Jean E. Wallace

Physician wellness: a missing quality indicator

When physicians are unwell, the performance of health-care systems can be suboptimum. Physician wellness might not only benefit the individual physician, it could also be vital to the delivery of high-quality health care. We review the work stresses faced by physicians, the barriers to attending to wellness, and the consequences of unwell physicians to the individual and to health-care systems. We show that health systems should routinely measure physician wellness, and discuss the challenges associated with implementation.

Employee Commitment Resolving some Issues

There has been a recent upsurge of interest among sociologists in the organizational commitment of employees, with loyalty and intent to stay identified as distinct forms that this commitment can take. This article argues that progress in understanding organizational commitment will not be made until conceptual and empirical distinctions among various forms of employee commitment are recognized and demonstrated. With this as the objective, it was hypothesized that loyalty and intent to stay are conceptually and empirically distinct from each other as well as from two other forms of employee commitment: work commitment and career commitment. This was tested with confirmatory factor analysis and was supported across a variety of tests. Construct validation was obtained by supporting the hypothesis that the two forms of organizational commitment but not work or career commitment are less stable during the initial employment period but then stabilize with tenure. Finally, predictive validity was established for intent to stay by demonstrating that it predicted quit behavior, or turnover, but loyalty, work commitment, and career commitment did not. Implications for studying organizational commitment within the context of substantive sociological issues are discussed.

Becker's Side-Bet Theory of Commitment Revisited: Is It Time for a Moratorium or a Resurrection?

The results of Cohen and Lowenbergs 1990 meta-analysis of 50 studies that empirically test Beckers (1960) side-bet model provide little empirical support for his theory of commitment. They conclude that severe limitations of past research, both in terms of measuring commitment and the strategies used to test the side-bet model, may be responsible for the lack of empirical support. Alternatively, they submit that if these methodological problems are not at fault, we should consider abandoning the side-bet theory. Three limitations of past side-bet research are addressed in this study. The results of this study suggest that it is time to resurrect Beckers side-bet theory of commitment. In doing so, we should subject his theory to tests that employ more valid and direct measures of the side-bet variables, that use measures of continuance commitment rather than affective commitment, and that apply to both organizational and occupational commitment.

Justice and the paradox of the contented female worker

Studies have shown that women are as satisfied with their jobs as are their male counterparts. This finding is viewed as suggesting a paradox because womens rewards and work conditions are usually less favorable than mens. Phelan (1994) evaluated five explanations for the paradox but could not evaluate the possibility that perceived justice accounts for the paradox. We evaluate the same explanations, but also examine the importance of perceived justice. We find, for a sample of female and male lawyers, that no paradox exists for job satisfaction when the model is specified properly. For pay satisfaction, however, perceived justice is critically important in explaining gender satisfaction differences, but even this does not account entirely for the paradox. The use of same-gender reference groups in evaluating justice may be responsible for the gap that remains, although supplemental data suggest that this is not the case for these lawyers.

Mental health and stigma in the medical profession.

Until recently, much of the recent upsurge in interest in physician health has been motivated by concerns about improving patient care and patient safety and reducing medical errors. Increasingly, more attention has turned to examining how the management of mental illness among physicians might be improved within the medical profession and one key direction for change is the reduction of stigma associated with mental illness. I begin this article by presenting a brief overview of the stigma process from the general sociological literature. Next, I provide evidence that illustrates how the stigma of mental illness thrives in the medical profession as a result of the culture of medicine and medical training, perceptions of physicians and their colleagues, and expectations and responses of health care systems and organizations. Lastly, I discuss what needs to change by proposing ways of educating and raising awareness regarding mental illness among physicians, discussing approaches to assessing and identifying mental health concerns for physicians and by examining how safe and confidential support and treatment can be offered to physicians in need. I rely on strategically selected studies to effectively draw attention to and support the central themes of this article.

MOTHERHOOD AND CAREER COMMITMENT TO THE LEGAL PROFESSION

The literature suggests that women are less committed to and less successful in their careers than men because of family responsibilities. I examine whether mothers practicing law are less committed to their legal careers than other women. Mothers acknowledge that they violate certain time and career norms associated with practicing law and work in different settings, which may be interpreted by others as indicators of their lack of career commitment. The survey results reveal that, despite these violations, mothers report greater career commitment than other women in law. I conclude by examining possible explanations for these findings.

ARE SMALL FIRMS MORE BEAUTIFUL OR IS BIGGER BETTER? A Study of Compensating Differentials and Law Firm Internal Labor Markets

Research on the size–job rewards relationship emphasizes extrinsic rewards that are typically more prevalent in large, complex organizations. We examine whether certain intrinsic rewards are more characteristic of small firms and shift the focus from manufacturing industries to professional service (law) firms. We find that small is not entirely beautiful. Smaller firms offer more autonomy but no more challenging work or better coworker relations, whereas larger firms offer lucrative salaries, enhanced benefits, and greater promotional opportunities. Our results challenge the compensating differential explanation whereby large firms offer superior extrinsic rewards to compensate for a shortfall of instrinsic job rewards.

Can Women in Law Have it All? A Study of Motherhood, Career Satisfaction and Life Balance

Studies suggest that women in law appear dissatisfied with the practice of law due to the difficulties of balancing work and family. Little research has examined how the contextual characteristics of law firms affect women lawyers’ sense of life balance and career satisfaction, which is the focus of this study. I propose that if women in law firms can have children and be just as satisfied with their careers and have the same degree of life balance as women without children, then women practicing law can “have it all”. I show how contextual characteristics of law firms are important in understanding mothers’ and non-mothers’ work experiences.

Burnout among doctors

A system level problem requiring a system level response

Instrumental and socioemotional communications in doctor-patient interactions in urban and rural clinics

BackgroundLocation of practice, such as working in a rural or urban clinic, may influence how physicians communicate with their patients. This exploratory pilot study examines the communication styles used during doctor-patient interactions in urban and rural family practice settings in Western Canada.MethodsWe analyzed observation and interview data from four physicians practicing in these different locations. Using a grounded theory approach, communications were categorized as either instrumental or socioemotional. Instrumental communication refers to “cure-oriented interactions” and tends to be more task-oriented focusing on the patient’s health concerns and reason for the appointment. In contrast, socioemotional communication refers to more “care-oriented interactions” that may make the patient feel comfortable, relieve patient anxiety and build a trusting relationship.ResultsThe physicians in small, rural towns appear to know their patients and their families on a more personal level and outside of their office, and engage in more socioemotional communications compared to those practicing in suburban clinics in a large urban centre. Knowing patients outside the clinic seems to change the nature of the doctor-patient interaction, and, in turn, the doctor-patient relationship itself. Interactions between urban doctors and their patients had a mixture of instrumental and socioemotional communications, while interactions between rural doctors and their patients tended to be highly interpersonal, often involving considerable socioemotional communication and relationship-building.ConclusionsDespite the different ways that doctors and patients communicate with each other in the two settings, rural and urban doctors spend approximately the same amount of time with their patients. Thus, greater use of socioemotional communication by rural doctors, which may ease patient anxiety and increase patient trust, did not appear to add extra time to the patient visit. Research suggests that socioemotional communication may ultimately lead to better patient outcomes, which implies that health differences between rural and urban settings could be linked to differences in doctor-patient communication styles.