INTRODUCTION

Satisfaction of medical professionals is a key factor in delivering quality medical care. It is important to note that, not only is it vital to keep the professional moti- vated to stay in their respective specialty; it is also an indirect measure of patient outcome (1). In addition, it affects patient care by also increasing the tendency of professionals to unionize and participate in a strikes (2, 3).

Professional satisfaction is also strongly associated with patient satisfaction (4-6). According to a study in Japan, having a high income as well as, working in large hospitals were associated with high satisfaction, whereas, older age and night shifts were associated with dissatisfaction (8).

Factors affecting work satisfaction may also vary de- pending on time, with changes in practice, patient load, and income over time. Published works also show that close to half of all radiology professionals reported a decreased level of satisfaction in their job, as compared to five years prior (7, 8).

Although there are published research works in Ethiopia that analyze the radiological services, no published works so far investigate the level of satis- faction among radiology professionals. Therefore, the main aim of this survey is to do a baseline as- sessment of the level of professional/ job satisfac- tion of radiologists in local practice.

METHODS

Study design

This was a cross-sectional survey conducted on a source population of 140 radiologists who attended the 22nd annual radiology conference in 2017

Study setting

The study was conducted in Addis Ababa, Ethiopia during the 22nd annual conference of the Radiology Society of Ethiopia.

Study population and procedure

The study participants were all radiologists who have a minimum work experience of two years. 40 out of 140 radiologists who have work experience of less than two years were excluded from the study. The remaining 100 met the inclusion criteria. Among those eligible, 80 of them consented to participate in the survey.

Data collection and analysis

Data was collected using a structured questionnaire which contains sociodemographic characteristics, area and type of practice, staffing character, work sched- ule, number of institutions that the radiologist is work- ing or practicing in, stability within the current institu- tion, and career plans. Satisfaction was measured us- ing a five-level Likert scale. Data was entered into SPSS version 20 and analyzed. Descriptive and ana- lytical statistics were used as applicable. The depend- ent variable was satisfaction and independent varia- bles included age, sex, years of experience, income, and type of practice, and multivariate logistic regres- sion was used to test the association between the two variables. Statistically, a significant association was taken for p values <0.05.

Ethical considerations

Participation in the survey was voluntary. Informed consent was obtained from all respondents, and indi- vidual identifiers were not used during data collection. Ethical clearance was obtained from the Research and Ethics Committee of the Department of Radiology. Permission was obtained from the radiology society.

RESULTS

Out of the 100 eligible radiologists, 80 of the partici- pants in the study complied making the response rate 80 %. Around 2/3rd of the respondents were males and 55.1% of them were <45yrs of age (Table I).

All levels of professional experience above 2 years were represented and only 1.3% of the respondents were above the age of 65 (figure I & II). Among the participants, 68% of the respondents had 2-10 years of experience, while 31.3% had above 10 years (figure II). 74 (92.5%) of the respondents were general radiol- ogists and only 6 (7.5%) were subspecialists.

Concerning the area of practice, 88.8% of the re- spondents were practicing either in Addis Ababa or other larger cities. 88.4% were in clinical practice during the time of data collection and 70% percent of the respondents were full-time employees. Those who were working in private practice accounted for 41.3% of the respondents and the rest were working in gov- ernment institutions and uninformed services (Table II). The data showed that half of the respondents were working in only one institution while the remaining half was working in two or more institutions.

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The overall satisfaction level of radiologists in this study was 62.8%., 31.3% of respondents reported to be satisfied with their current monthly income and 53.8% of respondents were indifferent. Con- cerning stability of respondents, 83.8% of respond- ents were stable during the past two years with 52.3% having no plan to change their current working place within the next one year. Among the participants, 78.8% also had a plan to keep the current practice rather than change practice or ca- reer path (Table I).

