Journal articles on the topic 'Physicians (General practice) Job satisfaction Australia'

ObjectivesTo examine the association between physicians’ use of digital health technology and their job satisfaction and work–life balance.DesignA cross-sectional nationally representative survey of physicians and probit regression models were used to examine the association between using digital health technology and the probability of reporting high job satisfaction and a good work–life balance. Models included a rich set of covariates, including physicians’ personality traits, and instrumental variable analysis was used to control for bias from unobservable confounders and reverse causality.SettingClinical practice settings in Australia, including physicians working in primary care, hospitals, outpatient settings, and physicians working in the public and private sectors.ParticipantsRespondents to wave 11 (2018–2019) of the Medicine in Australia: Balancing Employment and Life (MABEL) longitudinal survey of doctors. The analysis sample included a broadly nationally representative sample of 7043 physicians, including general practitioners, specialists and physicians in training.Primary and secondary outcome measuresThe proportion of respondents who used any digital health technology; proportion answered ‘moderately satisfied’ or ‘very satisfied’ to the statement on job satisfaction: ‘Taking everything into account, how do you feel about your work’; proportion agreeing or strongly agreeing to the statement on work–life balance: ‘The balance between my personal and professional commitments is about right.’ResultsPhysicians with positive beliefs about the effectiveness of using digital health technology were 3.8 percentage points (95% CI 2.7 to 5.0) more likely to use digital health technology compared with those who did not. Physicians with colleagues who already used digital health technology were also 4.1 percentage points (95% CI 2.6 to 5.6) more likely to use digital health technology. The availability of IT support and lack of privacy concerns increased the probability of using digital health technology by 1.6 percentage points (95% CI 1.0 to 2.3) and 0.5 percentage points (95% CI 0.1 to 1.0). Physicians who used digital health technology were 14.2 percentage points (95% CI −1.3 to 29.7) and 20.3 percentage points (95% CI 2.4 to 38.1) more likely to report respectively higher job satisfaction and good work–life balance, compared with the physicians who did not use it.ConclusionsFindings suggested digital health technology served more as a work resource than work demand for physicians who used it.

Research on the professional satisfaction of doctors is especially relevant today, in relation to the crisis with medical staff. The purpose of this article is to study the factors of job satisfaction of general practitioners. An empirical sociological survey was conducted among general practitioners in the Stara Zagora region. The method used is a face-to-face interview. The approved Warr-Cook-Wall (WCW) toolkit is implemented - a questionnaire modified by the research team. The study includes 223 general practitioners, which determines the high responsiveness: 94.9%. The results show that GPs are mostly satisfied with the factors related to the autonomy of the profession. The clinical freedom defined as the ability of general practitioners to choose the method of treatment of their patients is assessed to the greatest extent as satisfactory. Physicians are most dissatisfied with the regulatory framework they have to comply with and with the constant change of activities required in their daily practice. The questionnaire for the assessment of job satisfaction of GPs is applied for the first time among Bulgarian physicians. This assessment is useful for the formation of policies for human resource management in health care, as it identifies adverse trends and leads to certain solutions. Models of professional satisfaction influence the professional behavior, important for staying and leaving certain medical area and the emerging shortage of doctors in some specialties.

The present study examined relationships among occupational stress, job satisfaction, and various individual characteristics and job-related variables in a population of 303 women physicians. Analysis showed that time pressures and threat of malpractice litigation were sources of stress and that over-all satisfaction was related to satisfaction with both professional and social aspects of the job. Low satisfaction was related to wanting higher income, changes in practice procedures, and several stressors, such as time pressures. Stress and satisfaction were also related to attitudes toward health care. Women who experienced high stress and low satisfaction were more likely to have negative views of the functioning of the health care system. In addition, demographic and practice variables contributed to negative attitudes.

Background: A high prevalence of poor job satisfaction and high chronic stress is documented for general practitioners (GPs) and non-physician practice staff from various countries. The reasons are multifactorial and include deficits in leadership, communication and workflows. This publicly funded study evaluates the effectiveness of the newly developed participatory, interdisciplinary, and multimodal IMPROVEjob intervention on improving job satisfaction among GPs and practice personnel. Here, we report the baseline characteristics of the participating GPs and practice assistants, focusing on job satisfaction and perceived chronic stress. Methods: The IMPROVEjob study was performed as a cluster-randomised, controlled trial (cRCT) with German GP practices in the North Rhine Region. The IMPROVEjob intervention comprised two leadership workshops (one for practice leaders only; a second for leaders and practice assistants), a toolbox with supplemental printed and online material, and a nine-month implementation phase supported by IMPROVEjob facilitators. The intervention addressed issues of leadership, communication, and work processes. During study nurse visits, participants completed questionnaires at baseline and after nine months follow up. The primary outcome was the change in job satisfaction as measured by the respective scale of the validated German version of the Copenhagen Psychosocial Questionnaire (German COPSOQ, version 2018). Perceived chronic stress was measured using the Trier Inventory of Chronic Stress (TICS- SSCS). Results: Recruitment of 60 practices was successful: 21 were solo, 39 were group practices. At baseline, n = 84 practice owners, n = 28 employed physicians and n = 254 practice assistants were included. The mean age of all participants was 44.4 (SD = 12.8). At baseline, the job satisfaction score in the total sample was 74.19 of 100 (±14.45) and the perceived chronic stress score was 19.04 of 48 (±8.78). Practice assistants had a significantly lower job satisfaction than practice owners (p < 0.05) and employed physicians (p < 0.05). In the regression analysis, perceived chronic stress was negatively associated with job satisfaction (b= −0.606, SE b = 0.082, p < 0.001, ICC = 0.10). Discussion: The degree of job satisfaction was similar to those in other medical professionals published in studies, while perceived chronic stress was markedly higher compared to the general German population. These findings confirm the need for interventions to improve psychological wellbeing in GP practice personnel.

Well-being is a major issue among health care professionals, especially physicians. Less job satisfaction and impaired health can have an impact on health care quality. Our aim was to examine the association of stressors (illegitimate tasks) and health related resources (work-related sense of coherence; recovery experience) with life satisfaction, happiness, job satisfaction and burnout among German general practitioners (GPs). We conducted a cross-sectional survey among general medical practices in Germany. Main outcome measures were life satisfaction, happiness (Subjective Happiness Scale), job satisfaction (Work Satisfaction Scale) and burnout (Copenhagen Burnout Inventory). 548 GPs from across Germany participated (53.6% males, 45.6% females; mostly representative of German GPs). One third (35.2%) of the participants reported a high prevalence of personal, and one quarter (26.5%) indicated a high prevalence of work-related burnout symptoms. Illegitimate tasks are negatively associated with life and job satisfaction and are positively associated with personal, work-related and patient-related burnout among GPs. Work-SoC and recovery experience are positively associated with life satisfaction, happiness, and job satisfaction and are negatively associated with personal, work-related and patient-related burnout. Female physicians have a higher job satisfaction than male physicians. Being female and working as an employed physician is associated with a higher prevalence of personal burnout symptoms. GPs working in a group practice are happier and more satisfied with their job than GPs in single practices. Personal, work-related and patient-related burnout symptoms are stronger in GPs working in a single practice than in GPs in group practices. Our results highlight that Work-SoC, recovery experience and illegitimate tasks are important for creating work-related well-being among GPs. Introducing health promotion activities which aim to strengthen recovery experience and Work-SoC, as well as interventions to restructure tasks, may increase life satisfaction, happiness, and job satisfaction and reduce burnout symptoms in this health care profession.

Barriers in advanced practice nurses’ work environment impede effective use in acute care settings, reduce job satisfaction, and increase intent to leave. Fostering psychological ownership for work through improved work design has increased satisfaction, motivation, and productivity, and lowered turnover in other fields, and may have similar effects for advanced practice nurses. This multilevel cross-sectional survey study examined the relationship between advanced practice nurse work environment and psychological ownership using data from a survey of advanced practice nurses and nurse executives in Florida hospitals. Barriers in scope of practice and exclusion from hospital governance were common. Advanced practice nurses reported good relations with physicians and moderate organizational climate but poor relations with administrators and limited control over work. Organizational climate had a strong positive relationship with psychological ownership. Fostering advanced practice nurse psychological ownership could improve job satisfaction and decrease turnover leading to increased effectiveness in acute care settings.

Purpose This paper aims to examine the relationship between physician leadership style and advanced practice health-care provider job satisfaction. Design/methodology/approach A total of 320 advanced practice providers (nurse practitioners and physician assistants) in Texas rated their supervising/collaborating physicians’ leadership style using the Multifactor Leadership Questionnaire 5X Short (Bass and Avolio, 2000) and assessed their own job satisfaction using the Abridged Job Descriptive Index (Smith, Kendall and Hulin, 1969). Regression models tested the relationships between physician leadership styles and several facets of job satisfaction of advanced practice providers while controlling for advanced practice provider age, gender, ethnicity, years of experience, salary level, clinical practice setting, level of physician supervision/collaboration and advanced practice provider type. Findings The results demonstrated that physician transformational leadership accounted for between 4.4 and 49.1 per cent of the variance in job satisfaction depending on the aspect of job satisfaction. Satisfaction with job supervision and satisfaction with job in general were those in which transformational leadership was found to have the most impact, explaining 49.1 and 15.5%, respectively. Demographic variables such as advanced practice provider type, age, years of experience and number of hours per week of physician collaboration/supervision had small but statistically significant associations with job satisfaction. Practical implications Recommendations for physician leadership development focusing on transformational leadership as a way to increase the satisfaction among other providers on health-care teams are discussed. Originality/value This paper examines the impact of supervising/delegating physician leadership style on other nonphysician members of the health-care team, specifically advanced practice health-care providers.

OBJECTIVE: to evaluate the characteristics of the professional nursing practice environment and its relationship with burnout, perception of quality of care, job satisfaction and the intention to leave the job in the next 12 months. METHOD: cross-sectional study with a quantitative approach to data. The sample was composed of 129 nurses working in adult Intensive Care Units from a region in the interior of São Paulo, Brazil. RESULTS: The structural equation modeling, using path analysis, revealed that characteristics of the environment influence job satisfaction, perception of quality of care, and having an intention to leave their job, when mediated by emotional exhaustion. Nurses with limited autonomy, poor control over their practice, and poor relationships with physicians, experience a greater level of emotional exhaustion, which can negatively influence their perception of quality of care, job satisfaction and an intention to abandon their jobs. CONCLUSION: the mediating role of emotional exhaustion may negatively influence care delivery. Therefore, there is a need to adopt strategies to minimize this condition among nurses.

Background: During the last decade, the events of violence against healthcare providers have been escalated, especially in the areas of conflicts. This study aimed to test the impact of conflict-related and workplace-related violence on job satisfaction among Iraqi physicians. Methods: A cross-sectional study with a self-administered survey was conducted among medical doctors in Iraq from January to June 2014. Participants (n=535, 81.1% response rate) were selected at random from 20 large general and district hospitals using a multistage sampling technique. Results: The mean (+SD) value on the total job satisfaction score was 42.26 (+14.63). The majority of respondents (67.3%) experienced unsafe medical practice; however, the conflict- related violence showed no significant difference in job satisfaction scores. In backward regression analysis, two socio-demographic variables (age, gender), and three work-related variables (being a specialist, working less than 40 hours per week, working in both government and private sector) were positively related to job satisfaction, while the workplace violence variables were negatively related. It was found that increases in physical attack, verbal abuse, bullying, and racial harassment brought about decreases in job satisfaction scores of 6,087, 3.014, 9,107, and 4,242, respectively. Conclusion: Our results suggest that work-related variables and workplace violence do affect job satisfaction. Specifically, when physicians have been physically attacked, verbally abused, bullied, and racially harassed, their job satisfaction decreases significantly.

Abstract Background More and more gastroenterologists are not satisfied with their working conditions and run the risk of developing burnout symptoms. Little is known about the job satisfaction and burnout risk among physicians working in endoscopy units in Germany. This study examines the risk of burnout and job satisfaction among gastroenterologists in Germany. Methods An electronic survey was distributed to gastroenterologists organized mainly in the Federal Organization of Gastroenterology in Germany (BVGD, Berufsverband Gastroenterologie Deutschland e. V.). In addition to general demographic variables, job satisfaction was determined using the Work Satisfaction Questionnaires (WSQ), and burnout risk was determined using the Maslach Burnout Inventory (MBI). Results A representative sample of gastroenterologists organized in the BVGD (Berufsverband Gastroenterologie Deutschland e. V.) took part in the study (n = 683, 22 %). Above all, we could demonstrate relevant differences with regard to burnout risk and job satisfaction depending on the place of work, clinic structure, position in the clinic, and age. Younger physicians had significantly higher depersonalization (p < 0.001) and exhaustion scores (p < 0.001) with almost medium and small effect sizes (δt = 0.45 and −0.31). The higher the position in the clinic, the higher the accomplishment scores (medium effect size 0.27). Older physicians were especially more satisfied in the areas of patient care (p < 0.001, medium effect size δt = −0.53). Employed doctors show a higher level of satisfaction in terms of “burden” compared to practice owners (p < 0.001, δt = −0.69). Compared to norms used in the EGPRN study which were adapted to physicians, almost one-third of our sample had high depersonalization scores, about 17 % had high exhaustion scores, and about half had low personal accomplishment scores showing a higher general burden among German gastroenterologists. Conclusion Decreased work satisfaction and risk of burnout are important issues among German gastroenterologists. Specific actions should address this problem in order to avoid negative consequences, respectively.

