Factors affecting job and career satisfaction among ...

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Factors affecting job and career satisfaction among community pharmacists: A structural equation modeling approach Matthew M. Murawski, Nalin Payakachat, and Cynthia Koh-Knox

Received July 27, 2007, and in revised form February 11, 2008. Accepted for publication February 28, 2008.

Abstract Objectives: To investigate the effects of continuing pharmacy education (CPE), preceptorship, and the relationship between intrinsic and extrinsic factors affecting job and career satisfaction. Design: Cross-sectional study. Setting: Two grocery store pharmacy chains located in Indiana between May 2002 and February 2004. Participants: 108 community pharmacists. Intervention: Self-administered survey. Main outcome measures: Structural equation modeling was used to determine the effects of intrinsic and extrinsic factors, perceived benefits of CPE, advanced training, and being a preceptor on community pharmacists’ job and career satisfaction. Results: Job satisfaction predicted career satisfaction (regression weight 0.49, P = 0.007). The final model comprised extrinsic factors only (regression coefficient = 0.897, P = 0.013) with reasonable-fit indices (χ2 ratio = 1.38, root mean square error of approximation = 0.07 [90% CI 0.05–0.09], Bentler comparative fit index 0.915). Intrinsic factors were omitted because of insignificant regression weight (B) in the initial model (B = 0.24, P = 0.278). CPE and preceptorship provided significantly positive effects on extrinsic factors, with coefficients of 0.30 (P = 0.029) and 0.27 (P = 0.027), respectively. While perceived value of being a preceptor contributed significantly to extrinsic factors related to job satisfaction, it was associated with a negative impact on career satisfaction (B = −0.41, P = 0.005). Advanced training had a negative impact on career satisfaction (B = −0.21, P = 0.114). Conclusion: Job and career satisfaction are significantly influenced by extrinsic factors and may increase when pharmacists enroll in CPE programs and/or precept students. Pharmacists may engage in precepting in an attempt to increase job satisfaction. Further research in this area is needed. Keywords: Job satisfaction, careers, preceptors, community pharmacy, continuing education, structural equation modeling. J Am Pharm Assoc. 2008;48:610–620. doi: 10.1331/JAPhA.2008.07083

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Matthew M. Murawski, BPharm, PhD, is Associate Professor, Department of Pharmacy Practice, School of Pharmacy and Pharmacal Sciences, Purdue University, West Lafayette, IN. Nalin Payakachat, PhD, is Assistant Professor, Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for the Medical Sciences, Little Rock, AR. Cynthia KohKnox, PharmD, is Associate Director, Pharmacy Continuing Education, and Clinical Associate Professor, Department of Pharmacy Practice, School of Pharmacy and Pharmacal Sciences, Purdue University, West Lafayette, IN. Correspondence: Matthew M. Murawski, BPharm, PhD, Associate Professor, Department of Pharmacy Practice, School of Pharmacy and Pharmacal Sciences, Purdue University, R. Heine Pharmacy Bldg., Rm. 502, 575 Stadium Mall Dr., West Lafayette, IN 47907-2091. E-mail: murawski@pharmacy. purdue.edu Disclosure: The authors declare no conflicts of interest or financial interests in any product or service mentioned in this article, including grants, employment, gifts, stock holdings, or honoraria. Acknowledgment: To James G. Anderson, PhD, Professor, Department of Sociology and Anthropology, Purdue University, for reviewing the manuscript.

