The Congress of Latvian Physicians and the 25th anniversary of the Latvian Medical Association was the right moment to analyze what has been done, define the current status and make conclusions regarding physicians work in Latvia on the whole, as well as the role of governmental and non-governmental institutions, the achievements and setting tasks and goals for the future.
To find out how doctors feel in Latvia at the current moment, their own assessment of their profession and the public opinion regarding doctors, the Latvian Medical Association commissioned the survey Medical Profession in LatviaToday to the public opinion research centre SKDS.
This survey was organized by carrying out two questionnaires – one for doctors and the other for the population of Latvia. Both were carried out in August 2013. Invitations to participate were sent to those physicians whose addresses were available in the data base of the Latvian Medical Association (LMA). Responsiveness was high and the questionnaire was filled out by 2274 doctors representing various fields. Not all respondents were members of LMA. Consequently, it may be assumed that the results represent not only the opinion of the Association members, but they might be referred to the physicians of Latvia on the whole.
The questionnaire addressed to the people of Latvia embraced in total 1,005 permanent residents of Latvia aged 18 to 74 according to quota sampling. The questionnaire was carried out in the Internet while the respondents were selected to make a national representation as well.
To formulate the goals, research themes and questions to be asked, the LMA formed a working group. Later the issues were discussed and supplemented by the LMA Board members. After the discussions six themes were chosen to be included:
· prestige of medical profession, satisfaction with professional choices;
· professional burnout;
· habits of doctors and their attitude to personal health;
· the system of health care in Latvia;
· assessment of the activities of the LMA, governmental and non-governmental institutions concerning health care.
The survey results had been reported during 7th Congress of Latvian Physicians by the sociologist ArnisKaktiņš. All graphs and tables were published in the journal LatvijasĀrsts (Physician of Latvia). Now here we are going to highlight the most important data and outcomes. Mostly the research confirmed what was already known and suspected. The results could have been more optimistic, but bitter truth is better than sweet lies.
The doctors assessment of the organizations makes interpreting of the data possible. The survey covers more than one fourth of doctors working in Latvia, so their opinion is fairly comprehensive. The assessment was done using the scale from 1 to 10. The activities of the LMA were evaluated as very good (9 or 10, according to the scale) by 20% of the respondents, while 37% admitted it was good (7 or 8), which altogether makes 57%. It is also essential that 12% of the doctors have no opinion about the LMA activities. To compare – 51% of the doctors have no opinion about the Latvian Hospital Association. Another comparison – the Ministry of Health was evaluated as very good by 2%, or good – by 8% of the doctors.
At any rate the data give evidence that the Trade Union of Health and Social Care Employees, the Hospital Society and governmental health structures have more room for improvement than the Medical Association.
Undoubtedly, the questionnaire for our colleagues contained a question on what they consider to be good points of the Latvian Medical Association. And particularly positive is the fact that 83% of the respondents evaluated the journal LatvijasĀrstsas very good (36%) or good (47%). This is a really positive evaluation which decisively makes the Latvian Medical Association to improve even more! Interdisciplinary conferences organized by the LMA were evaluated as very good or good by 73% of the respondents, thematic conferences – by 68% and likewise the process of certification – by 53% of the respondents. In many opinions the thematic conference What do Latvian Children Eat? was the year’s best.
Moreover, the survey revealed that doctors are not informed well enough about everyday work of the LMA, e.g. the concerns of the activities of Ethics Committee or Professional Court
The colleagues had evaluated the work of the LMA and LMA, in our turn, could evaluate doctors work. The survey revealed that a doctor works average in 1.93 work places. More work places are common for male doctors, younger people as well as radiologists, surgeons, neurologists. Latvian doctor’s income usually is from medical activities in 1.73 work places average. The remaining 0.2 work places usually are connected with pedagogical or organizational work while a number of colleagues get income from business, scientific research or dividends.
More than 34% of the doctors work directly with patients more than 40 hours a week (which means more than 8 hours in a working day). More than 50 hours are worked by 15%, while more than 60 hours – by 7% of the doctors. Please, note that these hours are spent in direct contact with patients, not including the time spent on settling bureaucratic formalities. In general, more than the official hours for direct contact with patients are worked by doctors in inpatient clinics as well as anaesthetists, reanimatologists, specialists in obstetrics and gynaecology. Bureaucratic formalities take more than 5 hours a week for 67% of the doctors, but 13% of the doctors spend on it 20 hours a week.
91% of the doctors believe that the health care system should be better financed, 88% think that the care giving system and management should be improved, 85% consider that the population awareness about health issues should be raised. Regarding the question whether health care provided by government should be tied to taxes paid by a respective patient, 49% answered positively while 29% opposed it. We can add here that 35% of the doctors admitted that their income decreased during the last year, while only 15% reported increase of income. Only 12% of the colleagues consider that their work is sufficiently rewarded financially. Only 33% of respondents think that non-financial rewards like appreciation from patients and colleagues, prestige of the profession etc. are sufficient. 80% of the colleagues are of the opinion that financial reward is not sufficient while 45% also think that non-financial rewards are scarce.
