Psychological safety, Job satisfaction, and the Intention to Leave among German early-career physicians.

Background: Healthcare systems worldwide experience shortages of healthcare professionals. Retention of physicians is becoming an increasing problem. The psychological safety among physicians affects not only performance, but also their emotional well-being and job satisfaction. This study aims to evaluate early career physicians' perception of psychological safety and its influence on job satisfaction and intention to leave.

Methods: In a cross-sectional study, early career physicians, currently in fellowship programs in Germany were invited to fill in an electronic survey. The instrument consisted of demographic variables and sections from validated and well-established questionnaires. Psychological safety was evaluated on three levels - in relation to the team leader, team as a whole, and peers. Also job satisfaction was assessed with standardized measures, and participants were asked if they were considering leaving their current employer. Participants were recruited via a nationwide learning platform - an online educational portal for medical students and early career physicians. Data analyses included descriptive, correlation analysis and regression analyses to determine univariate and multivariate associations with job satisfaction and intention to leave.

Results: The study sample consisted of 432 early career physicians. Most were fulltime employed (85.6%), female (78.2%), and in first three years of their postgraduate education (77.5%). 47.2% indicated intention to leave their current employment. On a Likert-10 agreement scale, with high scores indicating grater psychological safety, the mean scores for leader related, team related and peer related psychological safety were 6.01 (95%CI=5.81 to 6.21), 7.30 (7.11 to 7.49) and 7.95 (7.78 to 8.12), respectively. In correlation analysis, all dimensions of psychological safety showed significant associations with Job Satisfaction and the Intention to Leave. In the multiple regression analyses, female gender (B=-0.10; p=0.04) and age group (B=-0.08; p<0.01) were associated with lower job satisfaction. High leader and team related psychological safety were significantly associated with higher job satisfaction (B=0.18, p<0.01; B=0.10, p<0.01), and negatively related to intention to leave (OR=0.53, p<0.01; OR=0.77, p<0.01).

Conclusion: This survey enhances our understanding of the nuances of psychological safety among early career physicians. In Germany, they reported low to medium levels of psychological safety related to the leader and low job satisfaction. Almost every second participant indicated intention to leave the organisation. Leader related psychological safety had highest effect on job satisfaction and intention to leave. Our findings corroborate the eminent role of leadership, workplace and safety culture for job satisfaction and retention of early career physicians, what consequently affects quality and safety of healthcare.