2021, Volume 37, Number 1, Page(s) 039-050
How Does It Feel to Be a Pathologist in Turkey? Results of a Survey on Job Satisfaction and Perception of Pathology
Burcin PEHLIVANOGLU1, Hur HASSOY2, Gulen GUL3, Umut AYKUTLU3, Basak DOGANAVSARGIL4
1Department of Pathology, Adiyaman University Training and Research Hospital, ADIYAMAN, TURKEY
2Department of Public Health Ege University, Faculty of Medicine, IZMIR, TURKEY
3Department of Pathology, Tepecik Training and Research Hospital, IZMIR, TURKEY
4Department of Pathology, Ege University, Faculty of Medicine, IZMIR, TURKEY
Keywords: Surgical pathology, Pathologists, Job satisfaction, Perspective, Minnesota satisfaction questionnaire
Job satisfaction affects productivity and professional performance in many aspects; however, there is limited data regarding
pathologists’ job satisfaction. Hence, in this study, we aimed to evaluate surgical pathologists’ job satisfaction in Turkey.
Materials and Methods: We conducted a 59-item web-based survey questioning respondents’ institutional background, history of training,
continuing education status/research activities, physical conditions, professional well-being, and job satisfaction level. Likert-type and open/
close ended questions were asked and scored. The participants were also asked to complete the Minnesota Satisfaction Questionnaire-Short
Results: Of the 321 respondents, 75% were female, the median age was 41 years (range 28-71 years), experience as a pathologist ranged between
0.12 and 44 years (mean 11.4±9.16 years). Academic pathologists, senior pathologists with ≥20 years of experience, and pathologists working at
large institutions and living in developed cities expressed better physical conditions, higher satisfaction with working conditions and, therefore,
higher overall job satisfaction (p<0.05). 98% agreed that pathologists have a critical impact on patient management; however, the majority
(>80%) thought that patients barely know what pathologists do and other physicians rarely understand the difficulty and limitations in pathology
practice. 82% were happy to have chosen pathology but 45% reported to experience the feeling of being “burnt out”.
Conclusions: Our findings suggest that younger pathologists are less satisfied with their jobs and a surgical pathologist’s job satisfaction increases
with the physical and technical quality of the pathology laboratory/institution, and years of experience. Pathologists seem to be aware of their
important role in patient management although they think that pathology remains “invisible” to many physicians and patients.
Every cell has a history 1
and pathologists try to reveal
this history, often amazed by the view they see through the
microscope. However, pathology is not just microscopic
examination, and most of the time, microscopy is just a
small part of a pathologist’s daily routine and it is quite
possible that his/her professional enthusiasm starts to fade
away and disappear after several years of multitasking.
Locke has described job satisfaction as a pleasurable or
positive emotional state resulting from one’s job experiences
and claimed that it is determined by the discrepancy
between what one wants and gets in a job 2. While job
satisfaction directly affects one’s motivation and workplace
performance, it would be unrealistic to consider that every individual has the same expectations in professional life
since not every person is at the same level according to
Maslow’s hierarchy of needs 3. However, it is also true that
a job must offer some basic qualities at least to fulfill certain
needs of an individual.
To the best of our knowledge, there are only a few studies on
the job satisfaction of surgical pathologists 4-6, some of
which focus on the residency period 7,8. In this study, we
aimed to evaluate the job satisfaction levels of pathologists
in Turkey and their perspective on pathology.
|Survey Design and Data Collection
The study protocol was approved by the institutional ethics committee(Approval no: 18-5.1/4). We conducted a 60-
item survey questioning the respondents’ 1) institutional
background and history of training, 2) workplace physical
conditions (WPC), 3) continuing education status/research
activities, 4) professional well-being (PWB; can be defined
as positive perceptions and favorable conditions at work
that meet occupational needs (9, 10), or having a “highquality”
work life while maintaining the work/life balance)
and job satisfaction, and 5) perception of pathology. The
survey was delivered via a web-based link and the questions
were based on the authors’ observations and self-experience
as well as previous job satisfaction surveys 7,11
study on the specialty choices of medical students 12
Different question types including Likert-type questions,
yes/no questions, open/close ended questions were used.
