title: Motivational determinants among physicians in Lahore, Pakistan.
abstract: BACKGROUND
  Human resource crises in developing countries have been identified as a critical aspect of poor quality and low accessibility in health care. Worker motivation is an important facet of this issue. Specifically, motivation among physicians, who are an important bridge between health systems and patients, should be considered. This study aimed to identify the determinants of job motivation among physicians, a neglected perspective, especially in developing countries.
  
  
  METHODS
  A stratified random sample of 360 physicians was selected from public primary, public secondary and public and private tertiary health facilities in the Lahore district, Pakistan. Pretested, semi-structured, self-administered questionnaires were used. For the descriptive part of this study, physicians were asked to report their 5 most important work motivators and demotivators within the context of their current jobs and in general. Responses were coded according to emergent themes and frequencies calculated. Of the 30 factors identified, 10 were classified as intrinsic, 16 as organizational and 4 as socio-cultural.
  
  
  RESULTS
  Intrinsic and socio-cultural factors like serving people, respect and career growth were important motivators. Conversely, demotivators across setups were mostly organizational, especially in current jobs. Among these, less pay was reported the most frequently. Fewer opportunities for higher qualifications was a demotivator among primary and secondary physicians. Less personal safety and poor working conditions were important in the public sector, particularly among female physicians. Among private tertiary physicians financial incentives other than pay and good working conditions were motivators in current jobs. Socio-cultural and intrinsic factors like less personal and social time and the inability to financially support oneself and family were more important among male physicians.
  
  
  CONCLUSIONS
  Motivational determinants differed across different levels of care, sectors and genders. Nonetheless, the important motivators across setups in this study were mostly intrinsic and socio-cultural, which are difficult to affect while the demotivators were largely organizational. Many can be addressed even at the facility level such as less personal safety and poor working conditions. Thus, in resource limited settings a good strategic starting point could be small scale changes that may markedly improve physicians' motivation and subsequently the quality of health care.
authors.affiliation: Institute of Public Health, University of Heidelberg, Germany. malik@uni-heidelberg.de
authors.forename: Ahmad Azam
authors.initials: AA
authors.lastname: Malik
authors.forename: Shelby Suzanne
authors.initials: SS
authors.lastname: Yamamoto
authors.forename: Aurélia
authors.initials: A
authors.lastname: Souares
authors.forename: Zeeshan
authors.initials: Z
authors.lastname: Malik
authors.forename: Rainer
authors.initials: R
authors.lastname: Sauerborn
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D009042:Motivation; D010154:Pakistan; D010821:Physicians, Family / Q000523:psychology*; D011795:Surveys and Questionnaires