Introduction

Job satisfaction could be considered as an emotional attachment of an employee to the workplace [1, 2]. While pharmacists may feel satisfied practicing pharmacy, the profession could become stressful [2, 3]. Few notable characteristics of community pharmacy practice include increased workload, long work shift, etc. However stress management skills among community pharmacists could come handy in these situations [4]. A study reported that 67.2% of pharmacists in the US were satisfied with employment [3]. A study in Australia highlighted job dissatisfaction as a core reason for job turnover [5]. It was also reported that stress at the workplace is one of the most common reasons mentioned by pharmacists for quitting employment [6].

From a theoretical standpoint, the theory of Maslow’s hierarchy of needs has been used previously to assess nurses’ motivation [7]. According to the theory there are 5 levels of human needs and is usually presented as a pyramid with 5 levels. The bottom level contains basic needs such as food, shelter, clothing, etc. followed by safety that includes employment, income, health, etc. The third level entails love and belonging that may translate into family, connections, friendship, etc. The fourth level entails esteem that incorporates recognition, respect, freedom, etc. The final top-most level is self-actualization. The theory further states that an individual can only ascend higher levels of needs after achieving the need of the previous level [8].

A study conducted among pharmacists working in community and hospital pharmacies in Jordan highlighted that pharmacists working in the community pharmacies were less satisfied as compared to those working in the hospital pharmacies. In addition, prolong work hours, lack of incentives, etc. acted as determinants of job satisfaction [9]. In a study conducted among pharmacists associated with hospital settings of Riyadh city in Saudi Arabia, it was reported that most pharmacists were satisfied with their work. However, most of them had an intention to leave [10]. Other studies conducted in Saudi Arabia highlighted that hospital pharmacists considered recognition, career advancement opportunities, autonomy, etc., as motivators while pharmacy managers considered financial rewards as major a driver for motivation for pharmacists as compared to non-financial rewards [11, 12]. Whereas a study among community pharmacists working in Riyadh region highlighted that independent community pharmacists were slightly less satisfied [2]. The pharmacists mentioned longer work hours, difficulty in securing work leaves, low financial incentives as few determinants of dissatisfaction [2].

The COVID-19 pandemic further added to the healthcare burden on community pharmacies as they become the primary point of contact for addressing the healthcare needs of the public [13]. Since March 2, 2020, a total of 500,083 cases have been reported in Saudi Arabia. The number of patients recovered was 481,225 while 7963 deaths have been reported so far. All figures are reported at the time of this writing, i.e., July 10, 2021 [14]. The Saudi health authorities adopted the World Health Organization’s recommendations and implemented a lockdown in the country [15]. The community pharmacies in Saudi Arabia remained opened for the public with newly adopted health guidelines.

To date, there have been few studies conducted to document employment satisfaction in Saudi pharmacy settings [2, 10–12]. Of these, only two studies evaluated community pharmacists’ job satisfaction and were conducted in Riyadh region [2, 10]. Hence, data pertaining to job satisfaction of pharmacists in Eastern Region of Saudi Arabia is not available. Based on the available evidence from aforementioned studies, it was observed that pharmacists working in Saudi healthcare settings especially the community sector usually seemed satisfied however, they did have a sense of dissatisfaction. Several reasons have been reported for this dissatisfaction such as type of work, financial benefits, cooperation with others, recognition, etc. [2]. However, which of these employment aspects impact a pharmacist’s overall job satisfaction the most, has never been investigated before. In addition, the pandemic has also affected the usual working pattern of the pharmacies. These aspects are essential to document as they can affect employment satisfaction. Also, documenting these aspects may provide an understanding of the determinants that affect overall satisfaction. This data could help in review and revision of employment contracts of pharmacists at workplaces.

The documentation and understanding of these aspects is essential to devise human resource policies that increase the chances of employee satisfaction and retention. As of now, no study has been conducted in this region that evaluates the extent to which employment aspects such as monetary benefits, vacations, promotions, etc., affect overall satisfaction with the job.

Methods

Results

After cleaning of completely missing surveys, 241 surveys were analyzed. The mean age of pharmacists was 32.72 ± 6.2 years. Most pharmacists were male (N = 168, 69.7%), and married (N = 175, 72.6%). Most pharmacists (N = 101, 41.9%) had a monthly income above SAR 10,000. Slightly more than half of the sample included Saudi pharmacists (N = 137, 56.8%) while rest were non-Saudi pharmacists. In addition, most Saudi pharmacists (N = 112) worked in hospital-based pharmacies while most non-Saudi pharmacists (N = 84) worked in retail pharmacies.

The mean years of work experience was 8.07 ± 5.96. The majority worked between 8–10 hours in a daily work shift (N = 219, 90.9%). Most pharmacists (N = 152, 63.1%) attended to more than 50 patients in a daily work shift. Few pharmacists had to work overtime (N = 94, 39%) and median hours of overtime was 4 (IQR = 8). The details are presented in Table 1.