Radiologists who were male and in the age group of 35 -44 were more likely to be satisfied than the females or younger, and older age groups (P-value

=0.02 & 0.01 respectively). (Table II) Radiologists working in larger cities other than Addis Ababa also reported to be satisfied than those working in Addis and smaller cities. Those who were working in small cities reported more dissatisfaction than those radiologists working in Addis Ababa and other large cities, respectively (P -value = 0.00). Those radiologists in clinical prac- tice also reported better satisfaction than those who were in academic practice (P-value = 0.03). (Table II)

The study also found that those radiologists who had longer years of experience (>11yrs) were more likely to encourage college-age students to join medicine than those who had <10years of experi- ence (P- value= 0.01) (table II).

Figure I: Age distribution of Ethiopian radiologists participated in the survey, Addis Ababa, 2017 GC.

Figure II: Category of years of professional experi- ences of Ethiopian radiologists, Addis Ababa, 2017GC

DISCUSSION

The survey revealed that the overall satisfaction of radiologists is 62.8%. Given the relatively low level of satisfaction, most radiologists have been stable at their current positions for two years and have no plans of moving to other places in the coming year or changing career paths. Middle-aged male radiologists and those working in the larger cities outside the capital city, Addis Ababa, have a higher level of satisfaction than younger and female radiologists and those working in the capital or smaller regional cities.

So far many studies have been published locally and internationally addressing issues of satisfaction among Ethiopian healthcare workers including general practi- tioners and specialists (9-12). However, since the dis- cipline differs substantially from other medical spe- cialties in terms of the level of interaction with pa- tients, and the speed of technological evolution, the results of these studies cannot be directly extrapolated to radiologists (13).

Radiologist satisfaction can be affected by many fac- tors, such as income, physical working environment, freedom to choose work method, recognition for good work, job security, and career prospects (14, 15). There are also differences in the level of satisfaction among the different age groups and gender. Most works of literature also demonstrated changes in the level of job satisfaction over time (7, 15, 16).

The level of job satisfaction also was shown to be different among radiologists working in different countries and even in different institutions within a

specificcountry. This is due to the difference in the determinants of job satisfaction, and the overall satisfaction of radiologists in the published works of literature, which ranged from 49.5% to 93% (7, 8, 14, 15). Our result also fell within this range.

Despite few reports which showing no difference in satisfaction among males and females (14, 15), most literature report the contrary (7, 14, 16, 17). Similarly, our study showed most males reported a higher level of satisfaction than females. In the authors' opinion, Gender differences in satisfaction among radiologists, found both in our study and other works of literature, arise from the different factors and tools used to meas- ure satisfaction.

In contrast to most studies that reported that academic, non-government practitioners reported more satisfac- tion than private practitioner (7, 15, 17), our results indicate that academic radiologists have a low level of satisfaction than radiologists in private practice (P- value 0.03). The authors attribute this to the work overload and working environment. Most private radiology services are well equipped compared to the academic radiology departments, which are all gov- ernment-owned.

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In addition, radiology equipment downtime in the academic departments is long due to a shortage of budget for equipment maintenance and a lack of preventive and corrective maintenance agreements. On the other hand, private radiologic facilities usu- ally get maintained quickly because of lack of bu- reaucratic channels and the income they present. As a result, these factors may contribute to the low levels of satisfaction reported by academic radiolo- gists in comparison to private practitioners.

A high level of job satisfaction was also reported from those working in the same institution for two years and above with intentions of staying for at least one more, during the data collection. The possible explanation may be related to fulfillment within their given employment. Job satisfaction is one factor for radiologist turnover intention (18).

Similar to reports in other pieces of literature, our survey showed that there is no statistically signifi- cant difference in the level of satisfaction between full-time and part-time employees(14, 16). Like- wise, working in single or multiple institutions was not associated with differences in the level of satis- faction.

Conclusion and Recommendations

This survey showed that Ethiopian radiologists have a level of satisfaction comparable with radiol- ogists in the rest of the world. Being female, younger than 35 and older 44, academic radiolo- gists as well as, working in the capital city, Addis Ababa, were associated with a low level of satis- faction.

The authors recommend investigating factors af- fecting the level of job satisfaction among radiolo- gists and running comparative studies between the different disciplines or specialties.

Acknowledgement

The authors would like to thank all those who par- ticipated in the survey and the radiological Society of Ethiopia for facilitating data collection.

Conflict of Interest

The authors declared no sources of financial sup- port or conflict of interest