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Optimising Professional Life:A grounded theory of doctors’ careers
Lesley Piko College of Medicine, Biology and Environment
Australian National University, Canberra6 June 2014
Research Context and Objectives
Context• Central role of GPs in Australia’s health care system• 80% of Australians aged 15+ visit a GP each year1
• Ageing population, increased health burden2
• Recruitment and retention3
• Changing work and career patterns
Objectives• To investigate how experienced GPs working in Australia develop
their career• To produce theory that can be applied in practice1. AUSTRALIAN BUREAU OF STATISTICS 2010. Health Services: Patient Experience in Australia, 2009. Cat. no. 4839.0.55.001, Canberra, Australia.
2. AUSTRALIAN GOVERNMENT NATIONAL HEALTH AND HOSPITALS REFORM COMMISSION 2009. A Healthier Future for all Australians - Final Report, Canberra, Australia. Commonwealth of Australia.
3. HEALTH WORKFORCE AUSTRALIA 2012. Health Workforce 2025 Volume 3 - Medical Specialities, Adelaide, Australia. Health Workforce Australia.
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Research Method
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Glaser’s grounded theory method4 • Inductive approach to produce theory grounded in data• Openness, research does not start with a theory to prove or
disprove, begins without preconceived questions and categories• Concurrent processes of data collection, analysis and comparison• Conceptualise the underlying pattern of vocational behaviour• Interviews with 30 Australian GPs and 7 managers of GP
businesses
Quantitative analysis • Medicine in Australia: Balancing Employment and Life (MABEL)• 2,255 survey responses, 35-59 years
4. GLASER, B. & STRAUSS, A. 1967. The Discovery of Grounded Theory, Chicago, Ill, USA,. Aldine.
GLASER, B. G. 1978. Theoretical Sensitivity: Advances in the Methodology of Grounded Theory, Mill Valley, CA, USA. Sociology Press.
GLASER, B. G. 1998. Doing Grounded Theory: Issues and Discussions, Mill Valley, CA., USA. Sociology Press.
GLASER, B. G. & HOLTEN, J. A. (eds.) 2007. The Grounded Theory Seminar Reader, Mill Valley , CA, USA. Sociology Press.
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Australian GP Demographics
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Interview data 2010
MABEL sample 2010
National data5 2011
Total GPs 30 2,255 17,099
% age groups< 35 years35-39 years40-44 years45-49 years50-54 years55-59 years60+ years
3%17%10%20%37%10%3%
-16%18%22%25%20%
-
-15%18%23%24%21%
-
% female 57% 53% 44%
% major city 70% 70% 72%
5. Sourced from Australian Institute of Health and Welfare, 2011. National Health Workforce Dataset (NHWDS), Medical workforce. Canberra, Australia. AIHW.
Research Results
The new Theory of Optimising Professional Life states that• Experienced GPs working in Australia are concerned about the
careful development of their professional life• To resolve this concern each practitioner makes a series of
assessments and enacts a series of choices, iteratively throughout their career, to optimise their personal situation
• Aspirational
‘to be the best GP that I could be’ (GP Monica)
• Self-protection and sustainability
‘I couldn’t do just general practice without having other outlets and still be a functioning healthy person’ (GP Meg)
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Framework for The Theory of Optimising Professional Life
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Propositions for The Theory of Optimising Professional Life
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Proposition #1 The main concern being addressed by the professionals in this study is the need for careful development.
Proposition #2 The aim of the Optimising process is to achieve the most satisfactory solution i.e. to satisfy the need for careful development to the greatest extent possible within a set of constraints.
Proposition #3 The process of Optimising has three stages – stage of discomfort, stage of assessment (a cross roads) and stage of resolution.
Proposition #4 The solution space holds a range of possible satisfactory and very satisfactory solutions which meet the GP’s need for careful development. Solutions are found in four dimensions – treating patients (control over work content and how the work is done), structuring the work day (administrative structure of the day), integrating work and personal life (balance between personal and professional life) and adapting oneself (changing oneself to resolve the problem).
Proposition #5 GPs are aware of, and respond to the constraints present in the internal and external environments.
Proposition #6 Having personal autonomy and control enables GPs to make the changes they wish to make to optimise their situation.
Proposition #7 Optimising is a psychological process that recurs throughout a professional career.
Stages and properties of Optimising Professional Life
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Results of the quantitative analysis
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• Principal components analysis identified four underlying factors consistent with the concept of careful development:
Workload, Intellectual aspects, Stressors, Financial reward
These explained 61% of the variance in 13 MABEL variables
• Discriminant analysis predicted satisfaction with 65% accuracy
• Significant relationships between careful development factors and satisfaction
• Autonomy and control are important to satisfaction
Contribution to Career Theory
Broad categories of career theories
• Theories of person-environment fit (Holland6, Dawis and Lofquist7)
• Career development theories (Super8)
• Learning theory (Lent et al9)
• Boundaryless Career (Arthur10)6. HOLLAND, J. L. 1997. Making vocational choices: a theory of vocational personalities and work environments, 3rd ed, Odessa, FL, USA. Psychological
Assessment Resources..
7. DAWIS, R. V. & LOFQUIST, L. H. 1984. A psychological theory of work adjustment, Minneapolis, USA. University of Minnesota Press..
8. SUPER, D. E. 1980. A life-span, life-space approach to career development. Journal of Vocational Behavior, 16, 282-298.
9. LENT, R. W., BROWN, S. D. & HACKETT, G. 2002. Social cognitive career theory. In: DUANE BROWN AND ASSOCIATES (ed.) Career Choice and Development (4th ed., pp. 255-311). San Francisco, CA, USA. Jossey-Bass.
10. ARTHUR, M. B. 1994. The Boundaryless Career: A New Perspective for Organizational Inquiry. Journal of Organizational Behavior, 15, 295-306.
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Features of the Theory of Optimising Professional Life
• The focus on resolving discomfort leads to an improved match between a GP and work
• Satisfaction of needs specific to GPs
• Addresses multiple environments (each patient, workplace, family)
• Spans organisational boundaries
• Dynamic, iterative approach to career development
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Contribution to GP vocational guidance
• New perspective that integrates macro (structural) and micro (psychological) dimensions of an issue
• Assists a GP to enhance comfort with self care, staying interested in the work and financial reward
• Identifies opportunities to resolve discomfort through treating patients, structuring the work day, integrating work and personal life and adapting oneself
• Supports GP autonomy
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Recruitment
• Attract and recruit GPs to the workforce by informing potential recruits about the nature and benefits of a career in general practice
• The Theory explains that over a career GPs will be concerned about continuing to have interesting work, receiving adequate financial reward and maintaining their own wellbeing
• The Theory shows potential recruits how a career in general practice can satisfy each of these personal needs
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Retention
• Retain GPs who are dissatisfied, or considering leaving, by empowering them to understand and resolve their concerns
• The Theory of Optimising Professional Life offers a problem-focused approach
Efficient and effective health care
• Realise efficient and effective health care delivery by preparing GPs to operate within new models of general practice as they evolve
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Further research: broader applicability of the Theory
• Other medical occupations in Australia
• Doctors in other countries and cultures
• Professional occupations outside of medicine that have
non-hierarchical workplaces
eg. veterinarians, dentists, lawyers, accountants, architects and others who work in small private businesses
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