A 5-point score was used for Likert-type questions: 1:
Strongly disagree, 2: Somewhat disagree, 3: Neutral, 4:
Somewhat agree, and 5: Strongly agree. The participants
were also asked to complete the Minnesota Satisfaction
Questionnaire-Short Form (MSQ)13
in order to compare
the results to a validated job satisfaction questionnaire.
Respondents were grouped based on their age, gender,
experience as a pathologist, the size and experience of their
laboratories, and the type of the hospital they worked/
trained at. Institutions with an actively working pathology
laboratory for >20 years were considered “experienced”.
The experience of the respondents was also grouped: 1)
0-2 years, 2) 3-10 years, 3) 11-19 years and 4) ≥ 20 years.
Institutions with a total biopsy number of >40.000 were
considered “large” (1-20.000 biopsies: small; 20.001-40.000:
medium-sized). The provincial development level, i.e.,
the level of socio-economic development in a residential
area/city, was grouped per the data provided by Ministry
of Development 14. Mean scores were calculated for
Likert-type questions (including MSQ). A cut-off level of
3.5 points was determined as the mean dimension score
based on previous studies 15. Likert-type questions
and the answer scores (between 1 and 5 points) were also
directly correlated with other variables while evaluating
job satisfaction and perception of pathology. The outcome
variables were converted into dichotomous variables for
statistical analyses. Similar answers for partial/complete
open-ended questions were grouped in the same category
Based on our initial findings, we divided the respondents
into four groups to compare the variables: 1) non-academic
junior, 2) academic junior, 3) non-academic senior, and
4) academic senior. 40 years of age was determined as the cut-off for seniority (≥40 years) 16. Pathologists with an
academic title were included in the academic groups. All
parameters were also compared between the geographical
regions of Turkey.
Statistical analysis was performed using the SPSS version
20.0 (SPSS Inc. Chicago, IL) software. Mean and/or median
values were presented as mean±standard deviation (SD)
and/or median (interquartile range [IQR]). Frequencies
were compared via the chi-square test. Mean scores
were calculated for Likert-type questions and compared
using non-parametric tests based on the results of the
homogeneity analyses demonstrating that the data did
not show a normal distribution. Two independent groups
were compared using the Mann-Whitney U test, as the
Kruskal-Wallis test was used to compare >2 independent
groups. The Dunn test was performed as a post-hoc test to
further analyze the results of the Kruskal-Wallis test and to
better demonstrate the significant differences between the
subgroups. A value of p<0.05 (two-sided) was considered
A total of 321 pathologists from 73 cities completed the
survey. The response rate (calculated based on the total
number of pathologists in Turkey 17
) was 24%. The
majority (75%; n=242) were female with a median age of
41 years (IQR: 15; mean 42±8.82 years). The respondents’
experience as a pathologist differed widely (range: 0.12
years to 44 years; mean 11.4±9.16 years). More than half
(56%; n=181) worked at medium-sized or large institutions
and 36% (n=116) had academic titles (Table I
35% (n=113) (mainly pathologists <40 years old, p=0.023)
stated that the institution they worked at was not their
primary choice. The majority (89%; n=286) worked at a
previously established pathology laboratory.
Click Here to Zoom
|Table I: Demographic characteristics and institutional background of the respondents.
