Original Article National Journal of Medical and Dental Research, July-September 2014: Volume-2, Issue-4, Page 31-35

Barriers to Career Development of Doctors in District

Hospitals

Manuscript Reference
Number: Njmdr_2410_14

Pawan KumarA, Swati GoyalB, Deep InderC, Indu GrewalD

AChief Medical Officer, Directorate of Health Services, Govt. of NCT of Delhi,
Karkardooma, Delhi, India
BSenior Resident, Department of Radio-diagnosis, All India Institute of Medical
Sciences, Bhopal, M. P., India.
CAssistant Professor, Department of Pharmacology, FOD, Jamia Millia Islamia,
New Delhi, India
DHead, Health Promotion & Education Division, Central Health Education Bureau,
Directorate General of Health Services, Ministry of Health and Family Welfare,
Govt. of India
Abstract:
Introduction: In hospital doctors are the key human resource for providing the health
care services to patients. Doctors are not only health care providers but they also
fulfill the role of managers and leaders in health care organizations.
Objective: To explore the barriers to career development of doctors and to find out
the factors responsible for working with such district hospitals in Delhi.
Material and Methods: A cross-sectional study was conducted in the three district
hospitals of Delhi in 2012. The responses of the doctors were recorded by a self
administered questionnaire. During the time of data collection, 90 doctors were
available in all the hospitals. Data was entered into MS excel sheet and analyzed by
SPSS version 18.
Results: Out of total 90 doctors only 72 doctors filled the self administered
questionnaire completely. Lack of training policy (44.4%) and lack of adequate
infrastructure (36.1%) in hospitals were the major barriers in the career advancement
of doctors. Main factors responsible for retaining more than half doctors in same
hospitals were pension benefits in job (55.5%) and non transferable job (50%). To
keep up the motivation of doctors salary enhancement (38.8%), reward system
(36.1%), good working environment (36.1%), need based training or sponsoring
for trainings (33.3%) and recognition of good work by administration (22.2%) were
various suggestions given by the doctors.

Date of submission: 18 August 2014

Date of Editorial approval: 20 August 2014
Date of Peer review approval: 25 August 2014

Conclusion: To overcome career development barriers, human resource development

policy is recommended at policy level keeping at forefront the present barriers and
binding factor responsible for working in such hospitals by the doctors.

Date of Publication: 30 September 2014

Conflict of Interest: Nil; Source of support: Nil

Key words: Human Resource, Trainings, Salary, Motivation.

Name and addresses of corresponding author:

Dr. Pawan Kumar
B-10, 1-A, Transit Officers Flat,
Battery Lane, Rajpur Road,

Introduction:

New Delhi- 110054. India.

Email: drpawan2000@gmail.com
Phone no: +91-98 68 86 46 66.
Conflict of interest: Nil
Source of support: Nil

World Health Organization reported that

there is a shortage of health workers with
an uneven distribution of human resources
particularly in developing countries.

31

India is listed among countries with a

critical shortage of health manpower [1].
Constraints related to human resources in
the health are hindrance for achieving the
health related goals. A growing concern
over poor outcomes for improvement

National Journal of Medical and Dental Research, July-September 2014: Volume-2, Issue-4, Page 31-35

of the health status of population in comparison to the

amount of resources spent has forced many countries
to introduce human resource reform measures in health
sector [2]. Human Resource Management in areas of skill
development, competencies and accountability are far away
from satisfaction in developing countries. An effective
workforce strategy can address the three core challenges
of improving recruitment, improving the performance
of the existing workforce, and slowing the rate at which
workers leave the health workforce [3]. There are a
number of complex and interrelated factors that contribute
to the ongoing workforce shortage globally, including
poorly resourced health systems, unsatisfactory working
conditions and career development and inadequate human
resources management in developing countries [4].
Non-financial incentives like provision of work autonomy,
flexibility in working time and recognition of work are vital
for organizations. Motivation at work is believed to be a key
factor in the performance of individuals and organizations
and is also a significant predictor of intention to quit the
workplace [5]. Professional development, education and
training are motivating, and they give health professionals
greater confidence in the way they can perform their duties
[6].
Increasing number of temporary doctors pose a threat to
the sustainability of the hospital medical workforce due
to lack of career development in the system. Doctors
who are having managerial responsibilities, inequality
in privileges and job conditions is seen as lower status
in the organisational hierarchy and this undermines their
authority when other health care workers working under
them are permanent employees [7]. Job characteristics
that influence job satisfaction in hospitals are the work
itself, pay, promotion opportunities, training facilities,
relationships with supervisor and co-workers, and the
working conditions, availability of infrastructure [8].
Job satisfaction represents the attitudes of organisational
commitment in which an employee identifies himself with a
particular organization and wishes to maintain membership
in that organization [9].

district hospitals and factors responsible for working with

such hospitals in Delhi, India and to provide suggestions
regarding the policies and programmes for engaging and
retaining doctors in public hospitals.

