The value of work for doctors in Pakistan: towards a framework for ensuring decent work

Figures & data

Table 1. Details of the interview participants.

Professional tile	Participant No.	Hospital department	Years of service
Consultant	2	Critical care	19
	4	Critical care	18
	7	Pathology	15
Director Immunisation	1	Immunisation centre	21
Head of the Department	10	General medicine	25
	12	Emergency	19
	19	Psychiatry	23
Medical Officer	5	Infectious diseases	8
	8	Pathology	8
	9	Emergency	7
	14	Pulmonology	9
	17	Gastroenterology	5
	18	Psychiatry	4
	21	Urology	2
	23	Pathology	2
	24	Nephrology	1
	25	Gynaecology	2
	27	Critical care	5
Registrar	16	Gastroenterology	8
Senior Medical Officer	3	Critical care	16
	6	Infectious diseases	13
	11	Internal medicine	10
	13	Internal medicine	11
	15	Pulmonology	7
	20	Anaesthesia	13
	22	Radiology	9
	26	Internal medicine	10

Table 2. Data themes and illustration quotes.

Data themes	Example from the participants’ data
Sense of fulfilment
Serving others	In the medical profession, even if you help someone minutely, or in a very small way, it will make you happy. As I said, what we are doing today is going to contribute tomorrow. This motivates us. When we do some meaningful work, for example, save someone in ICU and someone tells us that your treatment has saved someone’s life, it is a great feeling, sometimes it makes us cry. (Participant 2: Consultant Critical Care) Most of the people coming here are poor and suffering from different health issues. They have the issues of affordability. I as a doctor facilitate them and give them best treatment within the resources of this hospital and provide the best treatment possible in this hospital. So, this makes me feel that I am doing a good job for the people who are here and have expectations from us. (Participant 25: Medical Officer Gynaecology)
Recognition and appreciation	Well, when they are good, like when my seniors, they appreciate my work, that is when I like, I don’t know why, but I get an adrenalin rush in my bloodstream. And I think of myself like, you know, maybe I am someone, that is why they are respecting me, maybe that is why they appreciated me. So, and I try to work even harder then, like, for example, I would work hard for the next compliment, to fetch the next compliment. Tomorrow, I should get complimented again, and stuff like that. (Participant 5: Medical Officer Infectious diseases) I can bring a smile on someone’s face that they can give me blessing for their whole life, means you see them wandering in a hospital helpless and you meet a patient after one or two years and he says look at this doctor, my son look at this doctor, he has treated you and now you’re walking on your foot. So, that is how we see the interaction of career and life objectives with our work (Participant 15: Senior Medical Officer Pulmonology)
Professional leaning and development	They work, they learn, and they serve. If they deliver professionally, it will make them valuable. You know that when they join this field, they use the theoretical knowledge and put into practice. The practical work is challenging. When they learn practical work, they can deliver well. This is the way they can make their work meaningful. On the other way, if they do not practice, they will not be able to serve well. (Participant 2: Consultant Critical Care) I think we are gaining experience. We feel energetic and eager to put more efforts into our work. If you are gaining something, then obviously you feel accomplished, and you try to put your level best into it. This helps you gain more experience and whatever that you want out of this job. (Participant 19 Head of the Psychiatry Department)
Hinderances to decent work
Poor healthcare system	Generally, the service structure or structural program for doctors is almost non-existent. The compensation and benefit system is poor. If one is not happy with his job and has to work in a 2nd shift somewhere else, how can he be satisfied with the job. (Participant 12: Head of the Emergency Department) [The] referral system is very poor. Diagnosis is not proper. Patients coming from other towns and districts do not bring their previous reports. Doctors of those areas are not in contact with these big hospitals for advice. When patients come here, hospital has to do everything from the scratch. This creates load for doctors. Also, there is shortage of doctors at ground level in district hospitals. Very few doctors for millions of populations. So [patient] ratio is high. If those hospitals are strengthened and consultants are made available there, the load on our hospital can be decreased. (Participant 16: Registrar Gastroenterology)
Issues from patients and public	Yes, there is also lack of awareness among people. People also break the rules and have a negative attitude towards doctors. They sometime say that doctors give poison or poisoned injections to patients when they are brought to hospitals. We all know that that unfortunately people die due to negligence during this pandemic and some of them die at homes and then they bring them to hospitals. (Participant 5: Medical Officer Infectious Diseases) I would say that education of the patients, that is very important, because we find here day by day, that we, when we deal [our patients], we advise them, and yet they won’t accept our advice because they are not enough educated. They would accept a quack’s decision over ours, and which later on, I’ve seen this, that later on, maybe down one year down the line, or two or three years, we will see this patient, we will receive it in a critical condition. And maybe he’s close to dying, or he will be dead in a few more moments. I’ve seen this. (Participant 6: Senior Medical Officer Infectious diseases)
Poor work environment	If the environment is not comfortable, then your personal efforts get down, you get demotivated and may not experience meaningfulness. (Participant 14: Medical Officer Pulmonology) If work environment [is] going to affect my mental health negatively, I cannot be a part of such department or hospital. If I am not a good human at the end of my training, I think I have achieved nothing. In our hospitals, you become toxic and develop behaviour which is not desirable. (Participant 22: Senior Medical Officer Radiology)
Lack of essential facilities	Similarly, there are some challenges of facilities at our hospitals. For example, we were not provided with proper protective gadgets during the covid initially. It was a great risk [for us] to get infected with the virus. We demanded [for] risk compensation allowance, but no one listened. You know, such things make you feel a lesser person with no value. (Participant 8: Medical Officer Pathology) You can see queues of patients at every department. If things are managed well, it would influence positively, otherwise, it will cause to lessen your motivation. Doctors are not getting what they deserve. Despite [their] services, they lack basic facilities. (Participant 27: Medical Officer Critical Care)
Physical and mental health challenges	Now, you see many of our doctors and medicks fellow suffered. Some of them died and some of them faced the infection of their whole families. They cannot come to perform their duties. Now everyone is careful. It has negative effects on our work. (Participant 7: Consultant Pathology) Yes, when you face undesired circumstances, they will demotivate you or cause you to avoid the work having risks. (Participant 9: Medical Officer Emergency)

Figure 1. Themes illustrating the factors that enhance the value and meaning of doctors’ work.

Figure 2. Themes illustrating the factor that can negatively impact the value of doctors’ work.

Figure 3. The framework of the value of work and dimensions of decent work.