Physiotherapists’ job satisfaction in the workplace: A cross-sectional study in Jordan,Lebanon,West Bank,and Gaza

1 Introduction

Job satisfaction can be defined as people’s attitudes and feelings regarding their jobs [1] and refers to how individuals feel about various aspects of their work [2]. Favorable attitudes and positive feelings toward the job reflect job satisfaction [2]. Job satisfaction among healthcare professionals has become a global concern [3–7]. Higher job satisfaction is a cornerstone to improving retention among allied health professionals, including physiotherapists [7].

Job satisfaction is deemed a significant indicator of the general well-being of employees and their intentions or decisions to quit a job [8, 9]. Job satisfaction can positively affect professionals, including motivation, decision-making, relations with fellow workers and clients, and job performance [2, 11]. Many healthcare professionals leave their jobs and move to different ones primarily due to job dissatisfaction [11].

Burnout is common among physiotherapists and associated with physiotherapy job dissatisfaction [12]. Job satisfaction affects employees and organizations, and is positively linked with patients’ satisfaction in healthcare settings [11]. Therefore, improving physiotherapy satisfaction is vital to the health institution’s success and providing quality services to the patients. To improve job satisfaction, situational analysis should be conducted at both the institution and country level.

Physiotherapists expressed significantly lower job satisfaction than other healthcare professionals [13]. Literature reported many factors that might affect physiotherapists’ job satisfaction, including autonomy, where therapists can make decisions independently and have input to their workplace [14]. Good salaries and rewards have been reported to be significant positive satisfaction factors. Besides, work nature and task accomplishment compose the main predictors of job satisfaction among physiotherapists [15–20]. On the contrary, excessive workloads, limited workplace support, and inflexible scheduling negatively impacted job satisfaction [16, 20]. However, factors associated with physiotherapists’ job satisfaction vary at the level of institutions and countries.

Job satisfaction among physiotherapists has been studied in many developing and developed countries [5, 21], as well as in some Middle Eastern countries [6]. However, to our knowledge, job satisfaction has not been studied in areas recently affected by wars and refugee crises in the Middle East, including Jordan, Lebanon, West Bank, and Gaza regions. Therefore, this study aimed to evaluate physiotherapists’ job satisfaction in four regions in the Middle East, including Jordan, Lebanon, Gaza, and West Bank. The second aim was to compare physiotherapists’ job satisfaction between the regions mentioned above, gender, academic qualifications, and years of clinical experience. This study explains job satisfaction levels in the targeted regions, pointing out strengths and weaknesses to enable future improvements in physiotherapy job satisfaction to provide high-quality services.

2 Methods

A cross-sectional analysis with a self-reported survey to evaluate physiotherapy job satisfaction. The study was conducted in collaboration with the Jordanian Physiotherapy Society, the Order of Physiotherapists in Lebanon, Palestinian Physiotherapy Association in the West Bank and Gaza. The questionnaire was sent to physiotherapists by physiotherapy organizational bodies in Jordan, Lebanon, West Bank, and Gaza between January and February 2017. The respondents completed the informed consent for participation. The internal review board at Jordan University of Science and Technology approved the study (#18/133/2020).

An expert panel (HK, AM, and HK) designed and reviewed the survey based on qualitative interviews and experience. The survey was then piloted on a group of 10 physiotherapists to evaluate their understanding of the questionnaire’s items. Afterwards, the survey was updated based on the participant’s feedback. The survey included two sections. The participants’ characteristics section included participants’ age, gender, geographical region, academic qualification, and years of clinical experience. The second section consisted of 17 items that evaluated job satisfaction in the workplace. The first 15 items asked participants about different areas of their work and their satisfaction ratings. Item 16 asked physiotherapists if they had thought of quitting their current jobs. The last item asked participants to rate their overall job satisfaction. The respondents evaluated each item on a Likert-type scale with five response options ranging from “strongly disagree” (= 1) to “strongly agree” (= 5).

Categorical data were presented as counts and proportions. The rank test was used to order the items from higher satisfaction to lower satisfaction. The mean, standard deviation, and proportion of participants’ responses were reported for each item. Participants’ responses were then classified as (satisfied) if their response was “agree” or “strongly agree” and as (unsatisfied) if their responses were “undecided”, “disagree”, or “strongly disagree”. A cross-tabulation analysis with a Chi-square test was conducted to compare the proportion of satisfied responses to each item between the participating regions, genders, academic qualifications, and years of clinical experience. The statistical level was set at p < .05. SPSS Statistics 25.0 (IBM Corp., Armonk, NY, USA) was used for all statistical analyses.

3 Results

A total of 413 physiotherapists completed the survey. Most respondents were from the Gaza region, ≥27 years of age, males, bachelor’s degree holders, and with clinical experience between 5 and 10 years. Table 1 lists the study participants’ characteristics. Internal consistency analysis showed that the questionnaire has high internal consistency (Cronbach’s α= 0.851).

