the high combined prevalence of psychological and somatic morbidity among female physicians, it is not unreasonable to assign a causal role for high morbidity in the development of high mortality among female physicians in Hungary. In particular, the potential role of completed suicide or suicidal ideation as well as the augmentative interactions between somatic and psychological morbidity might be attributed for the excess mortality among female physicians in Hungary. Another potential explanation for the excess mortality among female physicians could be gender differences in health maintenance behaviours. Of concern is that physicians’ own health maintenance behaviour is poor and characterised by the well-known triad of ‘ignorance, indifference, and carelessness’. For example, they may not recognise psychological problems or they may recognise them but believe that they do not need professional help or they may recognise the problems and realise that treatment is needed but they do not seek help. In addition, physicians have a tendency to diagnose and treat themselves, and if they do seek care they often use informal consultations with colleagues. Although data from this research on the high prevalence of somatic and psychological morbidity and findings from our pilot study (Győrffy, et al., 2005a) regarding the health maintenance behaviour of physicians lend some support to the hypotheses of excess mortality among female physicians, further research is required to draw substantive conclusions.
5.5 High prevalence of job dissatisfaction among Hungarian
and in time available for family and personal life (Murray, Montgomery, Chang, Rogers, Inui, & Safran, 2001).
In our study, around 40% of physicians reported job dissatisfaction and around 13%
reported high levels of job dissatisfaction, which is comparable to data in the literature (Bovier & Perneger, 2003). Earlier studies have suggested that women physicians’
career satisfaction is at least as high as, if nothigher than, men’s. Our results appear to confirm this finding as the levels of job satisfaction among female and male physicians were comparable. This is an interesting finding given that female physicians in our study reported higher level of work-family conflict, a form of strain, which has been associated with lower level of job satisfaction (see below). However, this phenomenon is well-known among social scientists, and termed as the ‘paradox of the contented female worker’ who, despite having objectively poorer job quality, report equal or greater job satisfaction compared to men (Robinson, 2003). According to this hypothesis, women give more socially desirable responses or have different job expectations or work values from men. Despite the lack of gender difference in the level of self-reported overall job satisfaction among physicians, we found that significantly less female physicians reported high levels of job satisfaction and significantly more female physicians reported high levels of job dissatisfaction compared to men. This is in line with data in the literature, which show gender differences in certain facets or the intensity of job satisfaction between men and women (Kossek & Ozeki, 1998).
In an era of significant reorganization of the health care system and mounting pressures on physicians, understanding the factors associated with physicians’ job satisfaction is important for physicians themselves, medical associations, and patients in general. In our study, work-family conflict emerged as a significant predictor or job dissatisfaction among female physicians and in the whole population. In addition, support in the workplace showed a significant protective effect against job dissatisfaction among female physicians and the whole sample.
Our results about the significance of work-family conflict to predict job dissatisfaction confirm those that showed a consistent negative relationship between either of the two
directions of work-family conflict (i.e., family-to-work and work-to-family conflict) and job satisfaction (Kossek & Ozeki, 1998). When considering all three types of work- family conflict (time/strain/behaviour-based conflict), evidence suggests that behaviour- based work-family is the only type of conflict significantly related to job satisfaction (Bruck, Allen, & Spector, 2002). This is particularly important as our study revealed high prevalence of strain-based work-family conflict among female physicians (68%).
Taken together, these findings underscore the importance of considering both the direction and type of work-family conflict in the assessment of individual and organizational outcomes such as job satisfaction.
Our results also highlight the associations between burnout and job dissatisfaction.
Personal accomplishment among female physicians and lack of emotional exhaustion among male physicians emerged as significant predictors of job satisfaction. These findings are in line with recent data, which showed that lower job satisfaction correlated with emotional exhaustion and better satisfaction with personal accomplishment among a sample of physicians (McNearney, Hunnicutt, Maganti, Rice, 2008). Our findings on the significance of the different burnout dimensions to predict job satisfaction among female and male physicians draw attention to the importance of the personal accomplishment dimension among women to influence important organizational outcomes.
Some recent studies have identified associations between job satisfaction and socio- demographic, occupational as well as organizational factors among physicians such as gender bias, workload, number of children, job stress, and support in the workplace (Bovier & Perneger, 2003; Robinson, 2003). In addition, a recent metaanalysis on the relations between job satisfaction and different health outcomes, job satisfaction has been identified as a significant correlate of psychological health including burnout (Faragher, Cass, Cooper, 2005).
The correlation between job satisfaction and burnout experienced by physicians has been examined from two perspectives: job satisfaction as a cause of burnout and job satisfaction as a consequence of burnout (Shirom, Nirel, & Vinokur, 2006). This
correlation is particularly significant for the aspects of mental health such as burnout, and supports the claim that job dissatisfaction may be particularly damaging to health and well-being of physicians. Our results reaffirmed this claim, and showed that burnout among female and male physicians was a predictor of job dissatisfaction.
5.6 Associations between poor psychological as well as somatic health