These conditions cause the burnout syndrome that is felt by 88% of the colleagues (moreover, 31% of them suffer from it often, only 8% have never felt it). Burnout can be caused by many different reasons, however, the answers provided by the doctors reveal that mostly burnoutis connected with the never-ending reforms of the health care system, permanent uncertainty about the future, excessive bureaucracy, low salaries and too much time spent at work leaving too little for self-improvement.
59% of the doctors feel positive and optimistic about their own health while only 55% of them feel well mentally and emotionally. To be a good doctor while feeling emotional discomfort is a difficult task. Still in our survey we mostly focused on physical health and habits that support healthy lifestyle. So we recommend everyone to look closer into the graphs that show the doctors smoking habits and what they recommend to their patients concerning giving up smoking; the doctors sports activities, overweight, vaccinations, following one’s cholesterol level and blood pressure, PSA estimation, mammography or blood in faeces in connection with their recommendations for patients.
Despite all the above mentioned, most of the doctors still love their profession. 75% of the respondents are sure that they would choose to become a doctor again if they could turn the time back, 59% would choose the same speciality they are working in at the moment, 58% would prefer the work place they have now.
Description of the survey
The survey was carried out by the public opinion research centre SKDS.
The working group: ArnisKaktiņš, Margita Otto, AndrejsSolopenko, LailaBīriņa, IlzeGrase, SaivaBrežinska and Ieva Strode.
Time period: 25 July, 2013 – 15 August, 2013.
Respondents: Latvian doctors according to the data base supplied by the client. Valid and unique e-mail addresses in the data base: 4804. Reached sampling: 2274 respondents. Method of the questionnaire: Internet questionnaire (CAWI).
Time period: 2 August, 2013 – 7 August, 2013.
Respondents: permanent residents of Latvia aged 18 to 74. Reached sampling: 1005 respondents.
Method of sampling: quota sample. The data were weighed in accordance with the Population Register of the Office of Citizenship and Migration Affairs of the Ministry of the Interior as of 21 January, 2013. Geographical coverage: the whole territory of Latvia. Method of the questionnaire: Internet questionnaire (CAWI).
The following graphs reveal the data obtained according to Net Promoter assessment index that is often used by companies to estimate the customer loyalty level.
Net Promoter system is based on the principle that customers can be divided into 3 categories:
· promoters (the possibility to recommend the company is 9 or 10) – loyal and enthusiastic customers who will continue to use the company services and will recommend them to other people;
· passive ones (the possibility to recommend the company Is 7 or 8) – satisfied customers who could be tempted away by rival companies;
· detractors (the possibility to recommend the company is 1 to 6) – dissatisfied customers who could damage the brand with their negative references.
To calculate Net Promoter index, the percentage of detractors should be subtracted from the percentage of promoters. Theoretically Net Promoter index could range from –100 (everyone is a detractor) to +100 (everyone is a promoter).
Source: Fred Reichheld, Rob Markey. The Ultimate Question 2.0: How Net Promoter Companies Thrive in a Customer-Driven World,
To estimate the statistical measurement error it is necessary to know the number of respondents in the corresponding group and the outcome in per cent. Based on these characteristics, the table shows limits of statistical measurement error in +/– per cent with 95% probability.
For example, if the survey data show that 55% of all respondents (the number of respondents n=1005), taking into account the information available about doctors and their salaries, believe that doctors work in Latvia is not sufficiently rewarded financially, then we can assume with 95% probability that the statistical measurement error is within +/– 3.1%. It means that 51.9 to 58.1% from the target group believe that doctors work in Latvia is not sufficiently rewarded financially.
1. Occupational prestige, satisfaction with the chosen profession
Figure 1. Prestige of the doctor’s profession (Doctors’ view)
Please, estimate the prestige of the following professions in Latvia today
Figure 2. Prestige of the doctor’s profession (People’s view)
Please,estimate the prestig of the following professions in Latvia today
according to public opinion
Figure 3. Prestige of the doctor’s profession
Please, estimate the prestige of the following professions in
Figure 4. Whom to trust? (People’s view)
In your opinion, can representatives of the following professions
Whom to trust? (People’s view)
Please, estimate the prestige of the following professions in the eyes of Latvian society. In your opinion, what might be the trust level in the following professions on the whole?
Figure 6. Would you advise your child to choose your own profession?
Taking into account everything you know about your profession and your practical experience, would you recommend your child to become a doctor?
Figure 7. Satisfaction with your own choice
Are you sure that you would choose to become a doctor again if you could turn the time back?