Journal of the American Pharmacists Association

Pharmacist job satisfaction

I

n 1988, Barnett and Kimberlin1 noted that job satisfaction in pharmacists is of interest for three reasons: (1) job satisfaction positively affects the employing firm because satisfied employees are less likely to be absent, to engage in behavior adversely affecting the company, and to change jobs; (2) job satisfaction positively affects the patient because job satisfaction among pharmacists is associated with better performance; and (3) job satisfaction positively affects the pharmacist because it enhances the pharmacists’ well-being and physical and mental health. While all these factors remain credible concerns, in today’s environment, the importance of turnover (recruitment and retention) may have grown in importance from a concern of the employer to a matter of concern for society as a whole. The literature regarding pharmacist job satisfaction is too extensive to summarize here. A thorough review by Robers2 appeared in 1983, and a recent manuscript by Mott et al.3 includes At a Glance Synopsis: A total of 108 midwestern U.S. community chain pharmacists were surveyed to explore, using structural equation modeling, the relationship between job and career satisfaction and the impact of intrinsic (i.e., employee’s perception of the characteristics or activities of the actual work being done) and extrinsic (i.e., employee’s preconceived values regarding the importance of various work-related characteristics) factors on job satisfaction. Strong evidence from the current study suggests that increasing extrinsic motivation (e.g., enrolling in continuing pharmacy education programs, precepting students) will increase pharmacist job satisfaction; however, further research in this area is needed. Analysis: Advanced training after obtaining a pharmacy degree was shown to have a negative impact on career satisfaction. One potential explanation for this is that a pharmacist’s main responsibility in the community chain setting is dispensing; therefore, advanced training may be underused or have, when used, less impact than in other practice settings. This finding requires further investigation because the incidence of clinically related activities is increasing in the community chain setting and, therefore, advanced training might be used more frequently and lead to higher levels of job satisfaction. Intrinsic factors, such as the role of coworkers, had minimal impact in the final model. Typically, a chain pharmacy has only one pharmacist per shift; therefore, the coworkers in this study were more likely to be clerks, pharmacy technicians, or a store manager. Given the pharmacist’s supervisory role in most of those relationships, intrinsic factors may be weighted differently for participants in the current study compared with other practice settings.


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a superb literature review. Several findings from the literature are germane to this research. Evidence indicates that the rich and extensive range of practice settings available within the profession offer different sources and levels of job and career satisfaction. Although research has shown pharmacist job satisfaction to be quite high overall,4 certain characteristics of practice (training, staffing, experience) lead to differences in reported levels of satisfaction. The American Pharmacists Association commissioned a study examining pharmacist attitudes toward worklife; the research indicated that pharmacists working in the hospital and chain setting experience lower levels of job satisfaction compared with other practitioners.5 Similar results were found by Mott et al.3 A recent survey specifically focusing on job satisfaction found lower levels of satisfaction (although still relatively high compared with other occupations) among pharmacists practicing in community chain sites compared with community independent, hospital, or specialized settings.4 Similar job satisfaction results were reported in a survey among Arizona pharmacists by Cox and Fitzpatrick.6 The discrepancies (in terms of hospital versus community chain practice) may reflect the conceptual differences between worklife concerns and job/career satisfaction. The Cox and Fitzpatrick6 study is interesting because it also relates job satisfaction to pharmacists’ perceived use of their skills, and the authors make the point that job dissatisfaction can derive from a perception of being overeducated for a position’s responsibilities. As has been reported by a number of researchers, an important component of job satisfaction for pharmacists has to do with opportunities to engage in professionally related activities in their workdays. It seems reasonable to assume that opportunities for professional activities, while not absent from community chain practice, may be less common than in other practice settings, which is congruent with the repeated observation of lower levels of job satisfaction in these pharmacists.

Objectives This study explores the relationship between job and career satisfaction and the impact of intrinsic and extrinsic factors on job satisfaction and the effects of perceived benefits on community pharmacists’ job and career satisfaction of continuing pharmacy education (CPE), advanced training, and being a preceptor.

Model development Job and career satisfaction

Career satisfaction and job satisfaction both relate to happiness with one’s worklife but contribute to this happiness in different ways. Career satisfaction may be defined as the level of overall happiness experienced through one’s choice of occupations. Job satisfaction relates to one’s current work situation and depends on many factors, including the marketplace, work conditions, job location, and other dynamic influences. An individual may feel very certain of having made the correct career choice but experience an unsatisfactory current work experi-