Abstract Objective To monitor, for the first time in Portugal, job satisfaction on public health units (PHUs). Design Observational, transversal and descriptive/correlational study. Setting All 55 PHUs of mainland Portugal. Participants This study targeted all 1196 public health professionals working in PHUs. Main outcome measures Instrument to Assess Satisfaction of Professionals (IASP), filled online, respecting the ethical considerations and a conceptual measurement model. Results Data were obtained from 64% of professionals serving in PHUs, 73% of them female. Response rate of the physicians was 59.1%, with 72.3% of environmental health technicians, 62.0% of nurses and 58.3% of technical assistants. The average age was 47.6(±10.4) years, from 22 to 69 years. We found fair/good satisfaction with men, less educated and professionals with coordination functions more satisfied and low-level satisfaction with salary. Sociodemographic and labour characteristics play a relevant role on job satisfaction. Being female, a physician and an environmental health technician or working in a public setting increases the probability of low satisfaction. Conclusions Public health professionals are satisfied with their job, revealing high pride in their professions and strongly recommending their units to family and friends. Some variables, for example gender, leadership, marital status and education, do influence satisfaction. However, we found dissatisfaction among physicians when practice is compared with what is thought in the internship. It is possible to change the reality in which public health professionals work and to contribute to a reorganization of resources, new internal dynamics and establishment of improvement plans, aimed at a full accomplishment and job satisfaction.

Background: Work-privacy conflict (WPC) has become an important issue for medical professionals. The cluster-randomized controlled IMPROVEjob study aimed at improving job satisfaction (primary outcome), with additional outcomes such as examining the work-privacy conflict in German general practice personnel. Using baseline data of this study, the relationship between work-privacy conflict and job satisfaction (JS) was analyzed. In addition, factors associated with higher WPC were identified. Methods: At baseline, 366 participants (general practitioners (GPs) in leadership positions, employed general practitioners, and practice assistants) from 60 German practices completed a questionnaire addressing socio-demographic data and job characteristics. Standardized scales from the German version of the COPSOQ III requested data concerning job satisfaction and work-privacy conflict. Both scores range from 0 (lowest) to 100 (highest). Multilevel analysis accounted for the clustered data. Statistical analyses were performed using IBM SPSS and RStudio software, with a significance level set at p < 0.05. Results: Job satisfaction was 77.16 (mean value; SD = 14.30) among GPs in leadership positions (n = 84), 79.61 (SD = 12.85) in employed GPs (n = 28), and 72.58 (SD = 14.42) in practice assistants (n = 254). Mean values for the WPC-scale were higher for professionals with more responsibilities: GPs in leadership positions scored highest with 64.03 (SD = 29.96), followed by employed physicians (M = 45.54, SD =30.28), and practice assistants (M = 32.67, SD = 27.41). General practitioners and practice assistants working full-time reported significantly higher work-privacy conflict than those working part-time (p < 0.05). In a multilevel analysis, work-privacy conflict was significantly associated with job satisfaction (p < 0.001). A multiple regression analysis identified working hours, as well as and being a practice owner or an employed physician as factors significantly influencing WPC. Discussion: WPC was high among general practice leaders and practice personnel working full-time. Future interventions to support practice personnel should focus on reducing WPC, as there is good evidence of its effects on job satisfaction.

Abstract Introduction Having a mentor is associated with higher job satisfaction among U.S. physicians. The objective of this study was to assess satisfaction among military medical officers and to assess if mentorship and job satisfaction are associated with intention to continue military service. Materials and Methods This is a cross-sectional study using voluntary, anonymous data from 2018 Uniformed Services Academy of Family Physicians Annual Meeting registered attendees who completed an online Omnibus Survey. Outcome measures: satisfaction with work hours and workload; voice in organizational decision-making; amount of teaching, research, and other administrative tasks; being and having a mentor; and likelihood of remaining in the military beyond current service obligation. Statistical analysis: descriptive statistics, chi-square, and logistic regression. Results There was a 66% response rate (310/568) among registered attendees. Respondents reported being satisfied with work hours-workload (53.3%), voice in organizational decision-making (47.4%), and amount of teaching-research-other administrative tasks (55.7%). About 64.6% of respondents reported being a mentor, and 80.7% reported having a mentor. About 53.4% reported being likely/very likely to continue military service beyond their current service obligation. Adjustment for demographic and occupational factors, with significance defined as P ≤ 0.05, revealed that higher percent time in clinical care was negatively associated with satisfaction with voice in organizational decision-making; being a mentor and working in an academic practice setting were positively associated with satisfaction in amount of time with teaching, research, and administrative tasks; and having a mentor was the only factor associated with being likely/very likely to continue military service beyond current service obligation (odd ratio 3.9, 95% confidence interval 1.2–12.1). Conclusions Having a mentor was the only factor associated with intention to remain in the military among 2018 Uniformed Services Academy of Family Physicians Omnibus Survey respondents. These results support enhancing mentorship among military medical officers.

The best practice of oncology relies heavily on a mentally and physically healthy oncology clinician workforce. Historically, the mental health of physicians and clinicians has largely been ignored, perhaps in the spirit of a collective collusion to maintain the illusion of Oslerian equanimity. With exceedingly high and unacceptable rates of burnout and suicide in the practice of medicine and oncology in particular, a tacit disavowal of the problem is no longer acceptable. The practice of oncology presents several unique work-related issues that challenge the mental health of its clinicians and contribute to burnout, depression, and suicide. Oncologists work with patients at or nearing the end of life and face administrative and insurance hurdles to obtain needed anticancer medications, heavy workloads, paperwork and electronic medical record demands, and keeping up with expanding pertinent oncologic knowledge for practice and public relations issues. Although oncologists exhibit higher rates of depression with longer work hours than many other internal medicine colleagues, they have higher job satisfaction ratings. This article will (1) review the mental health of professionals in oncology, (2) explore similarities and differences between depression and burnout, (3) describe the unique nature of the oncology work environment, (4) examine suicide and its implications for oncology, and (5) review the evidence for interventions to prevent burnout and suicide. Although individual and system-level strategic approaches to the problem of burnout and its consequences are effective, combinatorial approaches offer the most hope for affecting the most long-lasting change and lessening burnout, depression, and suicide in oncology.

Background. Effective team communication is an essential aspect of care delivery and the coordination of patients in primary care settings. With the rapid evolution of health information technology (HIT), including the implementation of electronic health records, there remains a gap in the literature about preferred methods of primary care team communication and the subsequent impact of provider and team outcomes (e.g., team cohesiveness; burnout). This study explores the impact of varying modes of communication across provider disciplines and by geographic settings during primary care delivery. Methods. We used a cross-sectional survey design to collect data from a random convenience sample of PCPs (physicians, nurse practitioners, and physician assistants) (n = 314) in New York State (NYS). We mailed a paper survey with validated measures for communication methods, team cohesiveness, and provider outcomes (burnout, job dissatisfaction, and the intention to leave position). Descriptive statistics, linear regression models, and crude and adjusted odds ratios while controlling for individual and practice characteristics were calculated. Results. In-person communication was found to yield greater job satisfaction and less intention to leave current position in the next year ( p = 0.02 ) compared to other forms of communication including electronic health record features. The odds of job satisfaction was 1.51 times higher with in-person communication (OR: 1.51, 95% CI: 1.05, 2.19), and the odds of intending to leave a position was 45% less with in-person communication (OR: 0.55, 95% CI: 0.36, 0.85). The odds of reporting burnout at work was 36% less with in-person communication (OR: 0.64, 95% CI: 0.43, 0.92) compared to other communication modalities. There was no significant association between team communication via the EHR and team cohesiveness, provider burnout, or job satisfaction. Conclusion. This study demonstrates evidence that in-person communication is more likely to reduce burnout and job dissatisfaction compared to other forms of communication infrastructure in primary care settings. More research is needed to understand PCP perspectives about the functionality and potential burden that inhibits the use of EHR features for provider-provider communication. In addition, attention to the needs of teams by geographic location and by workforce discipline is warranted to ensure effective HIT communication application adoption.

<p><span lang="EN-GB">The patient outcomes of a health organization depend on the knowledge, skills and motivation of its individual employees. Therefore, it is important for health care employers to motivate their workers in order to meet the desired outcomes. It is widely acknowledged that health workers who are motivated facilitate the desired patient outcomes. This illustrates how the levels of physicians’ and nurses’ professional satisfaction influences the health care outcomes for patients based on a study of the Moi Teaching and Referral Hospital (MTRH). Descriptive quantitative research design was used. Data was collected using a structured questionnaire issued to <br /> a stratified group of 82 Physicians and 220 Nurses. <br /> All the completed questionnaires were entered into IBM SPSS 21.0 statistical software and data analysed for descriptive statistics. The results were presented in tables and figures. The study was powered to 95% confidence interval. With regards to effects of general practitioners’ and nurses’ work satisfaction on patient services, the study revealed that work associated with the respondents’ position allows contributions to be made to the hospital, <br /> the profession and to own sense of achievement. Furthermore, the study findings showed that praise received for work well done translates to improved job productivity and that the medicine/nursing practice allows autonomous professional decisions to be made which in turn promotes high levels of clinical competence. Based on these findings, the study concludes that health care practitioners’ work satisfaction has implications on <br /> patient care.</span></p>

Medical practice is a noble profession that bears with it critical responsibilities on the practitioner and expectations from the public. Few studies originating from low-income countries like Nepal indicate a greater extent of dissatisfaction in relation to workload, financial and social circumstances among doctors leading to lower Quality of life. In addition, there has been a rise in doctor’s migration to developed nations in aspire of better living standards and job satisfaction which has aggravated the already resource-constrained healthcare systems in those countries. This challenges both access and equity in healthcare. There are indications, based on first-hand experiences and the socio-political situation, that Quality of Life may be alarmingly poor among doctors working in Nepal. The first step towards a comprehensive effort to addressing this issue would be to carry out researches on doctors to gauge the scale and dimensions of the issue.

Background: Burnout syndrome (BOS) is caused both by psychological-emotional and physical stress. It is associated with decreased job performance and low career satisfaction. BOS has a significance influence both to physicians' performance in health care system, and in their private life. Until now, there was no data about this aspect of orthopaedic surgeon condition and health in our community. Aim: To assess the level of the burnout syndrome in orthopaedic surgeons and general practitioners (GPs), and the relations of their demographic features, job characteristics to the burnout syndrome Design: Questionnaire-based survey Methods: The sample consisted of 30 orthopaedic surgeons from the University Clinical Centre, and 40 GPs from the primary health care centres. The Burnout syndrome was measured by the Maslach Burnout Inventory (MBI). In addition to the MBI, the demographic data were collected and analyzed (age, age of practicing, gender, marital status) in relation to BOS. Results: Both groups expressed moderate to high rate of emotional exhaustion, depersonalization and low personal accomplishment. However, statistical significance between the groups had not been demonstrated. Neither gender nor years of practice or marital status did express statistically significant impact on the BOS items, i.e. they were not predictors of the BOS. Our results showed that about 70% of the physicians were emotionally exhausted considering both groups. On the other hand, orthopaedics demonstrated slightly higher depersonalisation level (55%) than GPs (38%). While GPs expressed lower personal accomplishment (48%) comparing to orthopaedics (29%). Discussion: The obtained MBI scores in this study were similar to those registered in US among residents, but when comparing to physicians in West Europe, which have similar health care system, our results demonstrated higher rates of BOS items. Conclusion: The Burnout syndrome represents an important problem for actively practicing physicians. The results of this and other similar studies should be used to evaluate medical training, practice, professional relations and introduce necessary changes.