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Table 1. Background characteristics of the study variables (N = 241).

https://doi.org/10.1371/journal.pone.0289587.t001

The overall job satisfaction score was 130.74 out of a maximum possible score of 199. The sub-scales for co-workers and communication had scores > 15.8 out of a maximum possible score of 24 while the subscale for operating conditions had score > 12.5 out of 20. The subscales for promotion and rewards had scores <14 out of 24. The scores with 95% CI for all subscales and overall satisfaction along with reliability coefficient are reported in Table 2.

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Table 2. Job satisfaction score and reliability analysis for different subscales and overall scale.

https://doi.org/10.1371/journal.pone.0289587.t002

The results for the distribution of job satisfaction based on demographic characteristics of the pharmacists is presented in Table 3. None of the demographic variables was significantly associated with overall job satisfaction (p > 0.05).

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Table 3. Distribution of participants based on overall job satisfaction (N = 241).

https://doi.org/10.1371/journal.pone.0289587.t003

The cross-tabulation analyses between demographic characteristics and subscales were conducted. The cross tabulation between income of pharmacist and satisfaction classification for the subscale of supervision was significant (p < 0.05). A larger proportion of pharmacists who had a monthly income of more than SAR 5000 that is equivalent to USD 1333.5, seemed satisfied with supervision (53.1%), as compared to those pharmacists with an income less than SAR 5000, i.e., USD 1333.5, i.e., (25%). The results are tabulated in Table 4.

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Table 4. Distribution of job satisfaction based on subscales of pay, promotion, and supervision (n = 241).

https://doi.org/10.1371/journal.pone.0289587.t004

Besides, the cross tabulation between age of pharmacist and satisfaction classification for the subscale of operating condition was significant (p < 0.05). A larger proportion of pharmacists who were above 30 years seemed dissatisfied (50.4%) and satisfied (22.6%) with operating conditions, as compared to pharmacists aged 30 years or less, i.e., (43.5%) and (13.9%), respectively. The results are tabulated in Table 5.

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Table 5. Distribution of job satisfaction based on subscales of contingent rewards, fringe benefits and operating conditions (n = 241).

https://doi.org/10.1371/journal.pone.0289587.t005

Further, the cross tabulation between number of patients attended in daily work shift and satisfaction classification for the subscale of nature of work was significant (p < 0.05). A larger proportion (53.5%) of pharmacists who attended > 30 patients in a daily shift seemed satisfied with the nature of work as compared to those (35.9%) who attended < 30 patients in a daily shift. The results are presented in Table 6.

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Table 6. Distribution of job satisfaction based on subscales of coworkers, nature of work and communication (n = 241).

https://doi.org/10.1371/journal.pone.0289587.t006

The regression analysis revealed that for a unit increase in pay score, the overall satisfaction score would increase by 0.155 provided other variables are adjusted. Similarly, for a unit increase in promotion, supervision and fringe benefit scores, the overall score for satisfaction with the job would increase by 0.148, 0.176 and 0.2, respectively. Besides, the job satisfaction score would increase by 0.172, 0.116, 0.182, 0.199, and 0.204, for a unit increase in scores for contingent reward, operating condition, co-workers, nature of work, and communication, respectively, provided all other variables are controlled.

Highest contribution towards overall job satisfaction score, i.e., ≥ 0.199 was observed from the score for communications, fringe benefits and nature of work. This means that the satisfaction of a pharmacist would be most affected if the satisfaction with benefits, nature of work, and workplace communication is affected. The results are presented in Table 7.

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Table 7. Multiple linear regression model for overall job satisfaction (n = 241).

https://doi.org/10.1371/journal.pone.0289587.t007

Discussion

It was observed in the study that less than a quarter of pharmacists were satisfied with their employment while more than half were ambivalent. This was in line with the results of Suleiman (2015) where independent community pharmacists seemed dissatisfied [2]. In another study, a lower score was reported for female pharmacists working in community pharmacies in Saudi Arabia [22]. The aspects of communication, fringe benefits and nature of work had the highest contribution towards overall job satisfaction score.

Our results reported communication as a major determinant of satisfaction. Communication is an important aspect in an organization as all organizations function in teams. For ease of discussion, this aspect could be divided into several segments. The first is the internal communication that occurs between pharmacists and their chain of hierarchy. The second segment is the inter-professional communication that occurs between pharmacists and other allied health members. The third type of communication that could be considered is the patient-pharmacist relationship. The aspect of communication within the line of command is very important as it was highlighted in a study that pharmacists have difficulties in requesting for leaves [2]. Studies have mentioned the need of forging a physician-pharmacist relationship [9, 23]. Moreover, skepticism exist among physicians regarding the clinical roles of pharmacists elsewhere [23]. At the same time, pharmacists may not find themselves confident in dealing with issues of clinical nature owing to inadequacies in their education and training [24]. This may significantly reduce communication with other allied health professionals. It was also mentioned in a study that patients are discouraged by other healthcare professionals when it comes to communicating with pharmacists for their healthcare needs [2].