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ence. Conversely, a current job situation may have many positive components but not be fully satisfying as a career choice.7–9 Job satisfaction is a subjective variable that does not lend itself readily to quantification. Pharmacists experience job satisfaction when they fulfill needs or considerations perceived as important in their work.10–13 ■■ Hypothesis 1: Job satisfaction is positively related to career satisfaction of community pharmacists. The literature addressing the technical aspects of measuring job and career satisfaction is also extensive, even if limited to pharmacyrelated research, and an in-depth review is beyond the scope of this report. A few particular issues are of direct importance to the research reported here, however. First, measuring job satisfaction may be undertaken with the use of questionnaires whose items can be considered either facet based or facet free. Facet-based items are ones that make direct reference to specific aspects of the work experience (facets). Facet-free items are ones that assess the respondent’s global sense of job or career satisfaction, without reference to any specific aspect of work. Using different forms and types of questionnaires to assess pharmacist work and career satisfaction over time has limited the extent to which studies can be compared. The core questionnaire used in this study is one developed by Barnett and Kimberlin1 specifically for use with pharmacists. This questionnaire uses facet-free items to assess overall job and career satisfaction and facet-based items to assess specific aspects of the pharmacist’s workday, such as autonomy, clinical encounter, and general job role (Table 1). The levels of job and career satisfaction reported in this study, therefore, reflect the responses of study participants based on facet-free items that seek to determine their global satisfaction with current employment and overall career. Intrinsic and extrinsic factors

The influence of intrinsic and extrinsic factors on job satisfaction are also an important consideration in this area of research. This model for understanding job satisfaction emerged from social psychological (or interactionalist) models of work satisfaction.14 This way of looking at work satisfaction assumes the degree of satisfaction experienced by an employee is determined by the degree of congruence between the employee’s perception of the characteristics or activities of the actual work being done (intrinsic factors) and the employee’s preconceived values regarding the importance of various work-related characteristics (extrinsic factors).15,16 Deci17 first published data (in 1971) suggesting that extrinsic rewards undermine intrinsic motivation. Although the issue eventually took a back seat to other pursuits in the field, the controversy continues to this day. Ullrich18 showed (in 1972) that individuals expressed job satisfaction when they achieved, or were in the process of achieving, those objectives to which they aspired and perceived as important. Intrinsic motivation, deriving from within the person or from the activity itself, positively affects behavior, performance, and well-being.8,9,19 Examples of intrinsic factors include having in-

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teresting and challenging work, opportunities to use training or ability, and responsibility. These can be thought of as factors associated with “doing the job.” Extrinsic factors are usually either social or organizational; social refers to the quality of workplace relationships, while organizational includes elements such as pay, promotion, titles, fringe benefits, and other visible signs of organizational recognition of the employee. Nevertheless, externally administered consequences or extrinsic behavioral contingencies also are powerful determinants of motivated behavior. Extrinsic and intrinsic factors are important for understanding pharmacists’ perception of their jobs and careers. Positive intrinsic factors are associated with increased satisfaction, whereas positive extrinsic factors appear to reduce dissatisfaction.20–22 Evidence suggests that patient care and heightened importance of the professional role is associated with increased levels of intrinsic sources of satisfaction.23 ■■ Hypothesis 1a: General job role, compensation, workload, stress, perceived no growth, and perceived overqualification are dimensions of extrinsic motivations. ■■ Hypothesis 1b: Communication with other health care providers, autonomy in consultation, clinical encounters, and relationship with coworkers are dimensions of the intrinsic motivations. ■■ Hypothesis 1c: Intrinsic factors are positively related to job satisfaction. ■■ Hypothesis 1d: Extrinsic factors are positively related to job satisfaction. CPE for pharmacists

CPE has an important role in helping pharmacists update their knowledge. CPE will ensure advancement of the pharmacy profession in drug information, drug delivery, technology, and patient education. Some evidence demonstrated that continuing medical education sessions could influence professional practice, improve physician performance, and, on occasion, improve health care outcomes.24,25 Rouleau et al.26 reported that community pharmacists’ knowledge improved after a CPE program. Cox and Fitzpatrick27 showed that job satisfaction was influenced by perceived use of skills among pharmacists practicing in institutional and ambulatory care settings in Arizona. Therefore, CPE might affect pharmacists’ evaluation of the quality of their job (as an extrinsic factor) if their employment provides paid opportunities to engage in CPE activities (as opposed to a position that does not provide such opportunities). CPE may also relate to intrinsic factors influencing job satisfaction because engaging in CPE allows pharmacists to learn and apply new skills that may lead to higher levels of perceived use of skills. ■■ Hypothesis 2a: Perceiving benefit of CPE is positively related to intrinsic factors. ■■ Hypothesis 2b: Perceiving benefit of CPE is positively related to extrinsic factors. Pharmacist preceptors

