Support, technology and mental health: correlates of trainee workplace satisfaction

Low physician workplace satisfaction may negatively impact patient care. Dissatisfaction may begin during residency training, where trainees face lower autonomy and less control over work conditions. The theoretical and empirical literature on trainees is couched mainly in terms of burnout. Theories of satisfaction, a different construct, are derived from studies of independent physicians. Identifying specific correlates of trainee satisfaction may be a clearer path to preparing a sustainable physician workforce.

We surveyed 3300 residents and fellows (response rate of 7.2% to 46,574 surveys sent) across multiple specialties and institutions in the US. The instrument was adapted from a previous large-scale survey of physician satisfaction, with changes reflecting factors theorized to specifically affect trainee satisfaction. We applied generalized linear regression to identify correlates of higher satisfaction.

A total of 1444 (44%) residents/fellows reported they were very satisfied and 1311 (40%) reported being somewhat satisfied. Factors associated with satisfaction included positive perceptions of supporting clinical staff, the electronic health record, and stability of personal mental health. Surprisingly, a strong negative perception of completing insurance and/or disability forms was also associated with higher satisfaction. Factors often presumed to correlate with satisfaction, such as duty hours, debt load, and specialty, did not show significant associations.

Multiple workplace factors are correlated with trainee satisfaction, but they are not the factors (such as financial debt) that we initially hypothesized. The factors we identified, including clinical staff support and personal mental health, may be targets for further study and/or pilot interventions aimed at improving satisfaction.