History of Training
Pathology was not the first specialty choice of 70% (n=225),
and 66% (n=213) did not have adequate information
about routine pathology practice when they graduated
from medical school. Most of the participants (73%;
n=235) had been trained at a university hospital; however,
barely more than half (52%; n=167) stated that they were
confident about their knowledge and skills on pathology
when they completed their residency period. Molecular
pathology, administration/management strategies, and
laboratory techniques seemed to be the weakest aspects of the residency programs (Supplement 1). Moreover, 21%
(n=67) reported a fear of responsibility/lack of confidence
to sign-out cases when they first started practicing, as 21%
(n=66) reported inexperience/lack of knowledge on several
topics of pathology, 20% (n=63) inexperience in laboratory
management, and 14% (n=46) lack of knowledge on
laboratory techniques. Remarkably, 11 of the 63 respondents
who reported inexperience in laboratory management had
to establish the laboratory themselves as they were assigned
to hospitals without a pathology laboratory while 6%
(n=18) complained about worse laboratory conditions than
they were used to.
The respondents that had been trained at a university
hospital were more satisfied with their training (p<0.001).
Interestingly, male participants were more satisfied with
their training (p=0.031). Training satisfaction scores of
academic and senior pathologists were significantly higher
Workplace Physical Conditions (WPC)
While almost two thirds (65%; n=208) appeared to be
satisfied with their routine tissue processing and staining
procedures, barely half (49%; n=157) thought that the
technical and physical background of their laboratory
was satisfactory despite the presence of automated tissue
processing and/or staining systems and experienced
technical staff in many laboratories (Supplement 2). The
vast majority (88%; n=285) stated that turn-around times
for sign-out had been determined and written in the test
guidelines. Incomplete clinical information was considered
the most significant factor interfering with turnaround time,
followed by ancillary tests such as immunohistochemistry
etc. (Supplement 3). Unfortunately, 22% (n=70) reported a
verbal disagreement with a patient or patient’s next of kin,
and 2% (n=6) reported physical abuse mainly regarding
turn-around time, payments for the ancillary tests, or a
diagnosis of malignancy.
Academic pathologists and senior pathologists with ≥20
years of experience working at larger laboratories were
significantly more satisfied with their WPC (p<0.001 and
p=0.019). Respondents who worked at large or experienced
institutions also had better technical background and
physical condition satisfaction levels, and they stated to be
working with more experienced staff/technicians (p<0.001).
WPC satisfaction level, technical background scores, and
the quality of the staff/technicians were also significantly
associated with the level of provincial development of the
city the respondents lived in (p<0.001).
Continuing Education Status/Research Activities
Getting a second opinion (consultation)
Of the 321 respondents, 65% (n=210) reported that they
did not subspecialize on certain fields. While the majority
(93%; n=298) consulted the cases intradepartmentally,
hematolymphoid pathology (33%, n=105) was the most
frequent subspecialty creating a need for a second opinion,
followed by dermatopathology including tumoral lesions
(16%, n=51) and soft tissue/bone pathology (13%, n=42).
Attendance at scientific meetings
Almost half (47%; n=151) stated that no clinicopathologic
meeting was being held at their institutions. Only 5% (n=15)
reported that they regularly attend monthly pathology
meetings/courses held by regional pathology societies,
while the majority (41%; n=130) reported this number
as once or twice a year. The number of respondents who
annually attended national and international pathology
meetings was low (28% (n=91) for the national pathology
meeting and 6% (n=18) for international pathology
meetings). The most important factors that determined
the decision to attend these meetings were the quality of
the scientific content (85%; n=273) and financial status/
support (76%; n=244).
Research activities and publication ethics
Almost two thirds had contributed to at least one original
research article and/or case report, also in cooperation with
other specialties (60%; n=193, 66%; n=212, respectively).
28% (n=90) claimed that their cases were included in
studies without their knowledge, or they were not listed as
a co-author (6%; n=18) although they fulfilled authorship
criteria by providing rare diagnoses, micro-photos,
performing further histopathological examination, etc.
Interestingly, another pathologist had been listed as a coauthor
instead of the person who initially provided the data
in 3 of these incidents.