Pharmacy schools’ need for preceptors has rapidly increased for several reasons: the increasing demand for pharma-



cists in the United States, growth in enrollment in and number of colleges of pharmacy, and inclusion of more experiential education in PharmD curricula.28,29 Nevertheless, the benefits of precepting, while rewarding, are generally intangible.30 Pharmacy sites can benefit from teaching student pharmacists by receiving assistance in developing and maintaining clinical services, sensing the satisfaction of giving back to the profession, and occasionally receiving tangible rewards.30 One component of professionalism is the process of perpetuating the profession through educational and/or experiential activities that propagate professional values to the next generation of practitioners. Educating students as a preceptor and playing a role in the professionalization process for new practitioners is clearly an opportunity to engage in professional activities and is, therefore, likely to be a source of professional job satisfaction. Additionally, unlike some components of professional practice that may be only possible within institutional settings, the professional function of preceptorship is one in which any pharmacist in any practice setting can conceivably engage. This fact is especially relevant in light of a recent article noting that, although precepting students is of benefit to the profession, the student, and the preceptor, a substantial shortage of willing, available preceptors exists.30 Given the importance of pharmacist job satisfaction, the likelihood that practitioners in community chain settings might experience less satisfaction with their jobs, the shortage of preceptors in the community, the reported positive impact of precepting on job rewards, and professional activities’ influence

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on intrinsic sources of job satisfaction,6 we felt that exploring the relationship between the extent to which community chain practitioners engage in preceptor activities and their reported levels of job satisfaction would be worthwhile. The research reported here explores the assumption that pharmacists who choose to act as preceptors for student pharmacists will derive professional satisfaction from the experience and, as a result, will enjoy higher levels of job and career satisfaction. Considerable evidence exists in the literature suggesting that job and career satisfaction is suboptimal for many pharmacists.4 ■■ Hypothesis 3: Pharmacists who have been preceptors for student pharmacists have higher levels of career satisfaction than those who have not precepted. ■■ Hypothesis 3a: Perceiving benefit of being a preceptor is positively related to intrinsic factors. ■■ Hypothesis 3b: Perceiving benefit of being a preceptor is positively related to extrinsic factors. Advanced training

Cline31 reported that pharmacists with advanced training and years of experience are associated positively with higher hourly wages in the hospital setting. On the contrary, neither advanced education nor experience was related to wages in large chain, mass merchandiser, or health maintenance organization settings. He suggested that advanced training has no effect on the career satisfaction of community pharmacists. ■■ Hypothesis 4: Advanced training has no effect on career satisfaction.

Figure 1. Theoretical model of factors influencing pharmacist job and career satisfaction. Abbreviation used: CE, continuing education. +, positive relationship; ±, no relationship.



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Theoretical model

The theoretical model (Figure 1) specifies a causal sequence, whereby extrinsic and intrinsic factors are hypothesized to influence job satisfaction and job satisfaction subsequently predicts career satisfaction. Extrinsic factors comprise six dimensions: (1) general job role, (2) compensation, (3) workload, (4) stress, (5) perceived no growth, and (6) perceived overqualification. Intrinsic factors consist of four dimensions: (1) communication with other health care providers, (2) autonomy in consultation, (3) clinical encounters, and (4) relationship with coworkers. Other factors included in the model are (1) advanced training, (2) being a preceptor prior to the survey, (3) perceived benefit of CPE, and (4) perceived benefit of being a preceptor. These factors are hypothesized to influence intrinsic factors, extrinsic factors, or career satisfaction.