Introduction: Osteopathy in Australia faces an uncertain future as an unprecedented number of graduates enter the profession. While most are destined to work in private practice, workforce data suggests that limited career diversity and practitioner maldistribution are associated with growing rates of job dissatisfaction and professional attrition. Cultivating employability skills that promote diverse careers is the responsibility of education providers, yet it is unclear whether existing osteopathy programs are achieving this. Our aim was to determine if osteopathic curricula provide the employability skills required to prepare graduates for diverse careers.Methods: This study was conducted as part of a larger project by RMIT University and Osteopathy Australia entitled “Strategic plan for the osteopathy profession 2030”. A two-part approach was utilised. Part A involved a comparison of core learning outcomes (contained within current Australian osteopathy curricula) against key employability skills required for success in a diverse range of careers. A consensus development panel was consulted in Part B to capture the perspectives of experts in the field. Results: Content analysis and expert panel discussions identified the curricula has a strong focus on critical thinking, communication and problem solving and less focus on teamwork, leadership, initiative and enterprise and technological skills. Furthermore, osteopathy programs offer limited elective and micro-credentialing opportunities. Conclusions: Career diversity and increased job satisfaction for osteopathy graduates may be achieved by empowering them with the skills to succeed in careers beyond private practice. This calls for curriculum reforms and expanded elective and micro-credentialing options to enable students to broaden their skills and widen their options.

Abstract Purpose We sought to determine if a medico-legal educational curriculum designed to increase physicians' familiarity with the legal system in a nonthreatening environment—a didactic and interactive educational seminar—would positively influence learners' knowledge base and self-awareness. Methods Because neither the Accreditation Council for Graduate Medical Education nor its Residency Review Committees specifically addresses medico-legal liability education, we designed a 2-day intensive medico-legal educational curriculum and piloted it in 2007 and 2008 at a large academic tertiary-referral medical center. Postcurriculum evaluations and precurriculum and postcurriculum testing were used to identify areas of common and/or persisting knowledge deficit. Results A total of 50 graduating residents, fellows, and community practitioners participated in the course. Common areas of knowledge deficit were “privilege,” “discovery,” statutes of limitations, and basic legal procedure. Discordance in physician interpretation of patient perspective and misunderstanding among physicians of the impact of the legal suit were evident. Conclusions Concentrated legal education at selected times during medical training may support physicians' motivations to improve the assurance of quality and continuity of care. We continue to revise the curriculum to address issues of lecturer style, lecture content, and overall attitudinal values related to clinical practice, legal education, long-term impact on practice patterns, job satisfaction and its effect on attention to quality and continuity-of-care issues, and health care provider attitudes about the provider's role within the legal system and the community. We plan to conduct follow-up of participants to assess retention and subsequent use of this knowledge.

Objective The aim of the present study was to investigate non-clinical work conducted by Australian doctors. Methods This study was an exploratory descriptive study using data from Wave 5 of the Medicine in Australia: Balancing Employment and Life (MABEL) longitudinal survey, collected in 2012 from Australian medical practitioners (2200 general practitioners (GPs), 3455 specialists, 1270 specialists in training and 1656 hospital non-specialists). The main outcome measure was the number of hours worked per week in non-clinical work. Regression analysis was used to determine associations between non-clinical activities (i.e. education-related, management and administration and other) and personal and professional characteristics, including age, gender, job and life satisfaction, total clinical working hours, sector of practice (public or private) and doctor type. Results Australian doctors spend an average of just under 7 h per week, or 16% of their working time, on non-clinical activities. Doctors who worked more hours on non-clinical activities overall, and in education-related and management and administration specifically, were male, younger, had lower life satisfaction and generally spent fewer hours on clinical work. Lower job satisfaction was associated with longer management and administration hours, but not with time spent in education-related activities. Specialists were more likely to work long non-clinical hours, whereas GPs were more likely to report none. Hospital non-specialists reported relatively high management and administration hours. Conclusions Further work is required to better understand the full range of non-clinical activities doctors are involved in and how this may impact future workforce projections. What is known about the topic? Doctors usually engage in a range of non-clinical activities, such as research, education and administration. Policy documents suggest these activities are expected to comprise 20%–30% of a doctor’s time in public settings. Understanding how engagement in non-clinical activities affects doctors’ time in direct patient care, their career progression and job and life satisfaction is highly important and poorly understood. What does this paper add? This national study provides the first empirical data on doctors’ non-clinical activity, and shows that non-clinical hours are traded off with clinical hours, and are associated with personal and professional characteristics. What are the implications for practitioners? Any changes in doctors’ non-clinical hours may influence doctors’ satisfaction as well as their clinical working hours. Workforce planning needs to take non-clinical hours into account.

The aims of the present study were to understand enablers to participation in postgraduate education for primary care nurses (PCNs), and to explore how postgraduate education has advanced their nursing practice. Cross-sectional questionnaires were mailed out in April 2012 to current and past students undertaking postgraduate studies in primary care nursing at The University of Melbourne, Victoria, Australia. Questionnaires were returned by 100 out of 243 nurses (response rate 41%). Ninety-one per cent (91/100) of the respondents were first registered as nurses in Australia. Fifty-seven per cent were hospital trained and 43% were university educated to attain their initial nurse qualification. The respondents reported opportunities to expand scope of practice (99%; 97/98), improve clinical practice (98%; 97/99), increase work satisfaction (93%; 91/98) and increase practice autonomy (92%; 89/97) as factors that most influenced participation in postgraduate education in primary care nursing. Major enablers for postgraduate studies were scholarship access (75%; 71/95) and access to distance education (74%; 72/98). Many respondents reported an increased scope of practice (98%; 95/97) and increased job satisfaction (71%; 70/98) as an education outcome. Only 29% (28/97) cited an increase in pay-rate as an outcome. Of the 73 PCNs currently working in general practice, many anticipated an increase in time spent on the preparation of chronic disease management plans (63%; 45/72), multidisciplinary care plans (56%; 40/72) and adult health checks (56%; 40/72) in the preceding 12 months. Recommendations emerging from findings include: (1) increased access to scholarships for nurses undertaking postgraduate education in primary care nursing is imperative; (2) alternative modes of course delivery need to be embedded in primary care nursing education; (3) the development of Australian primary care policy, including policy on funding models, needs to more accurately reflect the educational level of PCNs, PCN role expansion and the extent of interprofessional collaboration that is evident from research undertaken to date. Nurses with postgraduate education have the potential to increase their scope of practice, take on a greater teaching role and provide more preventive and chronic disease services in primary care. Policies aimed at increasing access to education for nurses working in primary care would strengthen the primary care nursing profession, and enhance the delivery of primary health care services in Australia.

Background: Doctors and paramedics in countries suffering from long-acting conflicts, including Iraq, are working in severe and exceptional conditions, putting them under severe physical and psychological pressure, therefore examining burnout is important when dealing with the quality of care and working conditions. This study aimed to assess the point prevalence and to explore factors associated with emotional exhaustion (EE) among medical doctors in Iraq. Methods: Descriptive and a cross-sectional study was conducted (January to June 2014) among a randomly selected sample of medical doctors (n=576, 87.3% response rate) working in twenty large general hospitals and medical centers. In addition to EE, the self-administered questionnaire used was consisting of questions on sociodemographic, work-related characteristics, conflict-related variables, and job satisfaction. EE was measured using the emotional exhaustion subscale of the Maslach Burnout Inventory (MBI). Results: The prevalence of EE reported by 60.0% of the respondents. In multiple linear regression analysis, the emotional burnout was higher among doctors who were married, female, bearing children, being threatened, displaced internally, non-specialist doctors, working more than 40 hours per week, experienced unsafe medical practice, disagreed with the way manager handle the staff and those who reported that the doctor-patient relationship as not excellent. Conclusion: Our findings suggest that job dissatisfaction, conflict, and violence-related factors were significantly associated with a high level of emotional exhaustion among Iraqi physicians.

ObjectivesWorkplace violence is relatively frequent among medical professionals who work in otorhinolaryngology units. This phenomenon reduces the quality of provided medical care and increases the incidence of depressive symptoms among physicians and nurses, seriously affecting their job satisfaction and work efficiency with a negative attitude towards providing treatment. Few existing studies have assessed workplace-violence-related factors associated with depressive symptoms among otorhinolaryngology physicians and nurses.MethodsWe conducted a cross-sectional study in grade A tertiary hospitals of Heilongjiang province in Northern China, to evaluate the occurrence and level of depressive symptoms among otorhinolaryngology physicians and nurses and to analyse the relationship between them and workplace-violence-related risk factors and demographic variables.ResultsOf all our participating professionals, (379 otorhinolaryngologists and 273 nurses), 57.2% were found to have depressive symptoms, whereas, of the respondents who had suffered from physical violence, 71.25% had depressive symptoms. Professionals with less than 1 year of experience, as well as professionals who more frequently worked alone, were more likely to suffer from depressive symptoms than their colleagues.ConclusionsThis research addresses an emerging issue of clinical practice, and its results differ from those of previous studies; specifically, it indicates that the frequency of depressive symptoms among otorhinolaryngology physicians and nurses may be influenced by physical violence, the number of coworkers they have for more than half of their working hours and other workplace-violence-related factors. To reduce the depressive symptoms caused by workplace violence and improve the quality of medical services, medical institutions should implement effective measures to prevent the occurrence of physical violence, strengthen team cooperation ability and increase peer support.

PurposeStudies document that primary care improves health outcomes and controls costs. In regions of the world where primary care is underdeveloped, building capacity is essential. Most capacity building programmes are expensive and take physicians away from their clinical settings. We describe a programme created, delivered and evaluated from 2013 to 2014 in Jordan.DesignCohort study.SettingPhysicians providing primary care in the United Nations Relief and Works Agency for Palestine Refugees clinics in Jordan.ParticipantsEighty-four general practitioners (GPs) were invited to participate and completed the training and evaluation. GPs are physicians who have a license to practice medicine after completing medical school and a 1 year hospital-based rotating internship. Although GPs provide care in the ambulatory setting, their hospital-based education provides little preparation for delivering ambulatory primary care.Intervention/ProgrammeThis three-stage programme included needs assessment, didactics and on-the-job coaching. First, the learning needs and baseline knowledge of the trainees were assessed and the findings guided curriculum development. During the second stage, 48 hours of didactics covered topics such as communications skills and disease management. The third stage was delivered one on one in the trainee’s clinical setting for a 4 to 6-hour block. The first, middle and final patient interactions were evaluated.Primary and secondary outcome measuresPreknowledge and postknowledge assessments were compared. The clinical checklist, developed for the programme, assessed eight domains of clinical skills such as communication and history taking on a five-point Likert scale during the patient interaction.ResultsPreknowledge and postknowledge assessments demonstrated significantly improved scores, 46% to 81% (p<0.0001). Trainee’s clinical checklist scores improved over the assessment intervals. Satisfaction with the training was high.ConclusionThis programme is a potential model for building primary care capacity at low cost and with little impact on patient care that addresses both knowledge and clinical skills on the job.

Background: Project Extension for Community Healthcare Outcomes (ECHO) utilizes telemedicine to connect a multidisciplinary team of experts with a network of primary care physicians to enable rapid dissemination of evidence-based guidelines and practices at scale. In this study, the Project ECHO model disseminated the Arizona Pain and Addiction Curriculum to providers in rural Arizona with the goal to educate providers on medication-assisted treatment (MAT).Methods: Participants engaged in biweekly, virtual teleECHO sessions, and post-session surveys were used to collect data on provider satisfaction, self-efficacy, knowledge, barriers to change, and changes in practice behavior.Results: Between February 2020 and November 2020, the MAT-ECHO program hosted 20 teleECHO sessions (N = 20) with 255 unique participating providers and delivered 877 learning hours. Analysis of a 6-month post-ECHO survey (N = 13) demonstrated that teleECHO sessions had broad geographic outreach. Participants had an average of 12 years of experience, 38 percent held NP/PA professional degrees, and 54 percent practiced in opioid treatment program settings. Assessment of job satisfaction and well-being revealed overall improved satisfaction among the small cohort of nonwaivered respondents (N = 8), except for meeting patient’s needs. MAT-waivered respondents reported no post-session changes.Conclusions: Data from this study demonstrated that teleECHO sessions were well attended, consisted of a diverse cohort with various degrees, and had broad geographic outreach; hence, the utilization of the teleECHO model has the potential to reach rural providers and subsequently increase the availability and efficacy of MAT in rural America.