Professional Well-being (PWB) and Overall Job
More than half of the respondents were satisfied with the
city they lived in (64%; n=204), and the institution they
worked at (60%; n=194) (Figure 1). However, almost half
(45%; n=143) reported experiencing the feeling of burn out,
regardless of their seniority and academic status (p>0.05).
65% (n=209) reported having physical problems such as
back pain or neck pain and 59% (n=192) described fatigue
due to excessive working. In addition, 52% (n=167) thought
that case load/distribution in their department was not fair and 28% (n=89) stated that they experienced conflicts with
their colleagues (Supplement 4). The most common reasons
for the conflicts were personal disagreements (64/89), case
distribution (30/89), subspecialization (23/89), monthly
income (22/89), and differences in scientific/diagnostic
Click Here to Zoom
|Figure 1: Answers to Likert-type questions on professional well-being and job satisfaction.
Respondents who worked at large or experienced
institutions and academic pathologists expressed higher
satisfaction with working conditions, and the PWB
score was also significantly correlated with the level of
provincial development of the city the respondents lived in
(p<0.001). Pathologists from smaller institutions reported
significantly less conflict with their colleagues (p=0.007).
Female respondents were more satisfied with their working
conditions and reported having better relationship with
colleagues (p<0.05). Finally, the majority were not satisfied
with their wage and salary supplements (76%; 80% per
MSQ scores) (Figure 1, Supplement 5) and 64 respondents
(20%) also described inadequate financial compensation as
a discouraging factor.
Perception of pathology
Overall, 82% (n=263) of the participants were happy to have
chosen pathology (Figure 2), and interestingly happiness
was significantly associated with the level of provincial development of the city they lived in (p=0.024). The most
common factors that made the respondents happy were
flexible working hours/conditions (34%), to have a high
impact on patient management (18%), and to get and to
make the diagnosis (14%) (Supplement 6).
Almost all (98.4%; n=316) agreed that pathologists have a
critical impact on patient management, but 92% (n=295)
thought that patients barely know about pathologists. The
ratio of the respondents who agreed that other physicians
understand the difficulty and limitations in pathology
practice was only 16% (n=52) (Figure 2), and only 25%
(n=85) were satisfied with the hospital administration’s
enthusiasm to improve the pathology laboratory (Figure 1).
The perception of pathology of the respondents from large
and experienced institutions was more favorable (p=0.021
and 0.015, respectively).
Minnesota Satisfaction Questionnaire
Academic pathologists and senior pathologists with ≥20
years of experience had significantly higher scores of MSQ
(p<0.001)(Supplement 5). The mean MSQ score was also
significantly associated with the mean training satisfaction
score (p=0.29), WPC satisfaction score (p=0.003), the
relationship between colleagues (p=0.037), and the
perception of pathology (p=0.001).
Comparison Between Subgroups and Geographic
Significant differences in satisfaction levels of workplace
conditions, professional well-being, job satisfaction,
and perception of pathology were observed between
nonacademic junior, academic junior, non-academic senior,
and academic senior pathologists (p<0.05) (Table II).
Click Here to Zoom
|Table II: Comparison of satisfaction according to experience and academic status. The chi-square test was used to compare frequencies.
The Kruskal-Wallis test was used in the comparison of >2 independent groups (the post-hoc Dunn test was also performed to better
demonstrate the significant differences between 4 subgroups; please see supplement 7).
Respondents from the East and South East Regions tended
to be younger (p<0.001) (Figure 3). The experience of the
laboratory, the number of total biopsies and pathologists,
and the satisfaction level with the technical and physical
background were significantly higher in the Aegean and
Marmara Regions (p<0.05).
Click Here to Zoom
|Figure 3: Comparison between the geographical regions. Respondents from East and South East Regions tended to be younger. Technical
background was significantly better in the Marmara region, compared to the Black Sea and South East regions (not shown), while there
was no significant difference regarding the Minnesota Satisfaction Questionnaire (MSQ), workplace condition (WPC) and professional
well-being (PWB) scores.