Methods Samples and instrumentation

The survey was administered to 108 pharmacists in community settings (grocery store pharmacy chains) in Indiana over three periods: time 0 (immediately after a CPE conference provided by Purdue University), time 1 (6 months after the conference), and time 2 (12 months after the conference). The purpose of the survey was to collect information concerning demographic, educational, employment, and job/career satisfaction. The questionnaire was self-administered and provided during the conference. This study was cross-sectional and used only the first-period survey information. The questionnaire comprised 70 questions that were divided into four parts: demographics, job features, preceptor experience, and personal perspective (see Appendix 1 in the electronic version of this article, available online at www.japha.org). Intrinsic and extrinsic factors were measured using questions within the personal perspective category of the previously validated instruments of Barnett and Kimberlin1 and Khan and Morrow,32 except for stress and advanced training questions (Table 1). These items clearly stated favorable and unfavorable attitudes toward the variables in equal numbers to avoid biasing responses. Responses to both facet-based and facet-free items were recorded using a 5-point Likert-type scale (1, strongly agree; 2, agree; 3, neither agree nor disagree; 4, disagree; and 5, strongly disagree), except for the stress dimension, which had a 4-point scale (1, highly stressed; 2, somewhat stressed; 3, not too stressed; and 4, not at all stressed). Internal consistency reliabilities of each dimension were calculated using Cronbach’s alpha for all observed variables other than two-item variables (autonomy encounter, general job role, and coworkers), which were calculated using the Spearman-Brown split-half method. All reliability tests were performed in SPSS version 14.0 (SPSS, Chicago). Data analysis

A preliminary analysis provided baseline descriptive statistics and examined whether the data met the assumptions of structural equation modeling (SEM). This statistical procedure estimates the relationship between two or more constructs of

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interest to explain why and how people respond. SEM has two steps: the measurement model and the structural model. Confirmatory factor analysis (CFA) is applied in the measurement model using maximum likelihood estimation to test the linear relationships between the observed variables (items) and unobserved (latent) variables and the relationship among the latent variables. Then the structural model is applied to test the causal relationships among the latent variables. Latent variables are not directly measured but inferred from the observed variables. The observed variables are the items used in the questionnaire. For unfavorable statements, the scoring procedure was reversed because disagreement with an unfavorable statement is assumed psychologically equivalent to agreement with a favorable statement (reverse coded). As mentioned above, the intrinsic and extrinsic factors are latent variables. Based on the need to validate the latent variables and their factors, a second-order factor analysis was performed. We considered a two-factor model because our hypothesis, which referred to the influences of the intrinsic and extrinsic factors on job satisfaction, was specific about the number of constructs. The hierarchical CFA model (second-order analysis) was selected to validate the hypotheses of the intrinsic (hypothesis 1c) and the extrinsic (hypothesis 1d) factors on the job satisfaction. Any dimension with low factor loadings ( 0.05) were removed from the model to arrive at the final model (post hoc analysis).33 The purposes of these analyses were (1) to establish baseline models for multigroup analyses and (2) to establish wellfitting measurement models to use for testing the hypotheses. Fit statistics for the measurement model included (1) the model chi-square ratio (χ2/df), (2) the Steiger-Lind root mean square error of approximation (RMSEA) with its 90% CI, and (3) the Bentler comparative fit index (CFI). The preset value is 0.05 for RMSEA34 and at least 0.90 for CFI.35 Bias-corrected 90% CIs of the estimated coefficients are calculated using the bootstrapping maximum likelihood method (300 bootstrapping samples). AMOS 7.0 (SPSS) was used to test the measurement and structural models. Evaluation of underlying assumptions of SEM

■■ Normality: Maximum likelihood estimation and SEM assume that endogenous variables are normally distributed. Neither the skewness nor the kurtosis exceeded the acceptable value (skewness < 3 and kurtosis < 10) for all variables (online Appendix 2). Thus, the assumption of univariate normality appears reasonable. ■■ Outliers: SEM suggests that univariate outliers more than 3 SDs away from the mean (z > 3) require remedies such as correcting errors, dropping the cases, or transforming the variables. However, the categorical nature of the responses in the data (Likert-type scale) suggested that a remedy for outliers was unnecessary. ■■ Missing data: The mean imputation technique was used for all missing data.