ImportanceThe COVID-19 pandemic has affected clinician health and retention.ObjectiveTo describe trends in burnout from 2019 through 2021 with associated mitigating and aggravating factors.Design, Setting, and ParticipantsCross-sectional surveys were sent to physicians and advanced practice clinicians throughout 120 large US health care organizations between February 2019 and December 2021. From 56 090 surveys, there were 20 627 respondents.ExposuresWork conditions and COVID-19.Main Outcomes and MeasuresSurveys measured time pressure, chaos, work control, teamwork, electronic health record use, values alignment, satisfaction, burnout, intent to leave, and in 2021, feeling valued. Multivariate regressions controlling for gender, race and ethnicity, years in practice, and role determined burnout, satisfaction, and intent-to-leave correlates.ResultsOf the 20 627 respondents (median response rate, 58% [IQR, 34%-86%; difference, 52%]), 67% were physicians, 51% female, and 66% White. Burnout was 45% in 2019, 40% to 45% in early 2020, 50% in late 2020, and 60% in late 2021. Intent to leave increased from 24% in 2019 to more than 40% as job satisfaction decreased. Higher burnout was seen in chaotic workplaces (odds ratio [OR], 1.51; 95% CI, 1.38-1.66; P &amp;lt; .001) and with low work control (OR, 2.10; 95% CI, 1.91-2.30; P &amp;lt; .001). Higher burnout was associated with poor teamwork (OR, 2.08; 95% CI, 1.78-2.43; P &amp;lt; .001), while feeling valued was associated with lower burnout (OR, 0.22; 95% CI, 0.18-0.27; P &amp;lt; .001). In time trends, burnout was consistently higher with chaos and poor work control. For example, in the fourth quarter of 2021 burnout was 36% (95% CI, 31%-42%) in calm environments vs 78% (95% CI, 73%-84%) if chaotic (absolute difference, 42%; 95% CI, 34%-49%; P &amp;lt; .001), and 39% (95% CI, 33%-44%) with good work control vs 75% (95% CI, 69%-81%) if poor (absolute difference, 36%; 95% CI, 27%-44%; P &amp;lt; .001). Good teamwork was associated with lower burnout rates (49%; 95% CI, 44%-54%) vs poor teamwork (88%; 95% CI, 80%-97%; absolute difference, 39%; 95% CI, 29%-48%; P &amp;lt; .001), as was feeling valued (37%; 95% CI, 31%-44%) vs not feeling valued (69%; 95% CI, 63%-74%; absolute difference, 32%; 95% CI, 22%-39%; P &amp;lt; .001).Conclusions and RelevanceResults of this survey study show that in 2020 through 2021, burnout and intent to leave gradually increased, rose sharply in late 2021, and varied by chaos, work control, teamwork, and feeling valued. Monitoring these variables could provide mechanisms for worker protection.

Abstract Objectives.—To determine the success with which laboratories were able to report morning test results on time, the laboratory practice characteristics associated with improved success, and the degree of satisfaction among clinicians with the timeliness of laboratory service. Design.—Hospital laboratories participating in the College of American Pathologist Q-Probes laboratory quality improvement program prospectively calculated the percentages of morning-run complete blood cell count (CBC) and electrolyte results that were reported on or before predetermined reporting deadlines, completed questionnaires concerning their departments' practice characteristics as they related to performing morning blood work, and distributed to physician utilizers of morning laboratory services questionnaires evaluating physician satisfaction with laboratory services. Setting and Participants.—A total of 367 public and private institutions located in the United States (355), Canada (5), Australia (2), and 1 each in the United Kingdom, Spain, Brazil, Korea, and Guam. Main Outcome Measure.—The percentages of morning-run CBC and electrolyte results reported on or before predetermined reporting deadlines. Results.—Participants submitted data on 40 256 CBC and 39 604 electrolyte specimens. In aggregate, a total of 88.9% of these tests (90.2% of CBCs and 87.6% of electrolytes) were reported on or before the reporting deadlines that the participating laboratories set for themselves. Half of the participants reported 94.6% of their CBC results and 95.5% of their electrolyte results on or before their self-imposed reporting deadlines. No specific demographic features or departmental practice characteristics were associated with higher or lower rates of institutional reporting compliance. Most physician utilizers of early-morning laboratory test results believed that the laboratory is sensitive to and meets the needs of clinicians for timely reporting of early-morning test results. Conclusions.—Most laboratories are capable of reporting 95% of their routine morning laboratory tests on time, and most physicians are satisfied with their laboratories' morning testing service.

Family physicians (FPs) are exposed to high amounts of stress, and could be susceptible to the development of mental health disorders (MHD), especially after the emergence of the COVID-19 pandemic. The aim of the current study was to assess MHD history, attitudes toward MHDs and stress-coping strategies in FPs. An additional goal was to estimate their comprehensive well-being and investigate connections with resilience and a healthy lifestyle. A total of 483 FPs submitted their responses via online survey. MHD attitudes were assessed with the according questionnaires, while burnout levels, healthy lifestyle, resilience, job and life satisfaction were estimated with validated scales. Results have shown that 32.5% of FPs disclosed positive MHD history, while 68.7% used professional help. Resilience and healthy lifestyle levels were significantly higher in MHD negative FPs (p < 0.001), while burnout levels were lower (p < 0.001). Moreover, healthy lifestyle (β = 0.03, p < 0.001) was an independent correlate of resilience, while healthy lifestyle (β = −0.35, p < 0.001, and resilience (β = −1.82, p < 0.001) were of burnout levels. Finally, resilience (OR = 0.387, p < 0.001) and healthy lifestyle (OR = 0.970, p = 0.021) were shown as independent predictors of positive MHD history status. Strong promotion and education of FP population regarding resilience and healthy lifestyle should be utilized in practice in order to alleviate the possibility of mental health disturbances and the according consequences.

Purpose The Healthy Work Place (HWP) study investigated methods to improve clinicians’ dissatisfaction and burnout. The purpose of this paper is to identify factors that influenced study enrollment and completion and assess effects of initial clinic site enrollment rates on clinician outcomes, including satisfaction, burnout, stress and intent to leave practice. Design/methodology/approach In total, 144 primary care clinicians (general internists, family physicians, nurse practitioners and physician assistants) at 14 primary care clinics were analyzed. Findings In total, 72 clinicians enrolled in the study and completed the first survey (50 percent enrollment rate). Of these, 10 did not complete the second survey (86 percent completion rate). Gender, type, burnout, stress and intervention did not significantly affect survey completion. Hence, widespread agreement about most moral/ethical issues (72 percent vs 22 percent; p=0.0060) and general agreement on treatment methods (81 percent vs 50 percent; p=0.0490) were reported by providers that completed both surveys as opposed to just the initial survey. Providers with high initial clinic site enrollment rates (=50 percent providers) obtained better outcomes, including improvements in or no worsening of satisfaction (odds ratio (OR)=19.16; p=0.0217) and burnout (OR=6.24; p=0.0418). Social implications More providers experiencing workplace agreement completed the initial and final surveys, and providers at sites with higher initial enrollment rates obtained better outcomes including a higher rate of improvement or no worsening of job satisfaction and burnout. Originality/value There is limited research on clinicians’ workplace and other factors that influence their participation in survey-based studies. The findings help us to understand how these factors may affect quality of data collecting and outcome. Thus, the study provides us insight for improvement of quality in primary care.

Simulation training in medicine opens up new horizons for students’ practical training, advanced training of practicing physicians, as well as systems for assessing the formation of competencies. The Dentist Laboratory, in which dental students start learning already in the first year of study, is successfully functioning in the Training Simulation Center (TSC) of Kursk State Medical University (KSMU). To study the satisfaction of students with the effectiveness of using simulation training in the formation of practical skills, after passing the test during on-the-job training, a voluntary anonymous survey of 110 fourth-year students of the Faculty of Dentistry of Kursk State Medical University was conducted. The questionnaire included a question pool for approval of the argument, and the overwhelming majority of the surveyed students recognize the clear advantages of using simulation technologies at all stages of medical education. 84% of the respondents noted that the reality of sensations when modeling clinical situations in the phantom class of KSMU is close to a real hospital environment. The respondents identified the required number of trainings they needed to confidently master the basic practical skills, as well as highlighted the disadvantages of simulation training in comparison with actual clinical practice. Analyzing the data obtained and taking into account the students’ general desire to increase the total number of trainings, the schedule of classes in the simulation class of KSMU was corrected.

The present review examines the impact of management and husbandry decisions on the welfare of laying hens in Australia. The literature on many of these aspects is lacking for the Australian egg industry, and, indeed, for the egg industry in general. Management decisions that can affect hen welfare relate to the initial farm design, husbandry routines, and staff selection and training. As modern laying houses represent a considerable financial investment, the decisions made during the design phase are likely to affect both the hens and stockpeople for substantial periods. Hens in cage systems may benefit from fewer tiers and greater space allowances. In non-cage systems, the brown genotypes used in the Australian egg industry may benefit from lower structures that accommodate their heavier and less agile bodies. Keel fractures can be reduced by improving the skeletal health and spatial cognition of laying hens during the rearing period, in addition to minimising the distances they need to jump when navigating aviary structures. The addition of a wintergarden to fixed free-range systems appears to be beneficial. Housing hens in mobile units on free-range farms may challenge their welfare, particularly in relation to heat stress. There is also room for improvement in biosecurity practices and health monitoring of hens, as these appear to be lacking at some farms. The current strains of hen used in free-range systems may not be best suited to these conditions, on the basis of their body condition and flock uniformity. Feed quality may also need to be monitored for quality assurance and optimal hen nutrition. Hen welfare during depopulation can be improved through staff training and by reducing staff fatigue. Euthanising spent hens on farm offers welfare benefits over transporting spent hens to an abattoir. Both hen welfare and working conditions for stock people should be considered when designing laying houses to provide suitable conditions for both hens and stockpeople. This will help improve the job satisfaction of stockpeople, which may translate into better care for the hens and may aid in retaining quality staff. Stockpeople must be recognised as vital contributors to hen welfare in the egg industry, and it is important for the egg industry to continue to attract, train and retain skilled stockpeople to ensure that they enjoy their job and are motivated to apply best-practice care for their flocks. Promoting the animal-care aspect of stockmanship in combination with a supportive managerial environment with optimal working conditions may increase the attractiveness of the egg industry as a place to work.

As with many OECD countries, graduating medical students have been choosing specialist careers at a greater rate than ever before. Generalism in the form of family (general practice) and more generalist medical specialties have been trending down resulting in distributional geographic challenges. With the advent of COVID-19 in March 2020, medical schools and in particular the Joint Medical Program situated in a regional and rural area in NSW Australia had the unique opportunity to rethink the penultimate year curriculum when the previous rapid rotation model through numerous medical specialities became untenable. The need to vision a new practical pragmatic curriculum spurred a rapid revaluation of assessment, placement length and model with a pivot to an “embedded senior student placement” agnostic of discipline and supported by a competency-based learning portfolio. This article explores the barriers and enablers and identifies the potential elements of this type of placement which can be adapted to community and smaller rural sites. The positive student and supervisor experience also enabled an employment model to be woven into the students learning and ensured on hand medical student workforce for hospitals throughout the rural footprint. The capacity of these placements to celebrate variation in experience and support students to learn on the job have now caused a revision of the penultimate year with expectation of gains in students’ satisfaction and in employability. It has also opened up options to deliver and increase the inherent value of generalist placements with likely long term workforce benefit.

Objectives: Physician satisfaction with their job can lead to a better quality of care, fewer chances of making errors, and better patient outcomes. The purpose of the study was to examine physician satisfaction; and to assess job satisfaction across several factors, such as quality of care, ease of practice, relationship with leadership, and inter-professional collaboration. Method: A descriptive cross-sectional design was used. Data were collected between July 2019 and January 2020. Participants provided demographic information and completed surveys related to physician satisfaction (13-item Likert type items on a scale from 1 to 5), and inter-professional collaboration (15-item, 4-point Likert scale, ranging from 1 for “strongly disagree” to 4 for “strongly agree”). Multiple linear regressions were used to determine the relationship between overall job satisfaction and demographic features and inter-professional collaboration. Results: Out of 396 physicians who were contacted, 354 responded (response rate = 89.4%). The median age was 40 years, and there were 208 male and 124 female physicians. The vast majority (238/354 = 62%) were expatriates. Seventy percent had a post-graduate degree. The vast majority (308 = 87%) worked in government hospitals. Results showed that 15 (5%) of the physicians were not satisfied with their job (<3.00), 179 (40%) expressed a moderate level of satisfaction (3.00 – 3.75), and 129 (55%) were highly satisfied (>3.76). There was no difference in mean job satisfaction score among different groups of study participants, except for gender, and the working grade (p < 0.05). The overall job satisfaction rates were higher for the quality of care (M = 3.93, SD = 0.61), and for ease of practice (M = 3.89, SD = 0.55) and lower for the relationship with leadership (M = 3.67, SD = 0.86). Having a clinical postgraduate degree together with a PhD, a senior level of responsibility and good inter-professional relationship were associated with higher job satisfaction rates (p = 0.003 and 0.007, respectively). Conclusion: Overall, the job satisfaction rate was high. There was no difference among different groups of study participants, except for the working grade. Having a clinical postgraduate degree, a senior level of responsibility, and good inter-professional relationship were associated with higher job satisfaction rates. The overall job satisfaction rates were higher for the quality of care, and for ease of practice, and lower for relationship with the leadership. Relationship with the leadership is a modifiable factor and efforts at enhancing the physician-leadership relationship may lead to even higher satisfaction rates. Keywords: Interprofessional relations; Job Satisfaction; Leadership; Oman; Physician; Quality of health care

Background & Aim: The activities of advanced practice registered nurses in Korea have expanded, but studies on their job satisfaction are lacking. This study aimed to determine the factors influencing job satisfaction among Korean advanced practice registered nurses. Methods & Materials: A cross-sectional correlational study was conducted with 142 APRNs selected from three tertiary hospitals in Korea from December 2020 to January 2021. Job satisfaction and the factors influencing it were investigated using structured questionnaires; factors affecting job satisfaction were identified by multiple regression analysis. Data analysis was processed using the SPSS/WIN 25.0 program. Results: Advanced practice registered nurses’ sex (β=.15, p=0.004), satisfaction with workload (β=.24, p<0.001), professional visibility (β=. 21, p=0.004) and APRN-physician relations in the work environment (β=.38, p<0.001), and clinical decision-making ability (β=.17, p=0.004) were identified as the factors influencing job satisfaction, which together explained 67% of the variance in job satisfaction. Conclusion: To increase advanced practice registered nurses' job satisfaction, nurse managers must consider strategies for providing administrative and educational support for workload control, recognition of professional identity and autonomy, and improving the work environment to encourage efficient interaction with physicians and improved clinical decision-making ability.