Materials and Methods:

A cross-sectional study was conducted in the three
district level hospitals of Delhi, India in 2012. The district
hospitals were selected by simple random technique and
all the doctors working in different specialties of medicine,
surgery, paediatrics, obstetrics & gynaecology were
enrolled as a part of study. The responses of the doctors
were recorded by a self administered questionnaire after
taking the informed consent. The study tool was self
developed, pretested and contained closed and open ended
questions. During the time of data collection, a total of
90 doctors were available in all the three hospitals. Data
was entered into MS excel sheet and analyzed by SPSS
version 18. Results were presented in the form of counts
and percentages.

Results:
Out of total 90 doctors only 72 doctors filled the self
administered questionnaire completely (response rate
80%). Therefore results were analyzed for 72 respondents.
Majority of the doctors (36.2%) were in the age group of
39-49 years followed by 22.2% each for the age group
of less than 29 years and more than 49 years. The group
comprised of 47.2% males and 52.8% females doctors.
About three fourth (77.8%) doctors were post graduates.
Only 61.1% had permanent job and rest were on contractual
jobs. About half of the doctors (55.6%) had experience
of more than 10 years and 36.1% had less than 05 years
experience as shown in table 1. Only 41.6 % doctors stated
that they would achieve career goals at present hospital
however 33.3% were not sure.

In hospitals, doctors are the key human resource for

providing the health care services to patients. Doctors are
not only health care providers but also fulfil the role of
managers and leaders in health care organisations. With
this background study was undertaken with the objective
to explore the barriers to career development of doctors in

32

Table No 1:
Background characteristics of doctors working in
selected Hospitals (n=72)

Age

Sex

Background Characteristics
Less than 29 years
29 -39 years
39-49 years
More than 49 years
Male
Female

n
16
14
26
16
34
38

Percentages
22.2
19.4
36.2
22.2
47.2
52.8

National Journal of Medical and Dental Research, July-September 2014: Volume-2, Issue-4, Page 31-35
Education
Type Job
Experience
Working hours per
week

Graduate
Post Graduate
Regular
Contractual
Less than 5 years
5-10 years
More than 10 years
Less than 40 hours
40-50 hours
More than 40 hours

16
56
44
28
26
6
40
30
26
16

22.2
77.8
61.1
38.9
36.1
8.3
55.6
41.6
36.1
22.3

low salaries (13.8%). Almost more than half of doctors

feel dissatisfied and de-motivated in the present scenario
of hospitals.
However some of difficulties told by doctors did not fit into
above contents. Therefore they are narrated as such as they
are important for health managers to understand.

Table No 2:
Barriers perceived by doctors for advancement of
career in hospitals (n=72)

Sr.
No
1
2
3
4
5

Type of barrier

n*

Percentage

Lack of training policy

Lack of adequate infrastructure in hospitals
Contractual jobs of doctors
Inefficient administration of hospitals
Low salaries of doctors

32
26
16
14
10

44.4
36.1
22.2
19.4
13.8

Regular doctors opinion top to down approach in

hospital is authoritative...authorities should listen
to junior doctors views while dealing with training and
development issues in hospitals during sending nominations
etc
Contractual doctors opinion .I am working as contract
doctor and working more than my permanent colleagues
but getting salary half than those, always there is a threat
that contract would not be extended no promotion,
no facility for study leave, no cadre management, no career
development in such situations

*Responses were not mutually exclusive

Table 3:
Factors retaining the doctors in the same Hospitals
(n=72)

Sr.
No
1
2
3
4
5

Factors

n*

Percentages

Pension Benefits
Non transferable job to other stations
Working place near to their residence
Good patients exposure for learning in the
Govt. Hospitals
Handsome salary to regular staff

40
36
24

55.5
50.0
33.3

22

30.5

10

13.8

Further same group of doctors were asked that in-spite

of constraints and difficulties in career development why
are they continuing in same hospital. Responses were
categorized into five main areas as listed in table no 3.

* Responses were not mutually exclusive

Table 4:
Suggestions to increase the satisfaction and motivation
of doctors in hospitals (n=72)
Sr.
No
1
2
3
4
5

Human Resource initiatives

n*

Percentage

Salary at par with private sector

Reward/Incentive system for Doctors
Good Working atmosphere in the hospitals
Need based training programme /
sponsorship for trainings
Recognition of good work by the
administration

28
26
26

38.8
36.1
36.1

24

33.3

22.2

From the table no 3 it is evident that main factors responsible

for retaining more than half doctors in same hospitals were
pension benefits (55.5%) among regular doctors which
they get in government job and non transferable job (50%)
other stations. Other factors stated by doctors were work
place near to their residence (33.3%) and good exposure
to clinical skill in government hospitals as they get variety
and more number of patients in district hospitals (30.5%).
Doctors in the hospitals gave suggestions that how to keep
motivation and satisfaction level high in the organization.
Suggestions are detailed in table no 4.