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Table 1. Variables, dimensions, and items used in study of factors influencing pharmacist job and career satisfaction Independent variables Dimensions Facet-based items Intrinsic factors Autonomy in consultation Q19: I am not permitted to perform very many patient consultation duties. Q23: I determine the extent to which I provide patient consultation. Clinical encounter Q28: Patients are only concerned about getting their medications as quickly as possible so that they can leave quickly as possible. Q29: Patients and customers treat me courteously. Q32: Patients show appreciation for the services I provide for them. Q36: Compared with the respect shown to other health care professionals, patients and customers show pharmacists an appropriate amount of respect. Communication with Q34: Physicians consult with me often on professional matters. other health care Q38: Nurses are uncooperative when I must communicate with them about “jobproviders related” matters. Q39: Nurses often initiate consultation with me on professional matters. Q40: Physicians are uncooperative when I must communicate with them about “job-related” matters. Relationship with Q37: The people with whom I work are friendly. coworker Q41: I am satisfied with the “on-the-job” relationships I have with my coworkers. Extrinsic factors Stress Q16: How stressed do you feel during an average workday? Workload Q43: My workload is excessive. Compensation Q48: The monetary rewards I receive from my work are less than they should be. General job role Q45: I find challenge in my work. Q49: I have the opportunity to make use of my skills and abilities at my place of employment. Perceived Q59: My formal education overqualifies me for my present job. overqualification Q60: My talents are not fully used on my job. Q61: My work experience is more than necessary to do my present job. Q62: Frankly, I’m overqualified for the job I hold. Perceived no growth Q63: My job frequently provides me with new challenges. Q64: My job provides me with many opportunities to learn new things. Q65: The day-to-day content of my job seldom changes. Q66: My job has a lot of potential for change and growth. Dependent variables Job satisfaction

Career satisfaction

Dependent variables Advanced training Had been a preceptor Perceived benefit from CPE Perceived benefit from being a preceptor

Facet-free items Q50: All things considered, I am satisfied with my current job. Q51: The idea of spending the remainder of my working life in my job like my current one is depressing. Q52: I often leave work with a “bad” feeling, a feeling that I am doing something, which I do not enjoy. Q53: I often get so wrapped up (interested) in my work that I lose track of my time. Q55: Knowing what I know now, if I had to decide all over again whether to go into pharmacy, I would choose another field. Q56: If I had a son who told me he was interested in pursuing a career in pharmacy, I would encourage him. Q57: If I had a daughter who told me she was interested in pursuing a career in pharmacy, I would encourage her. Q58: If I were free to pursue any type of career I wanted I would stay in pharmacy. Facet-based items Q7: Advanced training/credentialing/certification received Q18: Have you ever precepted student pharmacists? Q67: CPE related to my job has improved my job performance.a Q69: Precepting students helps me hone and maintain my clinical skills.a

Abbreviation used: CPE, continuing pharmacy education. a Represents the question that is recoded to equal agreement with a favorable statement.



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Table 2. Reliability estimates for the observed variables in study of factors influencing pharmacist job and career satisfaction Variable Communication Autonomy in consultation Clinical encounter Coworkers General job role Perceived no growth Perceived overqualification Job satisfaction Career satisfaction

No. items 4 2 4 2 2 4 3

Reliability statistic 0.617a 0.428b 0.738a 0.669b 0.640b 0.828a 0.645a

4 4

0.800a 0.888a

Cronbach’s alpha reliability estimates. Spearman-Brown reliability estimates.

a b

Results A total of 108 pharmacists participated in this study, representing two midwestern-based grocery store pharmacy chains (chain A, n = 48) and (chain B, n = 57); the practice setting of 3 pharmacists was unidentified. Of the original 108 observations, 33 were omitted because respondents did not complete the personal perspectives section of the survey, leaving 75 observations for the final evaluation (chain A, 32; chain B, 43). The majority of participants were women (2:1), with ages ranging from 24 to 66 years. A total of 60 participants had a BPharm degree, and 15 pharmacists had a PharmD degree. Of partici-

