Indicators Associated With Job Morale Among Physicians and Dentists in Low-Income and Middle-Income Countries: A Systematic Review and Meta-analysis

Key PointsQuestionWhat are the levels of job burnout, job satisfaction, and job motivation, as indicators of job morale, among physicians and dentists working in low- and middle-income countries? FindingsThis systematic review and meta-analysis, including results from 79 studies with 45714 participants, found that 32% of physicians and dentists working mainly in middle-income countries exceeded the high threshold for job burnout and that 60% were satisfied with their job overall. MeaningDespite high workloads, poor working conditions, and low salaries, more than half of the physicians and dentists working mainly in middle-income countries reported positive job morale. This systematic review and meta-analysis analyzes studies that measure job morale, indicated by levels of job burnout, satisfaction, and motivation, among physicians and dentists working in low- and middle-income countries. ImportanceImproving health care in low- and middle-income countries (LMICs) requires a workforce with positive job morale. However, the level of job morale in this population remains unclear. ObjectiveTo analyze studies measuring the job morale of physicians and dentists working in LMICs, using levels of job burnout, job satisfaction, and job motivation as indicators of job morale. Data SourcesA comprehensive search of Scopus, PubMed, PsycINFO, EMBASE, Web of Science, and the Cochrane Library, from database inception to October 30, 2018, and gray literature was performed. Study SelectionStudies were eligible if at least 50% of the sample were qualified physicians and/or dentists working in public health care settings in LMICs. Three indicators of job morale in this population were used: job burnout, job satisfaction, and job motivation. Of 12324 records reviewed, 79 studies were included in the systematic review and 59 were eligible for the meta-analysis. Data Extraction And SynthesisData were extracted independently by several investigators in accordance with the Meta-analyses of Observational Studies in Epidemiology (MOOSE) reporting guidelines. Random-effects meta-analyses, planned subgroup analyses, and metaregression were performed. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess bias. Main Outcomes and MeasuresLevels of job burnout, job satisfaction, and job motivation as indicators of job morale. ResultsOverall, 12324 records were identified. Of them, 80 records, representing 79 studies and involving 45714 participants across 37 LMICs, met the inclusion criteria for the review; however, only 3 were from low-income countries. In 21 studies with 9092 participants working mainly in middle-income countries, 32% (95% CI, 27%-38%; I-2=95.32%; P<.001) reported job burnout, and in 20 studies with 14113 participants, 60% (95% CI, 53%-67%; I-2=98.21%; P<.001) were satisfied with their job overall. Sufficient data were not available for a meta-analysis of job motivation. Conclusions and RelevanceThe findings suggest that, among physicians and dentists working mainly in middle-income countries, more than half reported having positive job morale. Positive job morale among physicians and dentists may help with recruitment and retention and thus support programs for improving health care in LMICs.