This study, to the best of our knowledge, is the most detailed
study investigating surgical pathologists’ job satisfaction
and working conditions in Turkey, and also one of the
few relevant studies in the English literature 4-6
results show that job satisfaction in pathology is basically
influenced by both personal and environmental factors,
such as in other professions.
Academic pathologists and senior pathologists with ≥20
years of experience are more satisfied with their jobs and
their working conditions
This is in fact consistent with findings of some other job
satisfaction surveys among non-pathology subspecialties
18,19 and, more strikingly, academic pathologists have
been reported to express better job satisfaction in another
study by Jenkins et al. 4.
Age cannot be the only explanatory factor for the
association between seniority and job satisfaction since age
is not considered as a viable predictor of job satisfaction
20. However, younger individuals’ motivation has
been shown to increase as they are offered more career
opportunities 21 and, in this study, many non-academic
junior pathologists stated that the institution they worked
at was not their preferred choice (partly due to compulsory
service), suggesting that loss of motivation can indeed be
a contributing factor to their dissatisfaction. This may also
indicate that senior pathologists are more satisfied because
they have reached their career goals or that they just got
accustomed to the situation and gave up hoping for better.
However, further investigation is required to fully explore
Job satisfaction of pathologists is correlated with physical
conditions of the pathology laboratory
This is somehow expected and also one of the main
reasons why academic pathologists, senior pathologists,
and pathologists working at larger laboratories expressed
higher job satisfaction since academic institutions and large
institutions usually have better physical background. On
the other hand, half of the respondents were not satisfied
with the technical and physical background of their
laboratory and described insufficient and poor physical
conditions in the grossing room and suboptimal conditions
for microscopic examination, and many also complained
about inexperienced and/or unknowing and reluctant staff/
technicians. Moreover, 11% of the respondents had to setup
the pathology laboratory when they were first assigned
to the hospitals they currently work at. Therefore, it is clear
that workplace conditions are significantly heterogeneous
in Turkey and the number of the pathologists who work at
non-teaching hospitals is too high to be ignored since 87%
of all the hospitals in Turkey are non-teaching hospitals
17,22. However, it may not be possible and/or rational
to reserve the same amount of funding for every laboratory
across the country. Thus, centralization of the pathology
services, i.e. adopting a centralized pathology laboratory
approach by determination of the need for a pathology
laboratory by the number of the hospital beds and/or type and number of the surgical procedures in a hospital
appear to be the best option to overcome the mentioned
obstacles 23,24, and to improve surgical pathologists’ job
The city/area where the pathologist lives in affects job
Living in an advanced city or a developed area may offer
both better job opportunities and better sociocultural
activities, improving an individual’s quality of life.
Although it is impossible to provide equal conditions for
every pathologist, centralization of the pathology services
may produce a solution for this problem as well.
Shortfalls in the training system and pathology service
design negatively affect junior pathologists’ motivation
Although we did not aim to assess training in pathology
in detail, respondents declared that administration/management
strategies, laboratory techniques, and molecular
pathology as the weakest aspects of their residency programs.
Working at laboratories with poor lab conditions
contribute to junior pathologists’ dissatisfaction and a
feeling of insecurity. Unfortunately, one fifth reported a
fear of responsibility/lack of confidence to sign-out cases
and another one fifth reported inexperience/lack of knowledge
on several topics of pathology when they first started
practicing. Hence, residency core curriculums must be standardized and updated to strengthen these aspects. Also,
reporting of the complex cases should be encouraged in the
residency period to overcome confidence problems. Training
on hematopathology, dermatopathology and soft tissue/
bone pathology should also be supported by special courses
and by online training, given that these are the top 3 topics
creating the need for a second opinion. Inter-institutional
rotations or training of the trainers have been suggested
as other solutions 24. Additionally, constructing a new
training system focusing on subspecialty training may be
of help and encourage pathology residents to specialize in
areas that they are interested in. However, one should also
consider that this will also prolong the training period and
may cause a deterioration of the knowledge on surgical
pathology. A thorough targeted study comparing training
conditions and satisfaction in different institutions may
help to describe permanent solutions in detail.