Are you sure that you would choose the same doctor’s speciality again if you could turn the time back?
Are you sure that you would choose the same work place you are working in now again if you could turn the time back?
Figure 8. Income changes over the last year
Taking into account all the income you get from your medical activities,
can you estimate the changes during the last year?
Figure 9. Satisfaction in doctor’s work
In your opinion, is your work in medical area evaluated sufficiently?
Figure 10. Satisfaction in doctor’s work
Please, identify the most rewarding moment in your doctor’s job.
2. Professional burnout
Figure 11. Burnout in work
Sometimes doctors’ professional activities are associated with the burnout syndrome, which means emotional and physical problems, loss of interest concerning one’s work, cynical attitude, and feeling of no personal
achievements. Do you ever feel like that?
Figure 12. Burnout intensity
Please, using the 7 point scale, estimate the level of your professional burnout
Figure 13. Burnout causes
Please, evaluate the importance of the following factors that might enhance your feeling of burnout, according to the 7 point scale.
Figure 14. Satisfaction with different aspects of life
How satisfied are you in general with …
How would you evaluate in general …
3. Doctors’ habits and caring for their health
Figure 15. Smoking
Do you smoke?
Figure 16. Overweight
Are you overweight?
Figure 17. Going in for sports
How many hours a week do you spend on physical activities/sports, intensive enough to make you sweat?
Figure 18. Cholesterol index
Do you know what your cholesterol index is/do you follow your level of cholesterol?
Figure 19. Blood pressure
Do you know what your blood pressure is/do you follow your blood pressure?
Figure 20. Vaccination (Doctors’ answers)
Have you been vaccinated against the following infections?
Do you recommend your patients vaccination against the following infections?
There are different opinions about vaccination against infections.
Please, identify the infections everybody should be vaccinated
Figure 21. Early diagnosis of oncologic diseases
Have you had prostata specific antigen (PSA) timely determined according to guidelines? Have you had mammography done timely according to guidelines? Have you had hemoplus in faeces timely determined according to guidelines?
Figure 22. Recommendations for patients
Doctors’ attitude to their patients can be different. Some of them give
advice on healthy lifestyle while others do it rarely or never. Do you
recommend your patients the following actions?
Figure 23. Attitude towards clinical guidelines
Doctors differ in their attitude towards evidence based medicine. Part believes in accurate following the guidelines, performing the indicated activities, the sequence of their application and the tactics in the treatment. Others consider that such guidelines cannot substitute the doctors’ experience, intuition and individual approach to each patient. Where will you place yourself in the 7 point scale?
Figure 24. Passive euthanasia
In case, you would get into a situation when you are unconscious and
cannot make any decisions, and your life would be maintained in terminal condition without any medical solutions to improve the situation,
would you wish to have passive euthanasia performed??
In case, you would get into a situation when you are unconscious and cannot make any decisions, and your life would be maintained in terminal condition without any maedical solutions to improve the situation, would you wish to have passive euthanasia performed?
4. Health care system in Latvia
Figure 25. Available services and tax payment
In your opinion, should the health care paid by the state be connected with the taxes paid by respective patients?
Figure 26. Core values of health care system
Which two of the mentioned values should be the most important in Latvian medical care system, in your opinion?
Figure 27. Health care system in the future
Thinking about future development of health care in Latvia which two
theses do you agree with?
5. Evaluation of the performance of the Latvian Medical Association
Figure 28. Evaluation of the Association’s performance
How do you evaluate activities of the following institutions?
Figure 29. Evaluation of the Association’s performance
Please, evaluate the following events and activities organized by the Latvian Medical Association:
6. Statistics on the doctors-respondents
Figure 30. Number of work places
How many paid work places do you currently have?
In how many work places do you currently get income from medical activities?
Figure 31. Contacts with patients
On average for how many hours a week do you contact your patients directly?
How many patients do you contact on average per week?
Figure 32. Time spent on bureaucratic and administrative work
How many hours on average do you spend filling out documents and reports and doing administrative work?
Fiigure 33. Total length of service
For how many years have you been in a medical profession?
Figure 34. Statistics on the doctors-respondents
In what medical area do you work?
7. Data from the population questionnaire
Figure 35. Adequate remuneration for doctors
Taking into account everything you know about doctors and their salaries, do you think that doctors in Latvia are sufficiently financially rewarded?
Figure 36. Ideas on doctors’ remuneration
What is in your opinion an average Latvian doctors monthly earnings after taxes?
Figure 37. Requirements for the doctor
How important for you is that your doctor …
Figure 38. Statistics on the people-respondents
How many medical institutions did you visit as a patient
last year at least once?
How many doctors did you visit last year (including family doctors,
Dr. PēterisApinis, President of Latvian Medical Association
ArnisKaktiņš, sociologist, executive director of the public opinion research centre SKDS