The Impact of Hospital Privatization on Physicians’ Perceived Job Security, Job Satisfaction and Salary Satisfaction in Yerevan, Armenia

Abstract

Background: Privatization is an act of transferring a public hospital to private ownership. Although the privatization of Armenian hospitals began in 1994, no study was found evaluating the differences between private and public hospital ownership on physicians’ perceived working conditions, job security, and satisfaction in Armenia. The purpose of this study was to find similarities and differences in these factors between private and public general hospitals in Yerevan that may lead to improvements in physician satisfaction and quality of health care. Methods: This study applies an analytical cross-sectional design targeting public and private general hospital physicians in Yerevan, using a questionnaire to assess differences in physicians’ perceived job security, job satisfaction and salary satisfaction between private and public hospitals, and socio-demographic information. A census of all 427 eligible physicians in all seventeen public and private hospitals in Yerevan was attempted. Of the 164 physicians contacted, only 110 consented to participate in the study for a 33% refusal rate. The data entry and calculation was conducted using the SPSS 11 software package. Results: A total of 110 physicians participated in the study (45 from public and 65 from private general hospitals). Of the total number 25% (27/110) were female and 75% (83/110) were male physicians. The chi-square and multivariate analyses showed that there was no statistically significant difference in perceived job security and no statistically significant difference in physicians’ perceived job satisfaction between physicians’ working in private and public general hospitals of Yerevan. However, there was a statistically significant difference (p=0.04) in physicians’ perceived salary satisfaction. A total of 29% of physicians were satisfied with their salary in private general hospitals as compared to 20% salary satisfaction in public general hospitals. Multivariate linear regression with salary satisfaction as the outcome, showed that being a physician in a private general hospital on the average increases the salary satisfaction score by 0.36 (p=0.04) as compared to a physician working in a public general hospital and independently working as a therapist or general practitioner as compared to working as a resuscitation specialist on the average decreases satisfaction score by 0.55 (p=0.04). Conclusion and Recommendations: The similarities between physicians’ perceived job security and job satisfaction in public and private general hospitals suggest that current systemic differences between these two hospital systems is smaller than in other countries. Further research should be conducted on financial systems and functions as well as other factors that lead to the differences in physicians’ salary satisfaction between public and private general hospitals to inform policy, legislative and/or regulatory interventions that may lead to improved quality of care. Continued monitoring in systemic changes between private and public hospitals should be conducted to maintain and improve the quality of health care for the population.