Introduction

Pharmacists are commonly viewed as “marginal professionals” because their jobs vary so much in contents according to work settings, which are characterized as medical professionals and businessmen as well [1]. For example, pharmacists employed by hospitals are usually involved in drug dispensing, drug distribution, patient education and consultation and some clinical and administrative tasks. Pharmacists in clinics are usually involved in drug dispensing works and have little power to comment the prescriptions. Pharmacists working in community pharmacies not only dispensing medicine but also frequently find themselves taking on more responsibility for running the business and may be involved in marketing, financing, logistics, human resource management, and information management.

The relationship between job characteristics and work effectiveness has been studied. Quandt, McKercher, and Miller (1982) found that pharmacists were more satisfied with the jobs that were “enriched,” characterized as more perceptions of task variety, identity, significance, autonomy and feedback [2]. Rickert (1988) in a national survey of pharmacists found that those working in independent pharmacies characterized as autonomous professional working settings reported higher levels of intrinsic reward satisfaction and satisfaction, greater organizational involvement, and professionalism than those in hospital pharmacies [3]. Donders, et al. (2003) in a study of university personnel reported that positive job characteristics such as level of professional expertise and variety of tasks, contributed to job satisfaction [4]. This study examined the job characteristics and working outcomes for pharmacists across three major working settings, that is, hospital, clinic, and community pharmacies, and their effects on pharmacist job satisfaction and leaving intentions. The results might provide the information for pharmacy leaders to make some efforts to rearrange pharmacists’ job contents to be more enriched and effective.

Materials and methods

Study subjects

The study population consisted of 18,760 pharmacists working in hospital, clinic, and community pharmacies, listed in the 2003 Taiwan Actively Practicing Pharmacist List. All pharamcists were first stratified by work settings (hospital, clinic, and community pharmacies) and national administrative geographical locations (northern, middle, middle-sourthern, sourthern, eastern and outside island) in the sample frame list. We systematically and randomly selected 2,000 pharamcists as our sample subjects. Structured questionnaires were distributed by mail between Feb 2004 to Apr 2004.

Survey instrument

The structured questionnaire had three parts. The first part had six items used to characterize the pharmacist's job, including skill variety, task identity, task significance, autonomy, and feedback from others and feedback self, all considered “enriched” job characteristics by Hackman and Oldman (1976, 1980) [5, 6]. The second part was designed to access the pharmacist's satisfaction with his or her job and possibility of his or her quitting job. All items were measured on a 7-point Likert Scales. Information about the pharmacist's gender, age, education level, working settings, and geographic distribution were also collected.

Table 1 Personal backgrounds of the responding pharmacists (n = 298)
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Table 2 Personal background among pharmacists in different working settings
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Analytical techniques

The data was first analyzed descriptively with means and standard deviations calculated for continuous variables, and frequency and percentages for categorical variables. The ANOVA and χ2 univariate analyses were used to compare job characteristics and job outcomes (job satisfaction and intention to leave) across three working settings (hospital, clinic, and community pharmacies). Factor analysis was performed to create the common factor of six-item job characteristics to avoid the multicollinearity for the following multivariate analysis. Multiple regressions were used to examine the relationship between a common factor of job characteristics and job outcomes (job satisfaction and intention to leave).

Results

A final total of 298 respondents (average 41 years old; half male and half female) returned acceptable completed questionnaires, making a response rate of 14.90%. Fifty-nine percent held university degrees, 29% technical school degrees and 9% graduate degrees in pharmacy specialty. Around 50% reported incomes between $US1,344 to 2,000 per month. One hundred and thirty-three respondents were working in hospital pharmacies, 81 in clinic pharmacies and 79 in community pharmacies. A greater percentage of pharmacists in hospital pharmacies and a lower percentage of community pharmacists returned completed questionnaires (χ2 = 14.81; p<0.001), though there were no differences in geographical distributions among the groups (χ2 = 3.62; p > 0.05) (Table 1).

Table 3 Job characteristics and outcomes among pharmacists in different working settings
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Personal background across pharmacists in hospital, clinic and community pharmacies

We found statistical differences in age, gender, education, working experience and working hours among the three groups (Table 2). The hospital pharmacists had a higher percentage of male pharmacists than hospitals and clinics. Hospital pharmacists had a higher education level than clinic and community pharmacists. Community pharmacists had more years of working experience in pharmaceuticals (average 20.16 years) than pharmacists in clinics (average 15.32 years) and hospitals (average 10.20 years), and they had stayed longer in their current positions than those in clinics and hospital pharmacists. Community pharmacists worked more hours per month than their counterparts in the clinic and hospital pharmacies.

Job characteristics across pharmacists in hospital, clinic and community pharmacies

Because there exist significantly different personal characteristics across the pharmacists in different settings (shown in Table 2), it would be a better way to adjustify the job characteristics with pharmacist personal characteristics including age, gender, education, working experience and working hours. The individual scores (mean and SD) for pharmacist job characteristics, including skill variety, task identity, task significance, autonomy and feedback from others and self, are shown in Table 3 as the original and adjusted scores. Results of ANOVA across three practice settings showed that community pharmacists reported more skill variety, task identity, task significant, autonomy, and feedback than those working in hospitals. And community pharmacists also reported more skill variety, task identity, task significant, and autonomy than those working in clinic. Pharmacists working in clinics reported less skill variety, less task significance, less feedback form others, and more feedback from self than those working in hospitals.