Abstract Background Primary health care (PHC) was a keystone toward achieving universal health coverage and Sustainable Development Goals (SDGs). China has made efforts to strengthen its PHC institutions. As part of such efforts, regular in-service training is crucial for primary healthcare workers (PHWs) to strengthen their knowledge and keep their skills up to date. Objective To investigate if and how the existing training arrangements influenced the competence and job satisfaction of PHWs in township hospitals (THs). Methods A mixed method approach was employed. We analyzed the associations between in-service training and competence, as well as between in-service training and job satisfaction of PHWs using logistic regression. Interviews were recorded, transcribed, and analyzed using NVivo12 to better understand the trainings and the impacts on PHWs. Results The study found that training was associated with competence for all the types of PHWs except nurses. The odds of higher competence for physicians who received long-term training were 3.60 (p < 0.01) and that of those who received both types of training was 2.40 (p < 0.01). PHWs who received short-term training had odds of higher competence significantly (OR = 1.710, p < 0.05). PHWs who received training were more satisfied than their untrained colleagues in general (OR = 1.638, p < 0.01). Specifically, physicians who received short-term training (OR = 1.916, p < 0.01) and who received both types of training (OR = 1.941, p < 0.05) had greater odds of general job satisfaction. The odds ratios (ORs) of general job satisfaction for nurses who received short-term training was 2.697 (p < 0.01), but this association was not significant for public health workers. The interview data supported these results, and revealed how training influenced competence and satisfaction. Conclusions Considering existing evidence that competence and satisfaction serve as two major determinants of health workers’ performance, to further improve PHWs’ performance, it is necessary to provide sufficient training opportunities and improve the quality of training.

Abstract Background Job satisfaction of general practitioners (GPs) is important because of the consequences of low satisfaction for GPs, their patients and the health system, such as higher turnover, health problems for the physicians themselves, less satisfied patients, poor clinical outcomes and suboptimal health care delivery. In this study, we aim to explain differences in the job satisfaction of GPs within and between countries. Methods We performed a secondary analysis of cross-sectional survey data, collected between 2010 and 2012 on 7379 GPs in 34 (mostly European) countries, as well as data on country and health system characteristics from public databases. Job satisfaction is measured through a composite score of six items about self-reported job experience. Operationalisation of the theoretical constructs includes variables, such as the range of services GPs provide, working hours, employment status, and feedback from colleagues. Data were analysed using linear multilevel regression analysis, with countries and GPs as levels. We developed hypotheses on the basis of the Social Production Function Theory, assuming that GPs ‘produce’ job satisfaction through stimulating work that provides a certain level of comfort, adds to their social status and provides behavioural confirmation. Results Job satisfaction varies between GPs and countries, with high satisfaction in Denmark and Canada (on average 2.97 and 2.77 on a scale from 1–4, respectively) and low job satisfaction in Spain (mean 2.15) and Hungary (mean 2.17). One-third of the total variance is situated on the country level, indicating large differences between countries, and countries with a higher GDP per capita have more satisfied GPs. Health system characteristics are not related to GP job satisfaction. At the GP and practice level, performing technical procedures and providing preventive care, feedback from colleagues, and patient satisfaction are positively related to GP job satisfaction and working more hours is negatively related GP job satisfaction. Conclusion Overall and in terms of our theoretical approach, we found that GPs are able to ‘produce’ work-related well-being through activities and resources related to stimulation, comfort and behavioural confirmation, but not to status.

AbstractLeadership has become an increasingly important issue in medicine as leadership skills, job satisfaction and patient outcomes correlate positively. Various leadership training and physician psychological well-being programmes have been developed internationally, yet no standard is established in primary care. The IMPROVEjob leadership program was developed to improve job satisfaction among German general practitioners and practice personnel. Its acceptance and effectiveness were evaluated. The IMPROVEjob intervention is a participatory, interdisciplinary and multimodal leadership intervention that targets leadership, workflows and communication in general practices using three elements: (1) two leadership workshops with skills training; (2) a toolbox with printed and online material, and (3) a 9-month implementation phase supported by facilitators. A cluster-randomised trial with a waiting-list control evaluated the effectiveness on the primary outcome job satisfaction assessed by the Copenhagen Psychosocial Questionnaire (range 0–100). A mixed-methods approach with questionnaires and participant interviews evaluated the acceptance of the intervention and factors influencing the implementation of intervention content. Statistical analyses respected the clustered data structure. The COVID-19 pandemic necessitated intervention adjustments: online instead of on-site workshops, online material instead of facilitator practice visits. Overall, 52 of 60 practices completed the study, with altogether 70 practice leaders, 16 employed physicians, and 182 practice assistants. According to an intention-to-treat analysis, job satisfaction decreased between baseline and follow-up (not significantly) in the total study population and in both study arms, while the subgroup of practice leaders showed a non-significant increase. A mixed multilevel regression model showed no effect of the intervention on job satisfaction (b = − 0.36, p > 0.86), which was influenced significantly by a greater sense of community (b = 0.14, p < 0.05). The acceptance of the IMPROVEjob workshops was high, especially among practice leaders compared to assistants (1 = best to 5 = worst): skills training 1.78 vs. 2.46, discussions within the practice team 1.87 vs. 2.28, group discussions 1.96 vs. 2.21. The process evaluation revealed that the COVID-19 pandemic complicated change processes and delayed the implementation of intervention content in practice routines. The workshops within the participatory IMPROVEjob intervention were rated very positively but the multimodal intervention did not improve job satisfaction 9 months into the pandemic. Qualitative data showed an impairment of implementation processes by the unforeseeable COVID pandemic.Trial registration Registration number: DRKS00012677 on 16/10/2019.

Abstract Background Among the various factors identified as relevant for primary care career choice, financial considerations have been consistently shown to have an impact. In Germany, reliable and easily understandable information on physicians’ earning opportunities in self-employed settings is difficult to obtain for medical students, leading to substantial misperceptions that may negatively affect respective career considerations. This study investigated medical students’ evaluation of a 45-min evidence-based workshop on earning opportunities, workload and job satisfaction in different specialties and settings to examine its effect on the perceived attractiveness of working self-employed and working in general practice. Methods The workshop was implemented as part of a mandatory general practice clerkship in the fourth study year (of six). Post-hoc evaluations of all participants between October 2017 and September 2018 (one cohort) were analysed cross-sectionally including descriptive statistics, subgroup comparisons and qualitative analysis of free-text answers regarding students’ main insights. Results Response rate was 98.1% (307/313). Participants were on average 25.0 years old, and 68.3% were women. Based on a ten-point scale ranging from 1 = ’no influence’ to 10 = ’very big influence’, 91.9% confirmed at least some (> = 2) and 57.3% a rather high (> = 5) influence of earning expectations on their career choice process. Regarding the workshop, 86.1% were overall satisfied, and 89.5% indicated they had gained new insights, primarily regarding earning opportunities in different specialties and work settings, and frequently regarding job satisfaction, workload and the structure of revenues and expenditures in a doctor’s office (according to qualitative analysis). In the opinion of 89.8% of students, the provided learning content should be part of the undergraduate curriculum. More than half of participants reported an increase regarding the attractiveness of working self-employed and working as a general practitioner, most frequently regarding earning opportunities, but also in general and in respect to job satisfaction, cost–benefit ratio and workload. This increase was significantly higher among students favouring or at least considering a general practice career. Conclusions The workshop and its content were appreciated by the students and showed clear potential to usefully complement undergraduate curricula aiming at increasing or reinforcing students’ interest in working self-employed and working in general practice.

Background: Medical professionalism is considered, in modern clinical practice as the basis of the social contract between physicians and their society. It encompasses a wide range of values such as altruism, accountability, excellence, duty, service, honor, integrity, and respect for others. It has been researched extensively in the Western world, but only a dearth of studies exist in Saudi Arabia and the Middle East. Methods: A cross-sectional study was conducted on 157 physicians working in primary health care centers in Abha and Khamis-Mushayt cities of Saudi Arabia. The study tool was a self-addressed validated questionnaire. Results: Participants in the study were 157 general physicians, of whom 63.7% were males. The Saudis were 84.1%. The mean of experience of work in years was 3.5 years. Only, 50.3% had training in medical professionalism training, whereas 49.7% did not receive any training in professionalism (the mean number of training sessions was 3.1). The mean score of professionalism was 109.1 (out of a potential total of 130 points). Participants with High professionalism were 49%, while 49.7% were found to have moderate professionalism, and only 1.3%, was with poor professionalism. Factors related to a significantly positive association with professional behavior were; higher age, being married, being non-Saudi, higher qualifications (like Diploma/MSc), increased practice experience, and professional training one is involved in. Conclusion: The participant physicians reported high levels of professional behavior. However, there is a need to focus on addressing job satisfaction factors to improve participants’ practice attitude and subsequently increase professionalism.

Abstract Background Positive reports of nursing-related outcomes such as quality nursing care, nursing engagement with work and good practice environment are crucial in attaining and maintaining Magnet® designation. The majority of Magnet®-designated organisations (N = 482) are in the USA, with their aggregate nursing outcomes widely published as benchmark data. Australian Magnet® outcomes have not been aggregated or published to date. Methods The aims are to benchmark educational preparation, occupational burnout, job satisfaction, intention to leave and working environment of nurses in Australian Magnet®-designated facilities and to determine the reliability of the Practice Environment Scale-Australia. The design is a cross-sectional multisite survey set in all three Australian Magnet®-designated organisations. The demographics included age, gender, level of education, years in practice, level of seniority and position title. Two items measured job satisfaction and intent to stay in current employment. The Maslach Burnout Inventory explored the three domains of nursing engagement: depersonalisation, personal achievement and emotional exhaustion. The Australian version of the Practice Environment Scale interrogated participants’ perceptions of their work environments. Results 2004 nurses participated (response rate 45.9%). Respondents’ mean age was 39.2 years (range 20–72). They were predominantly female and had worked in their current facility for more than 5 years. Eighty five percent had a minimum of a Bachelor’s degree. Eighty-six percent of respondents were satisfied or very satisfied with their current position. Eighty eight percent had no intention of leaving their current employer within the next 12 months. Participants rated their hospitals highly in all domains of the practice environment. Respondents reported less burnout in the personal accomplishment and depersonalisation domains than in the emotional exhaustion domain, in which they reported average levels of burnout. The internal consistency of the Practice Environment Scale-Australia was confirmed in this sample (Cronbach α’s 0.87–0.9 for subscales and 0.89 for composite score). Conclusion In this paper, we present nursing outcome data from all Australian Magnet® hospitals for the first time. This provides a benchmark that facilitates comparison with nursing outcomes published by Australian non-Magnet® hospitals and with international Magnet® organisations.

