The current page is not translated to the selected language.
Job satisfaction among doctors in Bulgaria was the subject of a survey conducted by healthcare information network Healthgrouper. The research showed doctors were generally unhappy with their wages, work-life balance and health service reforms. High levels of stress at work also had a negative impact on doctors’ job satisfaction. High levels of job satisfaction were identified with the overall work environment, including relationships with colleagues and autonomy at work.
International online information network Healthgrouper has published a report (in Bulgarian, 1.5Mb PDF) on job satisfaction among doctors in Bulgaria. The survey, intended to identify factors that determined doctors’ job satisfaction, was conducted in March 2012.
Healthgrouper is an international healthcare exchange project which has been launched in several European countries including Macedonia, Bulgaria, Slovenia, Hungary, Serbia and Albania. The aim of the project is to create a network of healthcare providers, and increase the transparency of healthcare systems in the participating countries.
The data were collected using a 21-question electronic questionnaire. The respondents were asked to rank their degree of satisfaction with different aspects of their job on a seven-point Likert scale. Low mean values showed problem areas that affected job satisfaction, and high mean values demonstrated high job satisfaction.
The study involved 255 doctors from 55 cities, representing 54 medical specialties. Of the sample, 43% were women and 57% were men. The highest proportion of respondents were aged 36–50 years (56.3%), 36.7% were aged over 51, and 7% of the respondents were below 35.
The majority (58%) were physicians with more than 20 years’ experience in the job, and 44% of respondents worked in the public health sector.
Official figures from the Bulgarian Doctors’ Union show that more than 31,000 doctors were registered in the country at the end of November 2012.
Overall, the doctors showed moderate or low satisfaction with different job aspects. This was indicated by the relatively low score of the mean values of satisfaction, as shown in the table below. At the bottom of the range was the score of 1.88 for satisfaction with health service reforms. At the other end of the scale, with a score of 5, were relationships with other healthcare professionals – for example nurses – and the image of the profession among the family and friends.
The survey showed 90% of respondents were dissatisfied with reforms of the health care system, and over 60% of them expressed general dissatisfaction with their work. Around 44% would not recommend the profession to a young person.
Approximately half of the physicians (47%) were considering changing their job, and the majority of them (78%) were looking for work in another country. A significantly lower proportion (16.5%) said they would consider moving from the public to the private sector, while about 5% had considered changing their profession completely.
The highest levels of frustration were expressed by doctors working in public hospitals (62%) and university clinics (53.8%).
Based on this data, Healthgrouper estimated that between 4,000 and 5,000 of the country’s 31,000 registered doctors were potential emigrants from Bulgaria.
| Aspect of the job | Mean value | Aspect of the job | Mean value |
|---|---|---|---|
Image among family and friends | 5.54 | Public image | 3.83 |
Relationship with healthcare professionals (nurses) | 5.03 | Additional remuneration | 3.71 |
Image among patients | 4.91 | Time with family | 3.45 |
Relationship with colleagues | 4.94 | Overall satisfaction | 3.33 |
Overall working climate | 4.78 | Salary | 3.28 |
Autonomy at work | 4.65 | Stress | 2.65 |
Relationship with colleagues outside the workplace | 4.6 | Health reform | 1.88 |
Job security | 4.28 | ||
Scope of work | 4.22 |
Notes: Answers are based on a 7-point satisfaction scale, where 1 = ‘extremely dissatisfied’ and 7 = ‘extremely satisfied’, while 4 means neither dissatisfied, nor satisfied (neutral). Mean values are shown.
Source: Healthgrouper, 2012
During the survey, respondents were asked to express their satisfaction with various aspects of their working conditions. The answers are grouped into three broader categories – satisfied, unsatisfied and neutral as shown in the figure below.
The survey showed the highest levels of satisfaction with ‘relations at the workplace’. Figures showed 68.6% of respondents were happy with the overall work climate (60% in the public and 77% in the private sector). Most doctors were satisfied with their collaboration with colleagues in the workplace (71.6%), and with relationships with nurses (68.4%), as well as with colleagues outside the workplace (61.7%).
Reported satisfaction was also high for their image and respect among patients, family and friends, and their autonomy at work.
The relatively low overall job satisfaction seemed to be based around low wages, which was one of the main reasons for dissatisfaction, mentioned by almost 60% of all respondents. There was, however, a clear difference in the opinions of doctors working in the public and private sector. Figures showed 83% of doctors in the public health sector were unhappy with their wages. Satisfaction and dissatisfaction with the possibility of receiving additional remuneration was almost evenly distributed – 40.5% and 45.6% correspondingly.
The survey also showed that 45% of respondents were satisfied with their level of job security, and 37% were not.
Asked about work-life balance, 57% were unhappy that they had insufficient time for family and friends. Dissatisfaction was also high with lack of public recognition, and the image of doctors projected by the media and by people in some public authorities.
Grouping of respondents according to the level of satisfaction (%)
Note: To simplify the presentation of results, the authors put the responses into three groups: dissatisfied, satisfied and neutral. The ‘unhappy’ group consists of those not satisfied at all, not satisfied and partially satisfied. The ‘happier’ group consists of those who said they were partially satisfied, satisfied and very satisfied.
Source: Healthgrouper, 2012
The survey highlighted alarming levels of stress, mentioned by 72.6% of respondents as a leading factor in low job satisfaction. Stress was higher in the public health sector (82.2%) compared to 68.7% in the private sector.
Bulgaria is similar to a number of other countries in that it faces the challenge of medical personnel shortages. This is against the background of a huge demographic crisis and the increased emigration of health personnel.
The Healthgrouper survey sends a clear message to the authorities that a more comprehensive reform of the health care system is needed, as are improved working conditions in the sector.
The results of the survey were widely covered in the Bulgarian media. However there was no official reaction from the Bulgarian Government.
Professional associations representing doctors and medical specialists are concerned about the increasing numbers of healthcare experts who have left the country in the past few years. In 2010 and 2011 more than 1,000 doctors emigrated.
According to doctors’ groups, there is already a shortage of physicians in Bulgaria in specialities where pay is low. The numbers of anaesthesiologists, neurologists, infection specialists, paediatricians, pathologists, psychiatrists and nurses is said to be ‘critically low’.
This in turn reflects the quality of health services.
The health care reform initiatives in Bulgaria, including a strategy for human resource development in health care, still continues to be one of the most controversial issues in the country.
However, in late 2012 there was a breakthrough with the creation of an international forum, Doctors and Mobility, that brought together representatives of the government, Parliament, the professional community, social partners and the academic community. Its discussions addressed the issues of health reform, working conditions and doctors’ intentions to migrate.
Healthgrouper (2012), Special report on job satisfaction of doctors in Bulgaria (in Bulgarian), available at http://healthgrouper.com/documents/4417/Physicians-job-satisfaction-Bulgaria-2012.pdf
Doctors and Mobility (November 2012), International Round Table (minutes of meeting, in Bulgarian), Sofia, available at
http://www.parliament.bg/pub/cW/20121130030831prot.kr.masa-22.11.12.doc
Snezhanka Dimitrova, ISTUR