It should be noted here that, albeit low, a number of
pathologists (4%) expressed their discontent with the
current inter-institutional consultation mechanism and
pointed to a main shortfall: lack of an official feed-back
loop to follow-up the results and/or discuss opinions.
Usubutun et al. reported that suspecting the diagnosis,
need for immunohistochemical studies, patient requests,
and need for molecular studies are the most frequent
reasons for consultation in Turkey 25. The authors have
also found that 59% of the consultant pathologists report
the results to the first pathologist only if he/she asks for
it 25. Therefore, official/written protocols are needed to
enable institutional feedback, or telepathology options with
digital whole slide imaging can be encouraged as a good
option for consultation 26, also allowing online discussion
and feedback, thus enhancing self-confidence which may
improve job satisfaction.
Interpersonal conflicts overshadow professionalism
Some respondents (mostly academic junior pathologists
and pathologists who work at large institutions) expressed
conflicts with their colleagues, mainly due to personal
disagreements, subspecialization and caseload distribution,
which may be attributable to the competition in larger settings
that decreases job satisfaction in return. Interpersonal
conflicts can be mediated by mutual compromise at a
personal level, by adopting the concept of “team work”,
or by administrative measures such as training 24.
Although Güner et al. have claimed that Eastern cultures
rely on apprenticeship rather than standardized programs
in higher education 27, our professional organization(s)
can take a leadership role to help departments and training
programs define professionalism, ethical values, and codes of conduct for the practicing pathologist as suggested by
Domen 28 and the concept of professionalism may also
be implemented in standard training curriculums 29.
Alarm signal: Burn-out is not infrequent among
Chronic fatigue due to excessive work load, sleep deprivation
or decreased personal time, perceived threats such as making
mistakes, loss of autonomy, inefficiencies in administrative
tasks, balancing needs (multitasking), chronic stress due to
workplace setting and personal factors have been suggested
as factors that may contribute to burn-out symptoms
among physicians 30. In our study, 21% expressed feeling
pressured by the physicians for more rapid sign-out, which
is an important factor that causes job-related stress. Almost
half (45%) of the respondents reported to experience the
feeling of being burnt-out and 69% described fatigue due
to excessive working which is remarkably higher than the
series of Fritzsche et al, in which depression and burn-out
have been reported to affect 8% of pathologists 31. On the
other hand, in a recent study on pathologists’ burn-out in
the United States, 71% of the respondents expressed having
felt burn-out at some time 32, and in another recent study
among pathology residents and fellows, the majority also
appraised their work-life balance as poor or fair 8. A
previous study suggested that the main problem leading to
unbalanced workload in pathology laboratories in Turkey
to be the unequal institutional workload distribution
33. In other words, the workload in teaching hospitals is
remarkably higher than in smaller non-teaching hospitals,
and academic pathologists are expected to fulfill more
daily tasks (routine sign-out, teaching, research etc.) 33.
Ironically, the so-called “flexible work hours” seems to be
translated as “excessive work hours” in academic settings.
Moreover, the number of the pathologists in Turkey is also
clearly below the European average 17,34. Therefore,
strategic personnel planning is required to improve the
quality and productivity, and increasing the number of
the staff and pathologists in teaching hospitals should
be considered. Adopting individual and/or institutional
system-wide solutions to cope with burn-out are
Back pain and neck pain are the most common workrelated
In total, 65% of the respondents complained about
musculoskeletal problems such as back and neck pain.
Musculoskeletal problems have mostly been reported in the
neck, shoulder and upper back areas, occasionally referred
to as “pathologist’s hump” 31. Considering that these symptoms cause loss of manpower and fatigue, ergonomic
workplace optimization is recommended 31.