Abstract Background Perceived high chronic stress is twice as prevalent among German general practitioners (GPs) and non-physician medical staff compared to the general population. The reasons are multi-factorial and include patient, practice, healthcare system and societal factors, such as multi-morbidity, the diversity of populations and innovations in medical care. Also, practice-related factors, like stressful patient-staff interactions, poor process management of waiting times and lack of leadership, play a role. This publicly funded study evaluates the effectiveness of the newly developed participatory, interdisciplinary, and multimodal IMPROVEjob intervention on improving job satisfaction among general practice personnel. The intervention aims at structural stress prevention with regard to working conditions and behavioural stress prevention for leaders and other practice personnel. Methods In this cluster-randomised controlled trial, a total of 56 general practices will be assigned to either (1) participation in the IMPROVEjob intervention or (2) the waiting-list control group. The IMPROVEjob intervention consists of the following elements: three workshops, a toolbox with supplemental material and an implementation period with regular contact to so-called IMPROVEjob facilitators. The first workshop, addressing leadership issues, is designed for physicians with leadership responsibilities only. The two subsequent workshops target all GP and non-physician personnel; they address issues of communication (with patients and within the team), self-care and team-care and practice organisation. During the 9-month implementation period, practices will be contacted by IMPROVEjob facilitators to enhance motivation. Additionally, the practices will have access to the toolbox materials online. All participants will complete questionnaires at baseline and follow up. The primary outcome is the change in job satisfaction as measured by the respective scale of the validated German version of the Copenhagen Psychosocial Questionnaire (COPSOQ, version 2018). Secondary outcomes obtained by questionnaires and - qualitatively - by facilitators comprise psychosocial working conditions including leadership aspects, expectations and experiences of the workshops, team and individual efforts and organisational changes. Discussion It is hypothesised that participation in the IMPROVEjob intervention will improve job satisfaction and thus constitute a structural and behavioural prevention strategy for the promotion of psychological wellbeing of personnel in general practices and prospectively in other small and medium sized enterprises. Trial registration German Clinical Trials Register: DRKS00012677. Registered on 16 October 2019. Retrospectively, https://www.drks.de/drks_web/navigate.do?navigationId=trial. HTML&TRIAL_ID = DRKS00012677.

Occupational burnout is a critical issue affecting the welfare of veterinary care providers, their patients, and the sustainability of veterinary healthcare organizations. The current research aimed to evaluate the prevalence of and factors contributing to stress, wellbeing, burnout symptoms and job satisfaction among clinical and non-clinical staff at a large specialist small animal hospital in Australia. Participants completed an anonymous online survey including self-report measures of job satisfaction and symptoms of burnout, and open-text response questions probing sources of stress and wellbeing. Subsequently, participants rated how frequently they experienced commonly reported sources of veterinary stress, and a series of focus groups were conducted with clinical and non-clinical teams. The survey was completed by 249 participants (overall response rate = 70%; 67.1% “clinical;” 17.3% “non-clinical;” 5.6% “other”). Five focus groups (including 38 of the survey participants) were subsequently conducted with groups of clinical and non-clinical staff. The majority of respondents (80.7%) reported being satisfied, very satisfied, or extremely satisfied with their job. At the same time, 57.7% of respondents exceeded the threshold for burnout on at least one burnout dimension, with 48.1% reporting high levels of emotional exhaustion, 30.2% reported high levels of cynicism, and 16.3% reporting low levels of professional efficacy. Open text responses and focus group transcripts revealed three common sources of stress and wellbeing. Stressors included communication (conflict within teams), clients (dealing with client emotions and expectations), and heavy caseload. Wellbeing was enhanced by people (team cohesion, respect for colleagues), practice (variety, autonomy, challenge), and purpose (meaningful work and impact). Overall, for both clinical and non-clinical survey respondents, “heavy workload” was rated as the most frequent source of stress. Despite high levels of job satisfaction, approximately two thirds of respondents reported at least one symptom of burnout. Convergent results from the survey and focus groups indicated that strong relationships with colleagues and the intrinsic meaningfulness of the work were key sources of wellbeing and job satisfaction. On the other hand, challenging workplace interactions with colleagues and clients, as well as heavy workload, were identified as key stressors contributing to burnout symptoms.

Abstract Background A regional Australian Primary Health Network (PHN) has been subsidising administrative staff from local general practices to undertake the Medical Practice Assisting (MPA) course as part of its MPA Program. The MPA Program aimed to upskill administrative staff to undertake clinical tasks and fill in for busy or absent Practice Nurses (PNs), freeing up PNs to increase revenue-generating activity, avoiding casual replacement staff wages, and increasing patient throughput. An impact assessment was undertaken to evaluate the impact and estimate the economic costs of the MPA program to the PHN, general practices, and students to inform future uptake of the intervention. Methods The Framework to Assess the Impact of Translational Health Research (FAIT) was utilised. Originally designed to assess the impact of health research, this was its first application to a health services project. FAIT combines three validated methods of impact assessment—Payback, economic analysis and narratives underpinned by a program logic model. Quantified metrics describe the impacts of the program within various “domains of benefit”, the economic model costs the intervention and monetises potential consequences, and the narrative tells the story of the MPA Program and the difference it has made. Data were collected via online surveys from general practitioners (GPs), PNs, practice managers; MPA graduates and PHN staff were interviewed by phone and on Zoom. Results FAIT was effective in evidencing the impacts and economic viability of the MPA Program. GPs and PNs reported greater work satisfaction, PNs reported less stress and reduced workloads and MPA graduates reported higher job satisfaction and greater confidence performing a range of clinical skills. MPA Program economic costs for general practices during candidature, and 12 month post-graduation was estimated at $69,756. With effective re-integration planning, this investment was recoverable within 12 months through increased revenue for practices. Graduates paid appropriately for their new skills also recouped their investment within 24 months. Conclusion Utilisation of MPA graduates varied substantially between practices and COVID-19 impacted on their utilisation. More strategic reintegration of the MPA graduate back into the practice to most effectively utilise their new skillset could optimise potential benefits realised by participating practices.

Abstract Introduction: The coronavirus (COVID-19) pandemic has impacted healthcare worldwide. It has altered service delivery and posed challenges to practitioners in relation to workload, well-being and support. Within primary care, changes in physicians’ activities have been identified and innovative work solutions implemented. However, evidence is lacking regarding the impact of the pandemic on pharmacy personnel who work in primary care. Aim: To explore the impact of the pandemic on the working practice (including the type of services provided) and job satisfaction of pharmacists and pharmacy technicians within Scottish general practice. Due to the stressful nature of the pandemic, we hypothesise that job satisfaction will have been negatively affected. Methods: An online questionnaire was distributed in May–July 2021, approximately 15 months since initial lockdown measures in the UK. The questionnaire was informed by previous literature and underwent expert review and piloting. Analysis involved descriptive statistics, non-parametric statistical tests and thematic analysis. Results: 180 participants responded (approximated 16.1% response rate): 134 pharmacists (74.4%) and 46 technicians (25.6%). Responses indicated greater involvement with administrative tasks and a reduction in the provision of clinical services, which was negatively perceived by pharmacists. There was an increase in remote working, although most participants continued to have a physical presence within general practices. Face-to-face interactions with patients reduced, which was negatively perceived by participants, and telephone consults were considered efficient yet less effective. Professional development activities were challenged by increased workloads and reduced support available. Although workplace stress was apparent, there was no indication of widespread job dissatisfaction. Conclusion: The pandemic has impacted pharmacists and technicians, but it is unknown if changes will be permanent, and there is a need to understand which changes should continue. Future research should explore the impact of altered service delivery, including remote working, on patient care.

Background: Physician burnout is highly prevalent throughout medical education, training and practice, and substantially comprises the personal and professional well-being of those affected. This report is the first to comprehensively review published studies on physician burnout coming from the Gulf Region, examining the manner in which burnout is diagnosed, prevalence rates, and unique risk factors. Methods: We conducted a systematic literature review on studies of burnout among medical students, residents, general physicians, specialist physicians and consultant physicians in Arab Gulf countries (Kingdom of Saudi Arabia (KSA), United Arab Emirates (UAE), Kuwait, Kingdom of Bahrain, Qatar, Yemen and Iraq). Results: Our results demonstrate the increased recognition of, and interest in, physician burnout in the Gulf Region. For the most part, our findings parallel reports from other regions around the world. While there is great variability in the reported rates of burnout, at least in part to the different ways burnout is measure and defined, most studies of medical student, resident and attending-level physicians report burnout rates of between 30-50% in each cohort. Findings related to risk factors are inconsistent. Some reports suggest that working in the same center for long time, time on-call, shift work, tests/examinations, unfair assessment from superiors, lack of support from superiors, work demands affecting personal/home life, less satisfaction with career, less satisfaction with income, disorganized patient flow to clinics, patient pressure and violence, more paper work, less cooperative colleagues and job insecurity all may be related to burnout. Personal factors like having chronic disease, taking psychotropic drugs, smoking, sleeping less than 6 hours, suffering from sleep deprivation, back pain or having social problems also are associated with burnout, while participating in sports and having hobbies seem protective. Paralleling reports from other regions of the globe, burnout in the Gulf Region is associated with physical, psychological and occupational disturbances. Conclusions: This systematic review of burnout in the Gulf Region confirms the universality of physican burnout regardless of age, gender, race, geography, religion, cultural background or positions in the medical job hierarchy, and the critical need to find effective preventative strategies.

Abstract Background There are still concerns about the effectiveness of clinical education models which are done with the aim of reducing the theoretical-practical gap in nursing. In this article, we intend to describe an innovative model to create an integration and structured relationship between educational and healthcare provider institutions. The basis of this work is the full-time presence of nursing teacher in the clinical settings and the development of their role to improve the education of students and nurses and the quality of nursing services. Methods This was a participatory action research. This action research was implemented in four steps of problem identification, planning, action and reflection. Interviews, focus groups and observation were used for the qualitative part. Clinical Learning Environment Inventory (CLEI), Job Satisfaction in Nursing Instrument questionnaires and Patient Satisfaction with Nursing Care Quality Questionnaire were completed before and after the study. Qualitative content analysis, paired and independent t test were used for data analysis. Results The academic-practice integration Model of TPSN is a dynamic and interactive model for accountability in nursing Discipline. Unlike the medical education model that includes patients, students, and physicians as the three points of a triangle, this model, which is shaped like a large triangle, places the person in need of care and treatment (patient, client, family, or society) in the center of the triangle, aiming to focus on the healthcare receiver. The model consists of three components (Mentoring component, Preceptorship component, and integrated clinical education component). Each of the components of this model alone will not be able to eliminate the ultimate goal of bridging the theory-practice gap. Conclusions A new and innovative model was proposed to reduce the theory-practice gap in the present study. This model increases the collaboration between educational institutions and healthcare settings compared with the previous models. The TPSN model helps students, nurses, and nursing instructors integrate theoretical knowledge with clinical practice and act as professional nurses.

Abstract Aim A shortage in primary care physicians has been a well-known challenge in many Western countries for several years. In addition, we currently see a trend in primary care, where an increasing number of physicians work as employees instead of being self-employed, even among general practitioners. To address this shortage, knowledge of the future specialists’ attitudes toward working self-employed is needed. This qualitative systematic review aims to explore the attitudes of future specialists towards self-employment in private practice, and what factors influence these attitudes. Subject and methods We conducted a systematic search using PubMed, Embase, and Web of Science. We developed a search strategy that collected terms for future specialists, career choices, and self-employment and linked these with the Boolean operator “AND”. We analysed the results using a qualitative content analysis, as both qualitative and quantitative studies were included in the research. Results Self-employment is less attractive to future specialists. In particular, women prefer to be employed and receive a fixed salary. The main factors that influence the decision as to whether to become self-employed or not are financial conditions, bureaucracy and non-medical tasks, organisation, job satisfaction during residency, personal responsibility, career opportunities, specialty-dependent factors, personal environment, and education. Conclusion Among future specialists, being self-employed is less attractive than being an employee. Students should be better informed about future career opportunities to make an informed decision. However, it should be examined whether other forms of organisation are more in line with the wishes of future specialists.

The purpose of this study is to estimate the economic cost of burnout in the veterinary profession and highlight the financial reasons why the industry should address the burnout crisis from an organizational perspective. Using data from 5,786 associate veterinarians in private practice, information was obtained using employment information related to compensation, work hours, hour preferences, and job turnover. Burnout was measured using the Professional Quality of Life Scale and used to calculate conditional probabilities on turnover and reduced working hours due to burnout. Lost revenue from each outcome (turnover and reduced working hours) was then used to calculate the economic costs to the veterinary services industry. The attributable cost of burnout of veterinarians to the US industry is between $1 and 2 billion annually in lost revenue, though there is a large amount of uncertainty. The cost is dependent on whether veterinary technicians are included in the analysis. The highest economic cost per veterinarian is among food animal practitioners, while the lowest is among equine. This study demonstrates that there are significant economic costs due to burnout among veterinarians and veterinary technicians. We suggest pursuing organizational interventions as these have shown the most impact in decreasing burnout and increasing satisfaction among human health physicians.

