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The Perceptions of the Working Environment of Anaesthesiologists Migrating From the Public to the Private Sector in a Developing Country: An Exploratory, Qualitative Study


 Background

There is a significant disparity in the distribution of medical practitioners within the public and private healthcare sector of South Africa. This study explores the perceptions of anaesthesiologists of their working environment in the public sector following their migration into private practice. Their reasons for leaving are largely unknown.
Methods

Rich pictures were applied in an exploratory, qualitative research design using Checkland’s Soft Systems Methodology. Anaesthesiologists (specialist anaesthetists), who left the Department of Anaesthesiology at the University of the Witwatersrand between 2014 − 2017 and were working in the private sector in the Johannesburg Metropole were invited to a workshop. Participants were asked to draw a rich picture to illustrate their perceptions of the working environment in the Department and to then draw a picture to depict the ideal anaesthesiology working environment in the Department. Explanations of their pictures were audio recorded and deductive thematic analysis was used to analyse the data, guided by Herzberg’s Motivation- Hygiene Theory.
Results

The rich data from this study suggests job dissatisfaction and a lack of satisfaction in the Department due to poor hygiene and motivator factors such as poor working conditions, challenging workplace relationships, inflexibility with work-life balance and a lack of accountability. These factors are some of the important reasons for migration of anaesthesiologists from public to private practice.
Conclusion

This study demonstrates the complexity of interactions between individuals working together in systems which are often in tension and are sensitive to multiple dynamic influences. These systems are context-specific but need to recognise the factors which may ultimately impact quality health service delivery and education.