[7],[8],[9],[10],[11]

Our results matched the results of the previous studies[3],[5],[6],[7] suggesting that the majority of our participants are either satisfied or very satisfied with their career in EM. Although shift alternation was reported to negatively influence job satisfaction, most of the EM physicians denied that shift alternation prompted them to leave EM similar to the results reported elsewhere.[3] Most of the males admitted that shift alternation had a moderate impact on their social and family life, while most of the females believed it had a major impact.

On the other hand, most of our participants admitted that they believe shift alternation is the primary cause or contributed in aggravating medical conditions such as hypertension, headache, fatigue, insomnia, smoking, and others. Which is consistent with previous literature in showing health-related effects.[5],[6],[7],[8],[9],[10],[11]

Our study revealed that female gender, singles, physicians with children, evening shift workers, higher number of shifts, and less years of experience showed to have less job satisfaction more than their opponents. Some of these factors as increased clinical hours worked per year have been associated with less satisfaction rate in the literature as well.[7]

Older physicians reported higher satisfaction rates probably due to higher experience and/or lesser number of shifts; a senior is assigned compared to a junior physician. Physicians with equal distribution among morning, evening, and night shifts and physician with higher nonclinical hours (administrative and teaching) were found to have higher satisfaction rates in our study. However, involvement in medical education was correlated to a less job satisfaction in a study conducted on Canadian EP,[7] this variant could be attributed to personal preferences, time difference, or that our results could have been reinforced due to combining administrative and educational tasks in one question, which might have led to an increase in the level of satisfaction.

The results of this study provided us with an insight into the current situation and will allow us to implement these findings in giving recommendations for future work in this field.


  Conclusions Top


The current study reports a moderate-to-major negative impact of constant shift alternations on the social, family, and healthy life of EM physicians. However, this did not cause the physicians to think about leaving EM as indicated by their high satisfaction with this career. Distributing shifts equally between morning, evening, and night times caused a higher job satisfaction rate rather than prolonged work schedules. We encourage physicians to be involved in administrative and teaching tasks which caused an increase in satisfaction rate in this study. We highly recommend conducting similar studies for comparison, and we encourage future researchers to implement precise measuring tools for a more accurate and unified assessment across all specialties.

Limitation

Our study is based on a survey; it may not give a complete idea of the physician's perspective compared to other types of studies as a qualitative or interview study. Furthermore, a number of factors that could affect satisfaction may have not been measured in our study.

Acknowledgments

We express our gratitude to Prince Naif Bin Abdulaziz Health Research Center for their valuable contribution. We are also grateful to all the physicians who participated in the study.

This work was supported by the college of medicine research center, deanship of scientific research, king Saud university, Riyadh, Saudi Arabia.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


  Appendix A Top


The distributed questionnaire

The questionnaire below is intended to collect information related to our research. The study team is Dr. Najla Ewain and Dr. Anas Khan. The study is approved by KSU-MC IRB committee. This questionnaire targets board-certified physicians working in emergency departments in Saudi Arabia. Estimated time to complete this questionnaire is less than 2 minuets. Your participation will be highly appreciated.

We would like to inform you that all information will be confidential and will be used for research purposes only. No identifiable information will be asked. Thanks in advance for your valuable contribution.

* Required

1. Gender: * Mark only one oval.

Female

Male

2. Age:* _________

3. Are you a board certified emergency physician willing to participate in this questionnaire? Mark only one oval.

Yes

No

4. Marital status: * Mark only one oval.

Single

Married

5. Children * Mark only one oval.

With children

Without children

6. For how many years (in total) have you been practicing emergency medicine? * Mark only one oval.

<1

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30 or more.

7. What is your primary working hospital (current full-time employer): * Mark only one oval.

KSU-MC - King Saud University Medical City (MoE)

King Saud Medical City (MoH)

King Fahad Medical City King Faisal Specialist Hospital (Riyadh)

National Guard Health Affairs – King Abdulaziz Medical City (Riyadh)

Prince Sultan Military Medical City Security Forces Hospital (Riyadh)

Al Iman General Hospital

Prince Mohammed Bin Abdulaziz Hospital (Riyadh)

King Salman bin Abdulaziz Hospital

Dr. Sulaiman Al Habib Medical Group

Al Yamamah Hospital

King Abdullah Medical City (Makkah)

National Guard Hospital (Almadinah)

National Guard Hospital (Jeddah)

King Faisal Specialist Hospital (Jeddah)

King Abdulaziz University Hospital (Jeddah)

King Abdullah University Hospital (Prince Nourah University)

King Fahad Hospital (Almadinah)

King Fahad University (Jeddah)

King Fahad Specialist Hospital (Dammam)

Aramco Medical Center (Dhahran)

King Fahad Teaching Hospital (Khobar)

Assir Central Hospital

King Abdullah Medical Complex (Jeddah)

Other: ____________

8. What is the average number of clinical shifts you do monthly at your primary hospital? * Mark only one oval.

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

9. What is the average number of clinical shifts you do monthly as a part time in another hospital? * Mark only one oval.