From elephants to ABBA fans, silicon to hormone, the following discussion uses a new research method to look at printed text, motion pictures and a teenage rebel icon. If by ‘print’ we mean a mechanically reproduced impression of a cultural symbol in a medium, then printing has been with us since before microdot security prints were painted onto cars, before voice prints, laser prints, network servers, record pressings, motion picture prints, photo prints, colour woodblock prints, before books, textile prints, and footprints. If we accept that higher mammals such as elephants have a learnt culture, then it is possible to extend a definition of printing beyond Homo sapiens. Poole reports that elephants mechanically trumpet reproductions of human car horns into the air surrounding their society. If nothing else, this cross-species, cross-cultural reproduction, this ‘ability to mimic’ is ‘another sign of their intelligence’. Observation of child development suggests that the first significant meaningful ‘impression’ made on the human mind is that of the face of the child’s nurturer – usually its mother. The baby’s mind forms an ‘impression’, a mental print, a reproducible memory data set, of the nurturer’s face, voice, smell, touch, etc. That face is itself a cultural construct: hair style, makeup, piercings, tattoos, ornaments, nutrition-influenced skin and smell, perfume, temperature and voice. A mentally reproducible pattern of a unique face is formed in the mind, and we use that pattern to distinguish ‘familiar and strange’ in our expanding social orbit. The social relations of patterned memory – of imprinting – determine the extent to which we explore our world (armed with research aids such as text print) or whether we turn to violence or self-harm (Bretherton). While our cultural artifacts (such as vellum maps or networked voice message servers) bravely extend our significant patterns into the social world and the traversed environment, it is useful to remember that such artifacts, including print, are themselves understood by our original pattern-reproduction and impression system – the human mind, developed in childhood. The ‘print’ is brought to mind differently in different discourses. For a reader, a ‘print’ is a book, a memo or a broadsheet, whether it is the Indian Buddhist Sanskrit texts ordered to be printed in 593 AD by the Chinese emperor Sui Wen-ti (Silk Road) or the US Defense Department memo authorizing lower ranks to torture the prisoners taken by the Bush administration (Sanchez, cited in ABC). Other fields see prints differently. For a musician, a ‘print’ may be the sheet music which spread classical and popular music around the world; it may be a ‘record’ (as in a ‘recording’ session), where sound is impressed to wax, vinyl, charged silicon particles, or the alloys (Smith, “Elpida”) of an mp3 file. For the fine artist, a ‘print’ may be any mechanically reproduced two-dimensional (or embossed) impression of a significant image in media from paper to metal, textile to ceramics. ‘Print’ embraces the Japanese Ukiyo-e colour prints of Utamaro, the company logos that wink from credit card holographs, the early photographs of Talbot, and the textured patterns printed into neolithic ceramics. Computer hardware engineers print computational circuits. Homicide detectives investigate both sweaty finger prints and the repeated, mechanical gaits of suspects, which are imprinted into the earthy medium of a crime scene. For film makers, the ‘print’ may refer to a photochemical polyester reproduction of a motion picture artifact (the reel of ‘celluloid’), or a DVD laser disc impression of the same film. Textualist discourse has borrowed the word ‘print’ to mean ‘text’, so ‘print’ may also refer to the text elements within the vision track of a motion picture: the film’s opening titles, or texts photographed inside the motion picture story such as the sword-cut ‘Z’ in Zorro (Niblo). Before the invention of writing, the main mechanically reproduced impression of a cultural symbol in a medium was the humble footprint in the sand. The footprints of tribes – and neighbouring animals – cut tracks in the vegetation and the soil. Printed tracks led towards food, water, shelter, enemies and friends. Having learnt to pattern certain faces into their mental world, children grew older and were educated in the footprints of family and clan, enemies and food. The continuous impression of significant foot traffic in the medium of the earth produced the lines between significant nodes of prewriting and pre-wheeled cultures. These tracks were married to audio tracks, such as the song lines of the Australian Aborigines, or the ballads of tramping culture everywhere. A typical tramping song has the line, ‘There’s a track winding back to an old-fashion shack along the road to Gundagai,’ (O’Hagan), although this colonial-style song was actually written for radio and became an international hit on the airwaves, rather than the tramping trails. The printed tracks impressed by these cultural flows are highly contested and diverse, and their foot prints are woven into our very language. The names for printed tracks have entered our shared memory from the intersection of many cultures: ‘Track’ is a Germanic word entering English usage comparatively late (1470) and now used mainly in audio visual cultural reproduction, as in ‘soundtrack’. ‘Trek’ is a Dutch word for ‘track’ now used mainly by ecotourists and science fiction fans. ‘Learn’ is a Proto-Indo-European word: the verb ‘learn’ originally meant ‘to find a track’ back in the days when ‘learn’ had a noun form which meant ‘the sole of the foot’. ‘Tract’ and ‘trace’ are Latin words entering English print usage before 1374 and now used mainly in religious, and electronic surveillance, cultural reproduction. ‘Trench’ in 1386 was a French path cut through a forest. ‘Sagacity’ in English print in 1548 was originally the ability to track or hunt, in Proto-Indo-European cultures. ‘Career’ (in English before 1534) was the print made by chariots in ancient Rome. ‘Sleuth’ (1200) was a Norse noun for a track. ‘Investigation’ (1436) was Latin for studying a footprint (Harper). The arrival of symbolic writing scratched on caves, hearth stones, and trees (the original meaning of ‘book’ is tree), brought extremely limited text education close to home. Then, with baked clay tablets, incised boards, slate, bamboo, tortoise shell, cast metal, bark cloth, textiles, vellum, and – later – paper, a portability came to text that allowed any culture to venture away from known ‘foot’ paths with a reduction in the risk of becoming lost and perishing. So began the world of maps, memos, bills of sale, philosophic treatises and epic mythologies. Some of this was printed, such as the mechanical reproduction of coins, but the fine handwriting required of long, extended, portable texts could not be printed until the invention of paper in China about 2000 years ago. Compared to lithic architecture and genes, portable text is a fragile medium, and little survives from the millennia of its innovators. The printing of large non-text designs onto bark-paper and textiles began in neolithic times, but Sui Wen-ti’s imperial memo of 593 AD gives us the earliest written date for printed books, although we can assume they had been published for many years previously. The printed book was a combination of Indian philosophic thought, wood carving, ink chemistry and Chinese paper. The earliest surviving fragment of paper-print technology is ‘Mantras of the Dharani Sutra’, a Buddhist scripture written in the Sanskrit language of the Indian subcontinent, unearthed at an early Tang Dynasty site in Xian, China – making the fragment a veteran piece of printing, in the sense that Sanskrit books had been in print for at least a century by the early Tang Dynasty (Chinese Graphic Arts Net). At first, paper books were printed with page-size carved wooden boards. Five hundred years later, Pi Sheng (c.1041) baked individual reusable ceramic characters in a fire and invented the durable moveable type of modern printing (Silk Road 2000). Abandoning carved wooden tablets, the ‘digitizing’ of Chinese moveable type sped up the production of printed texts. In turn, Pi Sheng’s flexible, rapid, sustainable printing process expanded the political-cultural impact of the literati in Asian society. Digitized block text on paper produced a bureaucratic, literate elite so powerful in Asia that Louis XVI of France copied China’s print-based Confucian system of political authority for his own empire, and so began the rise of the examined public university systems, and the civil service systems, of most European states (Watson, Visions). By reason of its durability, its rapid mechanical reproduction, its culturally agreed signs, literate readership, revered authorship, shared ideology, and distributed portability, a ‘print’ can be a powerful cultural network which builds and expands empires. But print also attacks and destroys empires. A case in point is the Spanish conquest of Aztec America: The Aztecs had immense libraries of American literature on bark-cloth scrolls, a technology which predated paper. These libraries were wiped out by the invading Spanish, who carried a different book before them (Ewins). In the industrial age, the printing press and the gun were seen as the weapons of rebellions everywhere. In 1776, American rebels staffed their ‘Homeland Security’ units with paper makers, knowing that defeating the English would be based on printed and written documents (Hahn). Mao Zedong was a book librarian; Mao said political power came out of the barrel of a gun, but Mao himself came out of a library. With the spread of wireless networked servers, political ferment comes out of the barrel of the cell phone and the internet chat room these days. Witness the cell phone displays of a plane hitting a tower that appear immediately after 9/11 in the Middle East, or witness the show trials of a few US and UK lower ranks who published prints of their torturing activities onto the internet: only lower ranks who published prints were arrested or tried. The control of secure servers and satellites is the new press. These days, we live in a global library of burning books – ‘burning’ in the sense that ‘print’ is now a charged silicon medium (Smith, “Intel”) which is usually made readable by connecting the chip to nuclear reactors and petrochemically-fired power stations. World resources burn as we read our screens. Men, women, children burn too, as we watch our infotainment news in comfort while ‘their’ flickering dead faces are printed in our broadcast hearths. The print we watch is not the living; it is the voodoo of the living in the blackout behind the camera, engaging the blood sacrifice of the tormented and the unfortunate. Internet texts are also ‘on fire’ in the third sense of their fragility and instability as a medium: data bases regularly ‘print’ fail-safe copies in an attempt to postpone the inevitable mechanical, chemical and electrical failure that awaits all electronic media in time. Print defines a moral position for everyone. In reporting conflict, in deciding to go to press or censor, any ‘print’ cannot avoid an ethical context, starting with the fact that there is a difference in power between print maker, armed perpetrators, the weak, the peaceful, the publisher, and the viewer. So many human factors attend a text, video or voice ‘print’: its very existence as an aesthetic object, even before publication and reception, speaks of unbalanced, and therefore dynamic, power relationships. For example, Graham Greene departed unscathed from all the highly dangerous battlefields he entered as a novelist: Riot-torn Germany, London Blitz, Belgian Congo, Voodoo Haiti, Vietnam, Panama, Reagan’s Washington, and mafia Europe. His texts are peopled with the injustices of the less fortunate of the twentieth century, while he himself was a member of the fortunate (if not happy) elite, as is anyone today who has the luxury of time to read Greene’s works for pleasure. Ethically a member of London and Paris’ colonizers, Greene’s best writing still electrifies, perhaps partly because he was in the same line of fire as the victims he shared bread with. In fact, Greene hoped daily that he would escape from the dreadful conflicts he fictionalized via a body bag or an urn of ashes (see Sherry). In reading an author’s biography we have one window on the ethical dimensions of authority and print. If a print’s aesthetics are sometimes enduring, its ethical relationships are always mutable. Take the stylized logo of a running athlete: four limbs bent in a rotation of action. This dynamic icon has symbolized ‘good health’ in Hindu and Buddhist culture, from Madras to Tokyo, for thousands of years. The cross of bent limbs was borrowed for the militarized health programs of 1930s Germany, and, because of what was only a brief, recent, isolated yet monstrously horrific segment of its history in print, the bent-limbed swastika is now a vilified symbol in the West. The sign remains ‘impressed’ differently on traditional Eastern culture, and without the taint of Nazism. Dramatic prints are emotionally charged because, in depicting Homo sapiens in danger, or passionately in love, they elicit a hormonal reaction from the reader, the viewer, or the audience. The type of emotions triggered by a print vary across the whole gamut of human chemistry. A recent study of three genres of motion picture prints shows a marked differences in the hormonal responses of men compared to women when viewing a romance, an actioner, and a documentary (see Schultheiss, Wirth, and Stanton). Society is biochemically diverse in its engagement with printed culture, which raises questions about equality in the arts. Motion picture prints probably comprise around one third of internet traffic, in the form of stolen digitized movie files pirated across the globe via peer-to-peer file transfer networks (p2p), and burnt as DVD laser prints (BBC). There is also a US 40 billion dollar per annum legitimate commerce in DVD laser pressings (Grassl), which would suggest an US 80 billion per annum world total in legitimate laser disc print culture. The actively screen literate, or the ‘sliterati’ as I prefer to call them, research this world of motion picture prints via their peers, their internet information channels, their television programming, and their web forums. Most of this activity occurs outside the ambit of universities and schools. One large site of sliterate (screen literate) practice outside most schooling and official research is the net of online forums at imdb.com (International Movie Data Base). Imdb.com ‘prints’ about 25,000,000 top pages per month to client browsers. Hundreds of sliterati forums are located at imdb, including