*Responses were not mutually exclusive

Barriers in career development, factors retaining

doctors in the same hospitals: Doctors were asked
about what kind of barriers they perceive for their career
development in the organization they work. Respondents
given multiple responses which were categorized under
five themes as shown in table no 2.
Lack of training policy (44.4%) and lack of adequate
infrastructure (36.1%) in hospitals were the major barriers
in the career advancement of doctors in the hospitals where
they work. Other barriers were contractual nature of jobs
(22.2%), inefficient administration of hospital (19.4%) and

Salary enhancement and making it at par with private

sector (38.8%), reward system/ introduction of incentives
(36.1%), good working environment (36.1%), and need
based training and sponsoring for training (33.3%) and
recognition of good work by administration (22.2%)
were various suggestions given by doctors enhancing the
satisfaction and motivation of doctors.

Discussion:

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National Journal of Medical and Dental Research, July-September 2014: Volume-2, Issue-4, Page 31-35

Trainings of doctors for career development in hospitals are

important areas which are often neglected due to shortage
of staff. Lack of training policy is the most important
barriers perceived by doctor in career advancement. Study
conducted in Gujarat by CBHI, MoHFW also highlighted
dissatisfaction in Gujarat by medical staff for trainings
and development [10]. Lack of adequate infrastructure
in the hospitals is another important barrier for doctors.
Similar findings of inadequate infrastructure in hospitals
for working were reported by Kaur et al in their study
[11]. They reported that logistics, drugs availability and
hospital infrastructure were important areas for health
workforce motivation in hospitals and career development.
Contractual job, ineffective administration in the hospitals
and low salary of doctors were the other barriers reported
in the current study. These are policy related administrative
issues in hospitals. Similar points were highlighted by
previous studies in hospitals where it was revealed that
organization policies, practices and administration are
important areas of dissatisfaction for medical officers in the
health organization [8]. There is no career growth and rise
in contractual kind of job. Doctors continue on contract for
more than 10 years and their salary is also fixed and less
than their regular counterparts in Delhi hospitals. Increased
number of contractual doctors poses threat to sustainability
of hospital work force [7]. Low salary was also de-motivator
for health work force in hospitals revealed in earlier studies
[12]. Study by Soeters and Griffiths has focused that
performance based financial incentives for health staff
led to better health services, increased productivity in the
health sector [13]. Such performance related incentives
were also suggested in present study by doctors.
In recent time, importance of motivated human resource
in health sector is increasingly realized by policy makers
in international organizations. Contractual character of
employment under National Rural Health Mission (NRHM)
throughout the country is now being associated with an
increasing number of problems. Renewal of contracts of
doctors, poor service conditions and low increments, high
turnover rate, reluctance to send them for longer skillbased training and unnecessary and retrogressive hierarchy
between the contractual and the permanent staffs are some
of the problems reported in CRM (GOI) reports [14, 15].
Few doctors in the study reported that non recognition of
good work is de-motivator for doctors. Recognition of work
in the organisation as non-financial incentives is being
highlighted by WHO in 2006 [4]. According to Herzberg

two factor theory recognition of work is a very important

satisfier or motivator in the organization [16]. Thus, playing
important role in human resource development.
For regular doctors pension benefits were the most
important binding factor in the hospitals. This gives feeling
of job security in the organization to the doctors. Earlier
studies also revealed that job security leads to employees
higher job satisfaction thus feel motivated [17]. Moreover
if employee is satisfied then they will be more motivated
for his work in the organization. Other binding factors for
the organization were; less likely transfers from the present
hospitals to distant hospitals and existing workplace near
to their residence. Good patient exposure in government
hospitals is also important reason to work with same
hospitals by the doctors. Meyer and Allen (1991) reported
that more perceived economic value of working with same
organization as compared to leaving it is important binding
force for organizational commitment [9]. Doctors were
working with hospitals purely on the basis of continuance
commitment only. If they would get better option they
might leave the present hospital.
The lack of attention for career development of doctors
in health sector is the result of lack of attention by
Government. Government is primarily concerned with
macroeconomic issues like health care expenditure and
size of the workforce rather than the micro level focus of
contemporary human resource (HR) practices of human
resource development.

Conclusion:
To overcome barriers for career development policy for
human resource development is recommended at policy
level, keeping at forefront the present constraints and
binding factor responsible for increasing the motivation of
doctors working in district hospitals. At the policy level,
improving the physical working conditions of hospitals,
introduction of performance based incentives, framing of
transfer and training policy for the organization, job rotation
of doctors to tertiary level hospitals, career growth potential
in the job are the required actions by the policy makers. At
the hospital level; proper distribution of work, job clarity,
recognition and appreciation of good work, job enrichment
and timely dissemination of information/instructions to all
doctors and staff are few suggested actions by the hospital
administrators.

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National Journal of Medical and Dental Research, July-September 2014: Volume-2, Issue-4, Page 31-35

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