0

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

10. How many non-clinical hours (administration and teaching) do you work weekly? (not during the shift) * Mark only one oval.

None

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

>30

11. Overall, how satisfied are you with your career in EM? (1 is not satisfied, 5 is very satisfied) * Mark only one oval.

1 - Very Dissatisfied

2- Dissatisfied

3- Neutral

4- satisfied

5- Very Satisfied

12. To what extent does alternating shifts negatively influence your job satisfaction? * Mark only one oval.

1 (not at all)

2 (slightly)

3 (somewhat)

4 (very)

5 (extremely)

13. Which shifts do you do more often? * Mark only one oval.

Equal distribution

Morning shifts

Evening shifts

Night shifts

14. Have alternating shifts ever caused you to think about leaving EM? * Mark only one oval.

Yes

No

15. To what extent is alternating shifts a factor in your decision to leave EM? * Mark only one oval.

1 (not a factor)

2 (minor)

3 (moderate)

4 (major)

16. Have alternating shifts had any negative impact on your social life and family time? * Mark only one oval.

1 (no effect)

2 (minor)

3 (moderate)

4 (major)

17. Which health problem you have and believe it is primarily caused or aggravated by shifts alternation? * Check all that apply.

Shift alternation has no direct effect on my health Headache

Fatigue

Insomnia

Hypertension

Smoking (Tobacco, Sheesha, etc)

Other: _________

18. To what degree do you believe shifts alternation is the primary cause? * Mark only one oval.

Not applicable

1 (not a factor)

2 (minor)

3 (moderate)

4 (major)

Thank you, we appreciate your participation.



 
  References Top

1.
Kuhn G. Circadian rhythm, shift work, and emergency medicine. Ann Emerg Med 2001;37:88-98.  Back to cited text no. 1
    
2.
American College of Emergency Physicians. ACEP Wellness Section Circadian Rhythms and Shift Work_Policy Resource and Education Paper (PREP); 2004. Available from: http://www.acep.org/Clinical---Practice-Management/Emergency-Physician-Shift-Work/. [Last accessed on 2017 Jun 06].  Back to cited text no. 2
    
3.
Cydulka RK, Korte R. Career satisfaction in emergency medicine: The ABEM longitudinal study of emergency physicians. Ann Emerg Med 2008;51:714-220.  Back to cited text no. 3
    
4.
Vagias WM. Likert-Type Scale Response Anchors. Clemson International Institute for Tourism & Research Development, Department of Parks, Recreation and Tourism Management. Clemson University; 2006.  Back to cited text no. 4
    
5.
Arora M, Asha S, Chinnappa J, Diwan AD. Review article: Burnout in emergency medicine physicians. Emerg Med Australas 2013;25:491-5.  Back to cited text no. 5
    
6.
Kuhn G, Goldberg R, Compton S. Tolerance for uncertainty, burnout, and satisfaction with the career of emergency medicine. Ann Emerg Med 2009;54:106-13.e6.  Back to cited text no. 6
    
7.
Lloyd S, Streiner D, Shannon S. Burnout, depression, life and job satisfaction among Canadian emergency physicians. J Emerg Med 1994;12:559-65.  Back to cited text no. 7
    
8.
Smith-Coggins R, Broderick KB, Marco CA. Night shifts in emergency medicine: The American board of emergency medicine longitudinal study of emergency physicians. J Emerg Med 2014;47:372-8.  Back to cited text no. 8
    
9.
Alsaawi A, Alrajhi K, Albaiz S, Alsultan M, Alsalamah M, Qureshi S, et al. Risk of burnout among emergency physicians at a tertiary care center in Saudi Arabia. J Hosp Adm 2014;3:20-4.  Back to cited text no. 9
    
10.
Machi MS, Staum M, Callaway CW, Moore C, Jeong K, Suyama J, et al. The relationship between shift work, sleep, and cognition in career emergency physicians. Acad Emerg Med 2012;19:85-91.  Back to cited text no. 10
    
11.
Doan-Wiggins L, Zun L, Cooper MA, Meyers DL, Chen EH. Practice satisfaction, occupational stress, and attrition of emergency physicians. Wellness Task Force, Illinois College of Emergency Physicians. Acad Emerg Med 1995;2:556-63.  Back to cited text no. 11
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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Abstract
Introduction
Methods
Results
Discussion
Conclusions
Appendix A
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