Job outcomes across pharmacists in hospital, clinic and community pharmacies

Because there exist significantly different personal characteristics across the pharmacists in different settings (shown in Table 2), it would be a better way to adjustify the job outcomes with pharmacist personal characteristics including age, gender, education, working experience and working hours. The individual scores (mean and SD) for pharmacist job outcomes, including internal motivation, satisfaction, and leaving intentions, were shown in Table 3. One way analyses of variance (ANOVA) across three practice settings found community pharmacists were more satisfied with their jobs and less inclined to leave than were hospital pharmacists. They also reported greater satisfaction with their jobs than did clinic pharmacists. Clinic pharmacists reported greater job satisfaction and less inclination to quit than did hospital pharmacists.

Relationship between the job characteristics and job outcomes

To examine the relationship between the job characteristics and job outcomes, multiple regression models were examined. The enriched job characteristics was recalculated as a common factor using factor analysis and referred as the predictor on determining its effect on a pharmacist's job satisfaction and intention to leave, controlling for age, gender, education, working settings, working experiences, and incomes (see Table 4). It found that the jobs more enriched was positively related to job satisfaction (p<0.000) and negatively to intention to resign (p<0.000). Pharmacists whose degrees were earned at technical schools reported greater job satisfaction and less inclination to resign than pharmacists with university degrees (p<0.05), while those with graduate degrees were more intent of leaving than the technical school pharmacists (p<0.000). Pharmacists with the monthly incomes between US1,668--2,000 were more satisfied with their jobs than those lower incomes (below US1,000) (p<0.05).

Table 4 Models of multiple regressions for job satisfaction and intentions to leavea
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Table 5 Practical job responsibilities among responding pharmacists in different working settings
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Discussion

This study analyzes the role of the enriched job characteristics in job outcomes of pharmacists across three major working settings, that is, hospital, clinic, and community pharmacies. Our study confirms the more enriched the jobs, the greater the pharmacist's job satisfaction and less likelihood that he or she would resign like earlier researches on job characteristics.

In this study, the community pharmacists showed more enriched job contents because community pharmacists serve in positions closer to ownership and management, as already mentioned by Rickert (1988) [7]. These added responsibilities would logically come with greater skill variety, task identity, task significance, autonomy and feedback, resulting in a more “enriched” job. That community pharmacists in our study reported greater job satisfaction and less inclination to leave in this study further confirms the enriched job model proposed by Hackman and Oldham (1980) associates about the job satisfaction and likelihood to stay in the same job with the richness of job [6]. Examining only hospital pharmacy settings, Quantdt, McKercher and Miller (1982) also revealed that the enriched job would result in more positive perceptions of satisfaction for their jobs [2].

The present study found that pharmacists working in hospital pharmacies rated their job characteristics as less enriched in some aspects than those working in clinic pharmacies; they rated their environments as less enriched in all aspects than those working in community pharmacies. Further examining the responsibilities for the pharmacists across hospital, clinic, and community pharmacies (see Table 5), a hospital pharmacist job mostly involved prescription and dispensing management, provided drug information and consultations to patients and physicians, and performed general managerial works. Those in clinic pharmacies mostly involved in prescribing and dispensing, provided drug information with patients, and managed inventory. In addition to the regular pharmacy job responsibilities, community pharmacists had other responsibility, including financial and marketing managements, which were less involved by hospital and clinic pharmacists.

We also found that several controlling factors showed statistical significance in influencing a pharmacist's job satisfaction and intentions to leave, including a pharmacist's gender, education level, and month income. For example, we found that male pharmacists showed higher intentions to leave than did female pharmacists. It might be the reason that female pharmacists usually show higher stability for their present pharmacist occupations, while male pharmacists might have more willingness to choose more challenging pharmaceutical works such as pharmaceutical sale representatives. In addition, pharmacists with lower education degrees (technical school degrees) showed higher job satisfaction and lower intentions to leave than those with university degrees. It might result from the pharmacists with higher education degrees usually have more work opportunities or they just think that the routine pharmaceutical works could not meet their work growth needs. These phenomena might be also applicable for pharmacists with graduate degrees. Future studies could target to understand the psychological status and growth needs of pharmacists with different education levels.

In this study, the responding pharmacists with the month income in US$1,668–2,000 showed higher job satisfaction than those with the month income below US$1,000. The mechanism behind this phenomenon was not explained through our available data such as age or pharmacist working experiences, which might usually be viewed as the moderators behind the income and job satisfaction. It could be further studied in the future.

This study has several limitations. First, the response rate in our study was not high, especially for community pharmacists. More should be done in the future to overcome this limitation because survey results may be influenced by poor response rates and response bias. Secondly, the job environments of the pharmacists in hospital, clinic, and community pharmacies are quite different, for example, there may very different dynamics existing with supervisors, colleagues, and institutional policy and practices [8], and even the national health political and economic environmental constraints for three different working settings. In addition, the intrinsic factors such as growth needs, and even personality might contribute the certain effects. These factors might also play important roles for pharmacists’ job satisfaction and intention to leave.

While the job enrichment is positively related to job satisfaction and negatively to job leaving intentions, we suggest pharmacy managers/chiefs could try to recognize the needs of pharmacists to redesign and enrich their work arrangements in the future.