Career Satisfaction among Community Pharmacists

Objective: This study's objective was to determine the level of career satisfaction among practicing Community Pharmacists (CPs) and the impact of various factors on career satisfaction. Methods: This cross-sectional study used a self-administered instrument to access the current level of career satisfaction among CPs. The survey instrument questions were adopted from previous studies and were contextualized to suit study objectives and revalidated using face and content validation. The study instrument was distributed and collected. Results: A total of 172 responses from CPs were received, 112 (65.1%) from males and 60 (34.9%) from females. The difference in age categories was significantly profound in the less than 34 years old group being 113 (65.7%) compared with the more than 34 years old being 59 (34.3%). Around 98 (57%) were working in chain pharmacies and 74 (43%) in independent pharmacy stores. The study result showed126 (73.3%) were unsatisfied in their careers and 46 (26.7%) were satisfied. Conclusion: Age and working experience are both major contributing factors to career satisfaction levels. Only 36.5% reported having higher career satisfaction levels among total participated CPs. Original Research Article Iqbal and Iqbal; JPRI, 32(5): 33-41, 2020; Article no.JPRI.56282 34


INTRODUCTION
In the never-ending war of diseases, pharmacists are the healthcare professionals who stand in the front line to deliver and provide better healthcare outcomes for patients. They represent the thirdlargest healthcare professionals in the world [1]. Pharmacists mainly practice in hospitals, clinics, drug law-enforcement sectors, and industries. Over the last decade, the role of pharmacists has evolved from solely dispensing medications to being a pharmaceutical health provider. Various career options developing innovative expertise such as medication therapy management, drug use reviews, disease management are the job role of pharmacists today [1].
Although there is an escalating number of pharmacy graduates in the market and newly opened pharmacy outlets all over the country, Pakistan still faces a shortage of CPs if compared to the population ratio estimated by the World Health Organization (WHO) [2]. As of today, Pakistan is far below the recommended WHO population ratio of pharmacists vs population i.e. 1:2000 [2]. The healthcare industry in Pakistan still requires more healthcare workers to accommodate the demanding patient care, particularly in the elderly and specialized populace [3]. Career satisfaction among healthcare workers is rapidly being recognized as a measure for quality improvement programs [4]. If there is a low satisfaction level among pharmacists, patient care and productivity will affect the efficiency of the healthcare services.
To the best of our knowledge, there is no specific study focusing on the career satisfaction of CPs in Pakistan. Studies on job satisfaction are indirectly linked to career satisfaction therefore a review is done to appraise contributing factors [5,6]. Variables of factors such as salary, demographic, intrinsic factors, extrinsic factors, pharmacy preceptorship, continuing pharmacy education are associated with high professional satisfaction levels which depict career satisfaction. This study aims to discover the level of career satisfaction of CPs in Pakistan. The impacts of various factors on career satisfaction levels are also evaluated.

MATERIALS AND METHODS
This cross-sectional study used a selfadministered instrument to assess the current level of career satisfaction among CPs. Only registered CPs with a license to practice were recruited. Convenience sampling was used to have an adequate sample at the end of the data collection phase (n 172). The study instrument was distributed and collected.
Around 12 statement-based questions about career satisfaction were used in this study.
Respondents were asked to answer in dichotomous answer categories. The study information sheet and consent (either verbal or written) were obtained from each participant before providing a questionnaire to those agreed to participate in the study. Those who were not willing to provide consent were not included in the study.
Data were expressed as descriptive frequencies and univariate analysis of variables compared to career satisfaction was performed using the chisquare test. A cut off point at 75% was set since the satisfaction data had a skewed distribution, above 75% was considered as satisfactory.
Multiple logistic regression analysis was then performed to examine the relative importance of social-demographics correlating with career satisfaction. Variables of age, marital status, number of dependants, years of service, perception status, and weekly working hours were included, 95% confidence interval, and pvalue were calculated.
Statistical Package for the Social Sciences Version (SPSS) 22.0 with significance set at a pvalue of ≤0.05 was used to analyze data. Internal consistency and reliabilities of career satisfaction scales were determined using Cronbach alphas. A Cronbach alpha value of 0.85 was obtained. Table 1 displays the demographic profile of the respondents. The difference in age categories was significantly profound with less than or equal to 34 years old being 113 (65.7%) and more than 34 years old being 59 (34.3%). The study population was categorized into two main age groups i.e. <34 years and >34 years of age because in the pilot study most of the participants were <34 years of age with fewer exceptions, that's why the cut-off was set at 34 years of age. Around 142 (82.6%) obtained undergraduate education levels while 30 (17.4%) were having postgraduate education levels.