The second most important aspect in terms of its weightage on satisfaction was fringe benefits. Generally, pharmacists working in the Gulf region are provided with a tax-free salary, paid vacation, end-of-service benefits, free housing, air fare and transport allowance, and free medical facility or insurance [25]. Thus, having such benefits in job contracts tends to increase employment satisfaction. It was observed in a study that pharmacists considered recognition, feedback, promotion, etc. as major motivators for job [11]. On the contrary, low wages have been mentioned by pharmacists in Saudi community settings that may drive dissatisfaction among them [2].

Our results highlighted that the nature of the work contributed a lot to overall satisfaction with the job. Apart from the patient-care services, the work in a community pharmacy also involves administrative services such as managing sales of goods and supply chain management that is usually regarded as an administrative task. Similarly, marketing of healthcare products and some value-added services such as blood pressure clinics, nicotine cessation clinics, diabetic foot clinics, etc., are carried out. Since the nature of community pharmacies is retail oriented, the focus of the pharmacy to some extent if not whole, remains towards the sales. Consequently, this would take considerable time from a pharmacists’ work shift thereby limiting them in performing clinical roles and patient oriented services such as reviewing prescriptions and counseling patients. This notion may explain why pharmacists in Saudi Arabia felt that their outlook seemed to be of a salesperson [2].

In our analysis, the analysis between place of work and satisfaction with the aspect of nature of work was near to statistical significance (p = 0.055) and revealed that pharmacists working in hospital-based settings tended to be slightly inclined towards being satisfied and ambivalent as compared to dissatisfaction. While those who work in community pharmacy settings followed the same trend, they tended to be slightly inclined towards dissatisfaction. In a study in Jordan, it was reported that pharmacists who had more patient-oriented responsibilities seemed to be more satisfied [9]. Suleiman (2015) observed that satisfaction among community pharmacists was positively linked with increase in the number of prescriptions [2].

This aspect was further evident in the results pertaining to the analysis between number of patients attended in daily work shift and satisfaction with the aspect of nature of work, as it was significant (p < 0.05). It was observed that the pharmacists who had more than 30 patient consultations in a day seemed more satisfied with the nature of their work. Thus, it could be said that our results support the findings of Khalidi and colleagues [9]. Our results establish that this aspect of job fuels most contentment or discontent among community pharmacists.

The aspect of operating conditions had the lowest impact on the overall job satisfaction score of pharmacists. This was interesting as pharmacists seemed indifferent to the notion of operating conditions influencing their overall work satisfaction. This may be partly due to the uniform regulations pertaining to the pharmacy policies and procedures given by the health authority of the country that are based on international standards and hence may not become a significant determinant in this case. However, when delved into the results focusing solely on satisfaction with operating conditions, it was observed that the age of pharmacist and satisfaction with operating conditions was significant (p < 0.05). Most pharmacists aged 30 years or younger tended to be ambivalent as compared to the pharmacists who were older than 30 years. The pharmacists who were older than 30 years had a clear response, i.e., satisfied, and dissatisfied.

Operating conditions in this scale referred to the policies and procedures pertaining to the operations of the pharmacy settings. A possible explanation for these occurrences could be the policies related to human resources and daily operations in a pharmacy setting that are usually focused on the level of experience and seniority of personnel. For instance, young and largely inexperienced pharmacists who have recently graduated would be hired on probation period for some time and may not be eligible for the benefits provided to the permanent employees. Besides, they may find themselves at the lowest slab of the pay scale, may have more workload, and may be subjected to more stringent supervision. As the pharmacists gain experience and seniority, the organizational policies may provide benefits based on experience which may be measured in the years of employment majorly and nature of work to some extent. Hence, this may be a reason why younger pharmacists seemed ambivalent. Though, this explanation lacks evidence.

In addition, the comparison between the marital status of pharmacist and this aspect was near to statistical significance (p = 0.06). It was observed that pharmacists who were married tended to be more satisfied as compared to those who were single. This was also reported in a study in Saudi settings where married healthcare professionals tended to be more satisfied. Although, the study involved both pharmacy and non-pharmacy healthcare professionals, it does serve as a good indicator of the association of healthcare professionals’ marital status with their job satisfaction. The social, emotional and economic support provided by a spouse, may contribute to this higher job satisfaction [26]. The operating policy and procedure of a pharmacy setting may include some benefits for the dependents of an employee such as maternal/paternal leave, educational allowance for dependent children, flexible working hours, etc., that may be appreciated to a greater extent by pharmacists who are in a relationship and/or have dependents.

