Pediatric generalists and subspecialists: determinants of career satisfaction

To evaluate the work life and job satisfaction of pediatric generalists and subspecialists in comparison to each other and to a group of general internists and internal medicine subspecialists.

Data were collected by survey of a national sample of 5704 general pediatricians, subspecialty pediatricians, general internists, internal medicine subspecialists, and family physicians who were selected randomly from the American Medical Association Masterfile using stratified sampling with disproportionate weighting to ensure ethnic diversity and representation of high managed care areas. Surveys were mailed up to 4 times and contained 150 items that reflected 10 facets of physician job satisfaction as well as an assessment of individual and practice demographic information. This study reports data from all groups except for family medicine.

The adjusted response rate was 58% for general pediatricians (n = 590), 67% for specialty pediatricians (n = 345), and 52% (n = 1823) for the entire pool. In comparison with general internists, general pediatricians were more likely to be female (44% vs 24%); to work part time (20% vs 12%); to have lower annual income ($125 679 vs $143 875); and to report significantly higher levels of job, career, and specialty satisfaction on a 5-point scale (3.81 vs 3.52, 3.80 vs 3.55, and 3.76 vs 3.17 respectively). In comparison with internal medicine subspecialists, pediatric subspecialists were more likely to be female (42% vs 22%); to work in academically affiliated settings (35% vs 17%); to have lower incomes ($156 284 vs $192 006); to receive significantly less time for a complete history and physical examination (39 minutes vs 51 minutes); and to report similar levels of job, career, and specialty satisfaction (3.69 vs 3.71, 3.74 vs 3.78, and 3.60 vs 3.47 respectively). Of all 4 physician groups, general pediatricians worked the fewest hours (50/week), spent the greatest percentage of time in the office and the lowest percentage in the hospital (58% and 16%, respectively), saw the lowest percentage of patients with complex medical and complex psychosocial problems (15% and 17%, respectively), and were the least likely to endorse symptoms of burnout or job stress (13% and 18%, respectively). In comparison, pediatric subspecialists worked longer hours (59/week), spent the lowest percentage of time in the office and the greatest percentage of time in the hospital (22% and 44%, respectively), saw a much higher percentage of patients with complex medical and complex psychosocial problems (46% and 25%, respectively), and reported significantly higher levels of burnout and job stress (23% and 26%, respectively).

Despite lower incomes, general pediatricians reported the highest levels of satisfaction and the least job stress of all 4 physician groups, whereas pediatric subspecialists reported levels of stress and burnout that raise significant concerns for the workforce of pediatric subspecialists of the future. Initiatives that improve clinical workload, balance inpatient and outpatient hours, and increase personal time of pediatric subspecialists should be considered.