Table 2 shows the items ranked from the highest to the lowest satisfaction as expressed by means and the proportions of the responses. Participants from all regions perceived the highest job satisfaction in the importance of physiotherapy to the organization’s success (94.2%), followed by their input to the development of the workplace (78.2%), the paperwork load (72%), ability to make decisions independently (68.2%), and facilitation of multidisciplinary teamwork in their workplace (67.1%). The physiotherapists perceived the least job satisfaction regarding lack of financial reward for their performance (34.1%), followed by low salaries (37.3%), lack of implementation of evidence-based practice (49.6%), lack of support for continuing education (50.8%), and insufficient resources (52%). The overall job satisfaction item shows that 66.1% of the physiotherapists were satisfied with their jobs, and only 35.8% thought of quitting their current jobs.

Table 3 demonstrates participants’ proportions responses to the satisfaction questionnaire by region. Physiotherapists from Jordan had the lowest satisfaction in their workplace related to the “opportunity to advance clinical knowledge and skills” (48.4%, p = .045). At the same time, physiotherapists from the Gaza region had the lowest satisfaction related to “insufficient resources” (46.0%, p = .0 33). Both physiotherapists from Gaza and Jordan had the lowest satisfaction in implementing evidence-based practice (45.5% and 40.6%, respectively, p = .007) and freedom to make decisions independently (64.7% and 62.5%, respectively, p = .026). There were no significant differences in satisfaction between the regions in the rest of the items, including the overall job satisfaction. Physiotherapists from Gaza and West Bank reported the highest percentage of therapists who thought of quitting their jobs (40.9% and 41.5%, respectively, p = .025).

Table 4 shows participants’ responses to the satisfaction questionnaire by gender, qualifications, and clinical experience. There were no differences in job satisfaction between males and females except that higher proportions of females perceived that they received adequate career advice from their mentors and coworkers (66.5% vs. 54.5%, p = .013). Table 4 also shows that physiotherapists with higher academic qualifications significantly perceived higher satisfaction in many items than those with lower qualifications. Finally, Table 4 shows the significant differences between physiotherapists according to their years of clinical experience. There were significant differences in four items: physiotherapists with less experience were the least satisfied with their ability to make decisions independently (62.5%, p = .047). Still, they had higher satisfaction related to the career advice from their mentors and coworkers. Physiotherapists with experience > 10 years had the highest satisfaction in the patients’ workload (70.9%, p = .022) and the lowest percentage of job quitting thoughts (27.7%, p = .018).

This cross-sectional study explored physiotherapists’ job satisfaction in Middle Eastern selected regions. The results showed that there is reasonable job satisfaction across these regions. Physiotherapists were satisfied with the importance of their job, their ability to make decisions, their input to their workplace’s developmental plan, and their work as part of the multidisciplinary team in their workplace. To a lesser level, participants were satisfied with the workload required for the number of patients or paperwork. On the contrary, they were dissatisfied with their salaries and financial rewards, workplace support for continuing education, and applying the evidence-based practice in their workplace. There were some differences in limited items of satisfaction in the participated regions. Gender was not related to job satisfaction, but physiotherapists with higher education or extended years of experience showed higher job satisfaction.

Our study showed that overall job satisfaction was 66.1%, which is higher than satisfaction in other Middle Eastern countries like Saudi Arabia (37%) and Turkey (50%). However, our overall job satisfaction results are comparable to other developing countries such as Bangladesh (more than half of the physiotherapists) and India (63.8%) [5, 21–23]. Satisfaction levels showed to be higher in developed countries such as Germany (88%) and Australia (41.9 out of 50) [7, 14]. The difference could be better payment and reward, a better professional system [24] including autonomous practice, continuing education availability, and evidence-based practice application.

Comparing the four regions, there was no significant difference in overall job satisfaction. Specifically, physiotherapists in Jordan and Gaza reported less satisfaction in some items. In Jordan, the organizational body of the profession is a society that lacks the authority to influence the profession and practice significantly. In Gaza, the current political situation and restriction on importing goods lead to a lack of medical equipment and power supply necessary for therapists’ work and satisfaction [25]. While in the West Bank, the political situations and health administration encounter fewer limitations compared to Gaza [26]. Lebanese Order of Physiotherapists has a higher extent of authority and influence on the physiotherapy profession, leading to higher satisfaction among Lebanese physiotherapists.