a forum for the Australian movie, Muriel’s Wedding (Hogan). Ten years after the release of Muriel’s Wedding, young people who are concerned with victimization and bullying still log on to http://us.imdb.com/title/tt0110598/board/> and put their thoughts into print: I still feel so bad for Muriel in the beginning of the movie, when the girls ‘dump’ her, and how much the poor girl cried and cried! Those girls were such biartches…I love how they got their comeuppance! bunniesormaybemidgets’s comment is typical of the current discussion. Muriel’s Wedding was a very popular film in its first cinema edition in Australia and elsewhere. About 30% of the entire over-14 Australian population went to see this photochemical polyester print in the cinemas on its first release. A decade on, the distributors printed a DVD laser disc edition. The story concerns Muriel (played by Toni Collette), the unemployed daughter of a corrupt, ‘police state’ politician. Muriel is bullied by her peers and she withdraws into a fantasy world, deluding herself that a white wedding will rescue her from the torments of her blighted life. Through theft and deceit (the modus operandi of her father) Muriel escapes to the entertainment industry and finds a ‘wicked’ girlfriend mentor. From a rebellious position of stubborn independence, Muriel plays out her fantasy. She gets her white wedding, before seeing both her father and her new married life as hollow shams which have goaded her abandoned mother to suicide. Redefining her life as a ‘game’ and assuming responsibility for her independence, Muriel turns her back on the mainstream, image-conscious, female gang of her oppressed youth. Muriel leaves the story, having rekindled her friendship with her rebel mentor. My methodological approach to viewing the laser disc print was to first make a more accessible, coded record of the entire movie. I was able to code and record the print in real time, using a new metalanguage (Watson, “Eyes”). The advantage of Coding is that ‘thinks’ the same way as film making, it does not sidetrack the analyst into prose. The Code splits the movie print into Vision Action [vision graphic elements, including text] (sound) The Coding splits the vision track into normal action and graphic elements, such as text, so this Coding is an ideal method for extracting all the text elements of a film in real time. After playing the film once, I had four and a half tightly packed pages of the coded story, including all its text elements in square brackets. Being a unique, indexed hard copy, the Coded copy allowed me immediate access to any point of the Muriel’s Wedding saga without having to search the DVD laser print. How are ‘print’ elements used in Muriel’s Wedding? Firstly, a rose-coloured monoprint of Muriel Heslop’s smiling face stares enigmatically from the plastic surface of the DVD picture disc. The print is a still photo captured from her smile as she walked down the aisle of her white wedding. In this print, Toni Collette is the Mona Lisa of Australian culture, except that fans of Muriel’s Wedding know the meaning of that smile is a magical combination of the actor’s art: the smile is both the flush of dreams come true and the frightening self deception that will kill her mother. Inserting and playing the disc, the text-dominant menu appears, and the film commences with the text-dominant opening titles. Text and titles confer a legitimacy on a work, whether it is a trade mark of the laser print owners, or the household names of stars. Text titles confer status relationships on both the presenters of the cultural artifact and the viewer who has entered into a legal license agreement with the owners of the movie. A title makes us comfortable, because the mind always seeks to name the unfamiliar, and a set of text titles does that job for us so that we can navigate the ‘tracks’ and settle into our engagement with the unfamiliar. The apparent ‘truth’ and ‘stability’ of printed text calms our fears and beguiles our uncertainties. Muriel attends the white wedding of a school bully bride, wearing a leopard print dress she has stolen. Muriel’s spotted wild animal print contrasts with the pure white handmade dress of the bride. In Muriel’s leopard textile print, we have the wild, rebellious, impoverished, inappropriate intrusion into the social ritual and fantasy of her high-status tormentor. An off-duty store detective recognizes the printed dress and calls the police. The police are themselves distinguished by their blue-and-white checked prints and other mechanically reproduced impressions of cultural symbols: in steel, brass, embroidery, leather and plastics. Muriel is driven in the police car past the stenciled town sign (‘Welcome To Porpoise Spit’ heads a paragraph of small print). She is delivered to her father, a politician who presides over the policing of his town. In a state where the judiciary, police and executive are hijacked by the same tyrant, Muriel’s father, Bill, pays off the police constables with a carton of legal drugs (beer) and Muriel must face her father’s wrath, which he proceeds to transfer to his detested wife. Like his daughter, the father also wears a spotted brown print costume, but his is a batik print from neighbouring Indonesia (incidentally, in a nation that takes the political status of its batik prints very seriously). Bill demands that Muriel find the receipt for the leopard print dress she claims she has purchased. The legitimate ownership of the object is enmeshed with a printed receipt, the printed evidence of trade. The law (and the paramilitary power behind the law) are legitimized, or contested, by the presence or absence of printed text. Muriel hides in her bedroom, surround by poster prints of the pop group ABBA. Torn-out prints of other people’s weddings adorn her mirror. Her face is embossed with the clown-like primary colours of the marionette as she lifts a bouquet to her chin and stares into the real time ‘print’ of her mirror image. Bill takes the opportunity of a business meeting with Japanese investors to feed his entire family at ‘Charlie Chan’’s restaurant. Muriel’s middle sister sloppily wears her father’s state election tee shirt, printed with the text: ‘Vote 1, Bill Heslop. You can’t stop progress.’ The text sets up two ironic gags that are paid off on the dialogue track: “He lost,’ we are told. ‘Progress’ turns out to be funding the concreting of a beach. Bill berates his daughter Muriel: she has no chance of becoming a printer’s apprentice and she has failed a typing course. Her dysfunction in printed text has been covered up by Bill: he has bribed the typing teacher to issue a printed diploma to his daughter. In the gambling saloon of the club, under the arrays of mechanically repeated cultural symbols lit above the poker machines (‘A’ for ace, ‘Q’ for queen, etc.), Bill’s secret girlfriend Diedre risks giving Muriel a cosmetics job. Another text icon in lights announces the surf nightclub ‘Breakers’. Tania, the newly married queen bitch who has made Muriel’s teenage years a living hell, breaks up with her husband, deciding to cash in his negotiable text documents – his Bali honeymoon tickets – and go on an island holiday with her girlfriends instead. Text documents are the enduring site of agreements between people and also the site of mutations to those agreements. Tania dumps Muriel, who sobs and sobs. Sobs are a mechanical, percussive reproduction impressed on the sound track. Returning home, we discover that Muriel’s older brother has failed a printed test and been rejected for police recruitment. There is a high incidence of print illiteracy in the Heslop family. Mrs Heslop (Jeannie Drynan), for instance, regularly has trouble at the post office. Muriel sees a chance to escape the oppression of her family by tricking her mother into giving her a blank cheque. Here is the confluence of the legitimacy of a bank’s printed negotiable document with the risk and freedom of a blank space for rebel Muriel’s handwriting. Unable to type, her handwriting has the power to steal every cent of her father’s savings. She leaves home and spends the family’s savings at an island resort. On the island, the text print-challenged Muriel dances to a recording (sound print) of ABBA, her hand gestures emphasizing her bewigged face, which is made up in an impression of her pop idol. Her imitation of her goddesses – the ABBA women, her only hope in a real world of people who hate or avoid her – is accompanied by her goddesses’ voices singing: ‘the mystery book on the shelf is always repeating itself.’ Before jpeg and gif image downloads, we had postcard prints and snail mail. Muriel sends a postcard to her family, lying about her ‘success’ in the cosmetics business. The printed missal is clutched by her father Bill (Bill Hunter), who proclaims about his daughter, ‘you can’t type but you really impress me’. Meanwhile, on Hibiscus Island, Muriel lies under a moonlit palm tree with her newly found mentor, ‘bad girl’ Ronda (Rachel Griffiths). In this critical scene, where foolish Muriel opens her heart’s yearnings to a confidante she can finally trust, the director and DP have chosen to shoot a flat, high contrast blue filtered image. The visual result is very much like the semiabstract Japanese Ukiyo-e woodblock prints by Utamaro. This Japanese printing style informed the rise of European modern painting (Monet, Van Gogh, Picasso, etc., were all important collectors and students of Ukiyo-e prints). The above print and text elements in Muriel’s Wedding take us 27 minutes into her story, as recorded on a single page of real-time handwritten Coding. Although not discussed here, the Coding recorded the complete film – a total of 106 minutes of text elements and main graphic elements – as four pages of Code. Referring to this Coding some weeks after it was made, I looked up the final code on page four: taxi [food of the sea] bq. Translation: a shop sign whizzes past in the film’s background, as Muriel and Ronda leave Porpoise Spit in a taxi. Over their heads the text ‘Food Of The Sea’ flashes. We are reminded that Muriel and Ronda are mermaids, fantastic creatures sprung from the brow of author PJ Hogan, and illuminated even today in the pantheon of women’s coming-of-age art works. That the movie is relevant ten years on is evidenced by the current usage of the Muriel’s Wedding online forum, an intersection of wider discussions by sliterate women on imdb.com who, like Muriel, are observers (and in some cases victims) of horrific pressure from ambitious female gangs and bullies. Text is always a minor element in a motion picture (unless it is a subtitled foreign film) and text usually whizzes by subliminally while viewing a film. By Coding the work for [text], all the text nuances made by the film makers come to light. While I have viewed Muriel’s Wedding on many occasions, it has only been in Coding it specifically for text that I have noticed that Muriel is a representative of that vast class of talented youth who are discriminated against by print (as in text) educators who cannot offer her a life-affirming identity in the English classroom. Severely depressed at school, and failing to type or get a printer’s apprenticeship, Muriel finds paid work (and hence, freedom, life, identity, independence) working in her audio visual printed medium of choice: a video store in a new city. Muriel found a sliterate admirer at the video store but she later dumped him for her fantasy man, before leaving him too. One of the points of conjecture on the imdb Muriel’s Wedding site is, did Muriel (in the unwritten future) get back together with admirer Brice Nobes? That we will never know. While a print forms a track that tells us where culture has been, a print cannot be the future, a print is never animate reality. At the end of any trail of prints, one must lift one’s head from the last impression, and negotiate satisfaction in the happening world. References Australian Broadcasting Corporation. “Memo Shows US General Approved Interrogations.” 30 Mar. 2005 http://www.abc.net.au>. British Broadcasting Commission. “Films ‘Fuel Online File-Sharing’.’’ 22 Feb. 2005 http://news.bbc.co.uk/1/hi/technology/3890527.stm>. Bretherton, I. “The Origins of Attachment Theory: John Bowlby and Mary Ainsworth.” 1994. 23 Jan. 2005 http://www.psy.med.br/livros/autores/bowlby/bowlby.pdf>. Bunniesormaybemidgets. Chat Room Comment. “What Did Those Girls Do to Rhonda?” 28 Mar. 2005 http://us.imdb.com/title/tt0110598/board/>. Chinese Graphic Arts Net. Mantras of the Dharani Sutra. 20 Feb. 2005 http://www.cgan.com/english/english/cpg/engcp10.htm>. Ewins, R. Barkcloth and the Origins of Paper. 1991. 20 Feb. 2005 http://www.justpacific.com/pacific/papers/barkcloth~paper.html>. Grassl K.R. The DVD Statistical Report. 14 Mar. 2005 http://www.corbell.com>. Hahn, C. M. The Topic Is Paper. 20 Feb. 2005 http://www.nystamp.org/Topic_is_paper.html>. Harper, D. Online Etymology Dictionary. 14 Mar. 2005 http://www.etymonline.com/>. Mask of Zorro, The. Screenplay by J McCulley. UA, 1920. Muriel’s Wedding. Dir. PJ Hogan. Perf. Toni Collette, Rachel Griffiths, Bill Hunter, and Jeannie Drynan. Village Roadshow, 1994. O’Hagan, Jack. On The Road to Gundagai. 1922. 2 Apr. 2005 http://ingeb.org/songs/roadtogu.html>. Poole, J.H., P.L. Tyack, A.S. Stoeger-Horwath, and S. Watwood. “Animal Behaviour: Elephants Are Capable of Vocal Learning.” Nature 24 Mar. 2005. Sanchez, R. “Interrogation and Counter-Resistance Policy.” 14 Sept. 2003. 30 Mar. 2005 http://www.abc.net.au>. Schultheiss, O.C., M.M. Wirth, and S.J. Stanton. “Effects of Affiliation and Power Motivation Arousal on Salivary Progesterone and Testosterone.” Hormones and Behavior 46 (2005). Sherry, N. The Life of Graham Greene. 3 vols. London: Jonathan Cape 2004, 1994, 1989. Silk Road. Printing. 2000. 20 Feb. 2005 http://www.silk-road.com/artl/printing.shtml>. Smith, T. “Elpida Licenses ‘DVD on a Chip’ Memory Tech.” The Register 20 Feb. 2005 http://www.theregister.co.uk/2005/02>. —. “Intel Boffins Build First Continuous Beam Silicon Laser.” The Register 20 Feb. 2005 http://www.theregister.co.uk/2005/02>. Watson, R. S. “Eyes And Ears: Dramatic Memory Slicing and Salable Media Content.” Innovation and Speculation, ed. Brad Haseman. Brisbane: QUT. [in press] Watson, R. S. Visions. Melbourne: Curriculum Corporation, 1994. Citation reference for this article MLA Style Watson, Robert. "E-Press and Oppress: Audio Visual Print Drama, Identity, Text and Motion Picture Rebellion." M/C Journal 8.2 (2005). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0506/08-watson.php>. APA Style Watson, R. (Jun. 2005) "E-Press and Oppress: Audio Visual Print Drama, Identity, Text and Motion Picture Rebellion," M/C Journal, 8(2). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0506/08-watson.php>.