pants, 93% worked full time. From these 75 participants’ responses, a negligible fraction of items was left unanswered (9 of 3,900 item responses). Values for these missing observations were mean imputed. All dimensions used in this study provided good reliabilities (reliability coefficients > 0.60), except for the autonomy dimension (Spearman-Brown coefficient = 0.428) (Table 2). However, the autonomy dimension was kept because it was important for the intrinsic factor. The validity of relevant constructs from the data obtained by the questionnaire survey was verified using CFA. To assess the validity of intrinsic and extrinsic constructs, a second-order factor analysis and two-factor analysis were performed (Figures 2–4). Three dimensions (compensation, workload, and stress) in extrinsic factors were deleted because their factor loadings were lower than 0.60 (Figure 2). All dimensions in the intrinsic factors yielded high factor loadings (Figure 3). The former results of both the extrinsic and intrinsic measurement models indicated convergent validity.36 The estimated correlation between the two factors was less than 0.85, which suggested that the model held good discriminant validity.36 The overall fit measures for both intrinsic and extrinsic factors, and the two-factor analysis indicated fairly good model fits (Figures 2 and 3). The zero-order correlations for the latent constructs are shown in Table 3. No multicollinearity was found among the latent constructs.37 All of the correlations were small to moderate in size. CFA was also applied to the endogenous variables (job and career satisfaction). The results showed no multicollinearity (i.e., the correlation between these variables was not high [0.55]). The second step was to apply SEM to the proposed research

Figure 2. One-factor analysis for extrinsic factors influencing pharmacist job and career satisfaction. Abbreviations used: CFI, Bentler comparative fit index; RMSE, root mean square error. A: Original components of extrinsic factors. B: Final model of extrinsic factors after removing three dimensions (compensate, workload, stress) with low factor loadings ( 1) were found in either the proposed or the reduced model. Hence, the assumption was made that the estimates in the model were valid. The result in Figure 5 shows that job satisfaction significantly predicted career satisfaction (standardized regression weight = 0.49, P = 0.007) (Table 5). The results showed that a significantly

Table 3. Zero-order correlations of the latent variables in study of factors influencing pharmacist job and career satisfaction 1. Communication 2. Clinical encounter

1 1 0.384a

1

3. Coworkers 4. Autonomy 5. General job role 6. Perceived overqualified 7. Perceived no growth 8. Stress 9. Workload 10. Compensation

0.302 0.237b 0.354a 0.240b 0.303a 0.144 0.126 0.206

0.274b 0.307a 0.477a 0.435a 0.365a 0.290b 0.321a 0.091

a

2

3

4

5

6

7

8

9

10

1 0.552a 0.511a 0.240b 0.364a 0.203 0.219 0.374a

1 0.437a 0.088 0.192 0.251b 0.260b 0.036

1 0.367a 0.594a 0.173 0.132 0.334a

1 0.363a 0.187 0.225 0.215

1 0.121 0.169 0.437a

1 0.571a 0.095

1 0.010

1

Correlation is significant at the 0.01 level (two tailed). b Correlation is significant at the 0.05 level (two tailed). a



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Figure 4. Two-factor model of intrinsic and extrinsic factors influencing pharmacist job and career satisfaction. Abbreviations used: CFI, Bentler comparative fit index; RMSE, root mean square error. All factor loadings and correlations between extrinsic and intrinsic factors were standardized.

career satisfaction. This surprising result seemed at first to be counterintuitive to the research team. Close consideration of the results suggests that this effect might be explained as follows: pharmacists who are experiencing lower levels of career satisfaction might accept opportunities for preceptorship in an attempt to meet extrinsic motivation needs (perceived growth and qualification in their career). In other words, pharmacists with (relatively) lower levels of career satisfaction may be more likely to engage in preceptorship, in an attempt to derive greater satisfaction from their career. This explanation is supported by the observation of a significant increase in the coefficients associated with the extrinsic dimension (Figure 5) among pharmacists who perceive benefits in being preceptors. Otherwise, pharmacists who reported a strong perceived benefit from precepting would have to achieve lower levels of career satisfaction when they do precept—a hypothesis that appears to be rejectable on logical grounds. A possible caveat does apply, however. Given the current intense levels of demand for pharmacists, many chains actively recruit and hire student pharmacists in the hopes of retaining their services after graduation. A possible scenario, given the results obtained here, would be that pharmacists are forced to