Physiotherapists are satisfied with being physiotherapists at their personal level and with the importance of their job in their health institution’s success. In Germany, one factor contributing to the high satisfaction of physiotherapists is the high regard for their profession [14]. The autonomous practice was introduced lately in physiotherapy practice in the study regions. However, this study showed that physiotherapists were satisfied with making decisions and input to their workplace. Furthermore, the ability to work in a multidisciplinary team was considered satisfying. The physiotherapists reported receiving advice from mentors and coworkers, which indicated a satisfactory leadership style and interpersonal relationship, especially when the facility applies a multidisciplinary work style. These items are detrimental to physiotherapy job satisfaction [6, 23], and similarly, were detrimental to occupational therapy satisfaction [27]. In a Malaysian study, physiotherapists were more satisfied than other health professionals with supervision, interpersonal work, and the nature of their work domains [16]. The workload indicated in this current study by the number of patients and paperwork was satisfactory. The high workload significantly predicts job satisfaction among allied health professions [16].

Job dissatisfaction in salaries was common in all physiotherapists in all studied regions. In our study, satisfaction in salary and rewards was not different according to the experience or qualifications of the therapists. Similar findings were reported in a study in Bangladesh that physiotherapists’ job satisfaction was positively associated with higher salaries and better access to mentoring and professional development [5]. Furthermore, similar findings were reported where the highest dissatisfaction was in salary and professional advancement opportunities [23]. Physiotherapists reported salary dissatisfaction in many developing countries [5, 21–23]. In many developing countries, there is no standard pay scale for physiotherapists [21]. A study in India showed that 63.68% of physiotherapists are satisfied with their job. Only 59% of physiotherapists were satisfied with their remuneration, and 44.2% were disappointed with the reward based on their performance. Similarly, occupational therapists from Saudi Arabia reported dissatisfaction due to low salaries and lack of continuous education [28]. Fair compensation and establishing a reward system would stimulate physiotherapists to retain their job and improve the quality of their service. Also, physiotherapists were dissatisfied with their performance and raise. A Malaysian study showed that physiotherapists were the least satisfied with promotions and financial rewards among other allied health professions [16]. Although financial satisfaction was very low, physiotherapists in our study were satisfied with the other benefits provided by their workplaces. This is contrary to findings from a German study, where satisfaction was high, but there was a discontent about social benefits provided by the healthcare system [14]. Our study’s findings suggested developing incentives for recognition and compensation for physiotherapist abilities and clinical experience to assure fair payment, job retention, and high-quality physiotherapy services.

Physiotherapy is a profession based on knowledge and skills that require continuous updates and training based on evidence-based practice [21]. Therefore, providing education opportunities for high-quality continuing education courses is essential to improving physiotherapists’ job satisfaction. However, in our study, most physiotherapists lacked continuing education support, and their institutions were not emphasizing evidence-based practice.

There was no significant difference in satisfaction according to gender. For example, a recent study in Bangladesh showed nearly half of physiotherapists were satisfied with their jobs and that females and the younger therapist had higher job satisfaction [5]. Similar findings were reported in a study including dentists in Poland [29]. There was no significant difference in satisfaction due to age or gender reported by physiotherapists in Turkey [23]. In contrast, a study in Saudi Arabia found that females had higher job satisfaction than males. Differences in satisfaction can vary according to the regions and culture due to the possible difference between males and females in career expectations, roles in life, and social expectations [22, 30]. Gender differences in job satisfaction can be analyzed at the institution and country level to ensure equal opportunities across gender.

There was no significant difference in overall job satisfaction according to years of experience. In this current study, as compared to the more experienced ones, new graduates reported more lack of autonomous practice and work support and a higher workload. An Australian study reported that new graduates lack career support and have more financial pressure than experienced ones [17]. To improve satisfaction among new graduates, there is a need to establish better peer support, mentoring, and professional development systems [17].

Although this study’s findings were similar to those in other countries, the results can be considered regionally specific. The findings of this study should be generalized cautiously, as the respondents were only members of organizational bodies and may not represent the entire physiotherapy employee in the targeted countries. In addition, unequal sample representation from different regions may affect the generalizability of the findings. Future studies may include a larger sample size with a better representation of physiotherapists from each region and physiotherapists working in different sectors, including governmental and non-governmental facilities. Future studies should consider having more equivalent sample sizes with a better representation of each targeted region. Finally, it is recommended to incorporate standardized job satisfaction scales and work stress scales in future studies.

5 Conclusion

There is reasonable and comparable job satisfaction in physiotherapy workplaces in Jordan, Lebanon, West Bank, and Gaza. Physiotherapists’ job satisfaction was the best regarding their perceived importance of the profession and abilities to change in the workplace. On the other hand, the therapists were least satisfied with their financial rewards and salaries and the lack of implementation of evidence-based practice. More experienced therapists and those with higher qualifications appeared more satisfied with their physiotherapy jobs than those with less experienced and lower qualifications. Healthcare administrators are encouraged to continuously offer career development opportunities and dynamic incentive systems to enhance their physiotherapy satisfaction with their jobs.

Ethical approval

Ethical approval was obtained from the Institutional Review Board at Jordan University of Science and Technology (# 18/133/2020).

Informed consent

Informed consent was obtained from all participants.

Conflict of interest

The authors declare no conflict of interest.