RESULTS
Around 98 (57%) were working in chain pharmacies and 74 (43%) in independent pharmacy outlets. This study found that the majority of CPs earns more than USD300 monthly, 150 (87.2%). Table 2 and Fig. 1 show that 126 (73.3%) were not satisfied and 46 (26.7%) were satisfied after setting a cut off at 75% due to skewness in the data distribution. Table 3 summarizes the univariate analysis of social-demographic variables with career satisfaction. Gender, age, marital status, number of dependants, the position held, education status, length of service, continuing professional development, intern perception, weekly working hours, monthly salary, and working experience were included. Variables with p-value < 0.05 were considered significant. Age less than 34 years old (p-value 0.009) and working experience in independent pharmacy stores (pvalue 0.044) were found significant in influencing career satisfaction.    The p-value of <0.05 was considered as significant The p-value of <0.05 was considered as significant  Table 4 displays the analysis of multiple logistic regressions. Variables were all having p-value > 0.05 which indicates no interrelation to affect career satisfaction due to confounding variables. Two variables were found to be significant, (1) age less than 34 years, (2) working experience in an independent pharmacy. Fig. 2 shows the receiver-operating characteristic (ROC) curve indicates strong discrimination power with the area under curve 0.684. The frequency of responses in career satisfaction parameters is shown in Table 5.

DISCUSSION
The purpose of this study was to determine the current level of career satisfaction among CPs in Pakistan. To date, there has not been a study focusing solely on community pharmacist's career satisfaction in Pakistan. A total of 172 CPs responded in this survey. Overall, 126 of them expressed unsatisfactory career satisfaction levels, and only 46 have satisfactory career satisfaction levels. In the parameters of career satisfaction, 56.4% answered 'No' for being extremely satisfied with their career. An individual's satisfaction level is determined by various factors, such as the salary, working environment, job stability, and respect in society. Age was found to be a significant factor in measuring career satisfaction. In our study, CPs aged less than 34 years old were majorly not satisfied with their career as a community pharmacist. Study findings were aligned with previous studies where age was also major contributor factors to job and career satisfaction levels [4,[6][7][8]. Younger pharmacists aged 26-35 years old were less contented about their current job satisfaction and future careers [5,9]. In many studies, female pharmacists were found to be more satisfied than their male counterparts in their career satisfaction whereas in our study it was almost equal.
Matthew et al. provided strong evidence related job and career satisfaction are extensively predisposed to extrinsic factors: quality of workplace relationships, salary, remuneration, benefits [6]. The research suggested that an increase in extrinsic motivation may increase pharmacists' satisfaction [6]. Although 87.2% was earning a monthly income of more than USD300, yet approximately two-thirds of participants responded that salary is a major contributor to dissatisfaction levels. Around 51.2% agreed to career satisfaction parameters that 'the monetary rewards received are less than they should be. These findings are similar to a study done on salary and job satisfaction in Malaysia [10].
Around 64% of participants revealed they had not received recognition and praise from their profession. Studies have shown that perceptions of an employee about the work activities positively affect their behavior, performance, and health. For CPs, interpersonal interactions such as more patient contact were found to a factor of higher contentment in the job. A low satisfaction level was found when pharmacists were not able to meet with other healthcare professionals to discuss patient care issues. Lack of reward from performance and insufficient data available at the workplace also showed lower satisfaction levels. Variety in work rather than repetition in daily activities also sought higher job and satisfaction [11]. Positive or negative treatment from topmanagement at the workplace also affect the satisfaction level [12].
Hincapie et al. reported that chain pharmacists were less satisfied when they had working experience outside a chain community pharmacy [13]. Pharmacists having experience working in an independent pharmacy store was also less contented about their careers. Holding a managerial position also showed higher dissatisfaction levels. The reason was that pharmacist in community settings has boundaries to expand in an organization. Furthermore, working in a hospital did not involve the perception of over-qualification. Work environment and pharmacy location is also a factor to the lower career satisfaction levels as reported in a study by Maio et al. [14] In another study, Seston et al. [9] also reported CPs were less satisfied when compared to hospital pharmacists regarding workplace facilities and career growth.
Being a community pharmacy preceptor of intern pharmacists without any additional remuneration has also a greater impact on their dissatisfaction (79.7%). This was similar to the findings by Murawski's study where pharmacists who were previously preceptors exhibited lower career satisfaction [6]. However, contradicting results were found in another study by Payakachat et al. stated that being a pharmacy preceptor was related to higher career satisfaction as it engages in extensive professional activities that are well associated with better professional satisfaction [15].

CONCLUSION
This study provides insights into the relationship between demographic variables and career satisfaction levels among CPs. Age and working experience both are major contributing factors to career satisfaction among CPs in Pakistan. Pharmacists with higher career satisfaction levels are likely to take part in better patient satisfaction and health outcomes. Therefore more efforts and motivations are needed among pharmacists for the selection of community pharmacy as a professional career in Pakistan.

LIMITATIONS OF THE STUDY
This study was only done in some specific areas so the results cannot be projected to the entire country. A detailed follow-up study can be done to evaluate the career satisfaction levels among all of the CPs in the country by considering some specific factors to predict detailed variables affecting career satisfaction among them.

CONSENT
The study information sheet and consent (either verbal or written) were obtained from each participant before providing a questionnaire that agreed to participate in the study. Those who were not willing to provide consent were not included in the study.

ETHICAL APPROVAL
It is not applicable.