engage in preceptorship by their management, and therefore the condition of being a preceptor could conceivably lead to a negative loading on extrinsic determinants of job satisfaction. This must be considered an extremely remote possibility, however. We found that advanced training after obtaining a pharmacy degree showed a negative impact on career satisfaction. A possible explanation for this finding may be that a pharmacist’s main responsibility in the community chain setting is dispensing, and therefore such advanced training may be underused or have, when used, less impact than in other practice settings. We feel that this finding will require further investigation in the near future, as the incidence of clinically related activities is increasing in the community chain setting and advanced training might be used more frequently, leading to higher levels of job satisfaction. Finally, noting the minimal impact of intrinsic factors in the final model is important. We think that the role of intrinsic factors (e.g., coworkers, workflow) in our model may have been limited by the nature of our sample and the nature of community chain pharmacy practice. The role of coworkers in chain pharmacies may be different from other pharmacy settings. Normally, a chain pharmacy has only one pharmacist per shift; there-

Table 4. Standardized regression weights for the proposed model of factors influencing pharmacist job and career satisfaction Dependent variable Job satisfaction Job satisfaction Career satisfaction Career satisfaction Career satisfaction Intrinsic Extrinsic Intrinsic Extrinsic

← ← ← ← ← ← ← ← ←

Independent variable Intrinsic Extrinsic Job satisfaction Advanced training Had been a preceptor Precepting student Precepting student CPE CPE

Estimate (90% CI)a 0.241 (–0.126 to 0.540) 0.789 (0.575–0.996) 0.470 (0.289–0.625) –0.218 (–0.387 to –0.022) –0.412 (–0.539 to –0.223) 0.323 (0.127–0.546) 0.258 (0.031–0.449) 0.386 (0.208–0.595) 0.279 (0.040–0.489)

P 0.278 0.005 0.009 0.078 0.011 0.015 0.055 0.013 0.055

Abbreviation used: CPE, continuing pharmacy education. a 90% CIs were obtained from the bias-corrected percentile method using 300 bootstrapping samples.

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Table 5. Standardized regression weights for the reduced model of factors influencing pharmacist job and career satisfaction Dependent variable Job satisfaction Career satisfaction Career satisfaction Career satisfaction Extrinsic Extrinsic

← ← ← ← ← ← ←

Independent variable Extrinsic Job satisfaction Advanced training Had been a preceptor Precepting student CPE

Estimate (90% CI)a 0.897 (0.759–0.996) 0.490 (0.291–0.659) –0.213 (–0.356 to –0.003) –0.411 (–0.572 to –0.247) 0.268 (0.084–0.4651) 0.297 (0.081–0.480)

P 0.013 0.007 0.114 0.005 0.027 0.029

Abbreviation used: CPE, continuing pharmacy education. a 90% CIs are obtained from the bias-corrected percentile method using 300 bootstrapping samples.

Figure 5. The proposed model (A) compared with the reduced model (B) of pharmacist job and career satisfaction. Abbreviations used: CE, continuing education; CFI, Bentler comparative fit index; RMSE, root mean square error. A: The intrinsic factors have insignificant regression weights on job satisfaction and should thus be removed. All factor loadings and regression weights were standardized.

fore, the coworkers in this study were more likely to be clerks, pharmacy technicians, or possibly a store manager. Given the pharmacist’s supervisory role in most of those relationships, intrinsic factors may be weighted differently in our participants’ minds compared with other practice settings. Also, the relatively limited variance in work patterns from one pharmacy to another within a specific chain may have resulted in some limitation in the variance in these intrinsic factors in a manner that could lead to a constrained model.

Limitations The most important limitations are related to the study sample. The sample was a nonrandomized convenience sample of practitioners who had already self-selected by deciding to participate in the CPE program. The sample, as already discussed, was quite homogenous, to the extent that we are concerned with how the limited variance may have affected our model. The limited variability in the data may limit the generalizability of the


results. Also, the sample, for the purposes of SEM, was small (n = 75), which renders the estimated coefficients less than efficient in an SEM framework. Perhaps as a result, for the SEM model, the case-to-parameter ratio was 6:8:1 in the proposed model (