The aspects of pay rewards, co-workers, supervision, and promotion moderately influenced job satisfaction. The statistical comparison between the income of pharmacists and their satisfaction with the aspect of supervision in the job was significant (p < 0.05). It was observed that pharmacist with an income above SAR 5000, i.e., USD 1333.15, seemed more satisfied with the supervision in the job. This salary could be considered as a rough benchmark to determine the level of seniority and may be linked to the human resource policy of pharmacy. Usually, pharmacy graduates with no prior work experience would start on a probation period for some time and at a lower salary. In this period the pharmacists would be supervised by a senior member of the department more strictly and would be evaluated for fitness in the department at the end of probation. Hence, pharmacists in lower salary range may not be pleased with supervision. It was reported in a pan-Arab study that pharmacists appeared dissatisfied with low salaries [27].

The comparison between nationality of pharmacist and aspect of satisfaction with coworkers in the job were near to statistical significance (p = 0.059). It was observed that response from non-Saudi pharmacists tended to be more concentrated towards being satisfied and ambivalent as compared to response from Saudi pharmacists. It has been reported in the literature that having good relationships with coworkers improves satisfaction among pharmacists. It may improve teamwork that may result in achieving organizational goals and managing work more efficiently [28]. Such accomplishment may invigorate a sense of trust in employment and decrease intention to leave the employment. It has been reported in the literature that most of the pharmacists working in the Saudi pharmacy setting are non-Saudi citizens belonging to more than 50 different nationalities [16]. Non-Saudi pharmacists working in such an environment may come across professionals from different cultural backgrounds, languages, experiences, and professional expertise. This may present an opportunity to learn about cultural competence in healthcare that may be rewarding for people from different backgrounds.

Applying Maslow’s theory of hierarchy of needs in our context [7]. The determinants with highest contribution towards overall job satisfaction, i.e., communications, fringe benefits and nature of work attest to the three middle levels of the pyramid, i.e., safety, belonging, and esteem. The determinant of fringe benefits, i.e., tax-free salary, paid vacations, free housing, transport allowance, airfare allowance, and free medical treatment, etc., may provide a sense of safety to the employee during work, and fulfills 2^nd level of needs in the pyramid. This may make the organization unique, and this sense of safety is above the level of basic needs of food and shelter that could be easily achieved with a monthly salary; something every organization offers. The determinant of communication provides a means of belonging to the organization, which is at the 3^rd level of pyramid. For instance, having a good rapport with other members of the healthcare team and line managers would make the organizational climate comfortable and may not let pharmacist toil in social isolation. Hence, pharmacists may enjoy their time during work. The determinant of the nature of work would attend to the 4^th level of the pyramid, i.e., esteem. Pharmacists may find it enjoyable to execute either a sole service or a combination of services, i.e., administrative, clinical, etc., in hospital pharmacy or in a community setup. This is highly subjective and may stimulate a pharmacist’s recognition internally. For instance, being a good medication inventor, dispenser, patient counselor, etc. In addition, the pharmacists may self-recognize their enhanced ability to perform a certain role better than others. This may instill confidence and interest in specializing in the role in future, a significant step towards self-actualization stage that is at the top of the pyramid.

The study had few limitations in terms of the geographic area as it was conducted in the Eastern region of the country. Despite taking controls measures, the presence of social bias could not be completely ruled out if the questionnaires were filled in presence of higher management. Since the data was collected using convenience sampling, the demographic make-up of the sample, and the overall results from this study cannot be generalized to other regions. In addition, the results of this study are documented after the first wave of COVID– 19 infections and may change considering the unpredictable nature of the pandemic. The study did not include any variable in the questionnaire to document any aspect of the pandemic in relation to job satisfaction. The geographic limitation could be negated as the pharmacy regulations and environment is similar to other regions of the country. The pharmacists were given the option of providing their response at a time of their convenience to provide the comfort of responding to the survey at their home in privacy.

Conclusion

The study found that the aspects that determined overall satisfaction with employment were satisfaction with communication, nature of work and fringe benefits in an employment. Having transparent and effective communication between pharmacist and management would inculcate a positive work environment. Conducting a needs analysis to align tasks at the job with pharmacists’ skills and interest would foster a sense of fulfillment and satisfaction with employment. Benefits that are beyond the usual salaries of pharmacists are appreciated positively. Results of this study could provide the means for human resource managers and organizational policy makers to delve into the determinants of satisfaction among pharmacists working in the community settings and strive to improve their satisfaction that is indirectly linked to patients’ safety.

Supporting information

Acknowledgments

We extend our gratitude to the concerned individuals for their help in data collection and support in this work.