Pathologists are generally happy with their decision to
become a pathologist, but they feel invisible to the public
and other physicians
Despite the fact that pathology was not the first career choice
of the majority and they chose pathology without actually
knowing what pathologists do, more than 80% seem to be
content with their choice. We have recently shown that
flexible working conditions, scientific excitement, and
attributed importance of pathology were the main reasons
why pathology residents from different European countries
chose pathology as a profession 7, and the findings of this
study confirm that these are the most liked aspects of being
a pathologist as well.
However, almost every respondent agreed that other
physicians and patients do not actually know what
pathology is and what pathologists do. Most respondents
expressed discontent about the lack of reputation in public
and underestimation of pathology by other physicians.
They acknowledged that many physicians do not know the
limitations and difficulties of the pathologic examination
and the patients consider pathology as “a laboratory test
performed on automated machines”. While the “invisibility”
of pathology is not country-specific 7, pathologists who
work at large laboratories and academic centers seem to
have a more favorable perception of pathology, probably
due to the positive impact of long-term collaboration,
and establishing a “common language” with clinicians
increasing the feeling of “being understood”. As it is quite
difficult to publicize pathology and to establish significant
co-operation with physicians in small hospitals, we think
that a national effort led by professional organization(s)
would be the best way to introduce pathology to the
public, and more joint meetings are required to develop cooperation
with other physicians.
Pathologists feel discouraged by inadequate financial
Only 20% of the respondents were satisfied with their
wage, a very low number compared to the United States,
where 63% of the pathologists feel satisfied with their
income 6. As some of the respondents articulated, this
may be attributed to the underestimation of several timeconsuming
procedures in pathologic examinations (gross
examination, reporting of major resections etc.) and
relative ignorance of the public, other physicians, and
hospital administrations about the pathology workflow
which results in less payment compared to other specialties.
As might be expected, this leads to disappointment and
frustration among pathologists and negatively affects their
work motivation. At this point, the expectation from the
professional organizations is simply “to build awareness of
the presence of many resentful and unhappy pathologists”
and to take steps to improve pathologists’ income.
Annual attendance to pathology congresses/meetings is
lower than desired and academic pathologists constitute
the core population
The number of respondents who annually attended the
national and international pathology meetings was very
low (28%), especially among non-academic seniors (12%
and 0%, respectively). The scientific content and financial
status/support appear as the main determinants of
attendance. Therefore, improvement of these factors may
encourage more pathologists to attend the meetings, and
increase professional excitement and job satisfaction.
Gender seems to affect job satisfaction
Although this finding is somehow biased due to the large
number of female respondents, female respondents were
more satisfied with their working conditions and expressed
better relationship with colleagues. Previously, it has been
controversially claimed that women’s expectations are
lower than men’s 36 and that women usually feel more
satisfied with their jobs even when they have worse job
options 36,37, which may also be true for pathologists.
We, interestingly, found that male participants were more
satisfied with their training, and felt more confident and
prepared to sign out cases when they first started practicing.
While self-esteem widely differs due to cultural differences
38, similar results were observed among nursing students
as well 39. Whether this could actually be the case for
pathologists needs further research.
The major limitations of our study were the relatively
low response rate and the survey length. The survey was
composed of 59 questions in addition to 20-item MSQ
and this may have intimidated the potential respondents.
However, the number of the respondents is within the 95%-
97% confidence interval and response to online surveys
tends to be low in general. In addition, despite its length,
it was completed by 321 respondents from all geographic
regions and all but 8 cities of Turkey, providing quite
a panorama about the job satisfaction throughout the
To summarize; our results show that the factors comprising
job satisfaction varies in different groups of pathologists.
Non-academic junior pathologists are unhappy, feel
more insecure as they more frequently work in smaller
cities, and in less well-equipped laboratories. Academic
juniors suffer from feeling burnt-out due to excessive and
unbalanced workload, multitasking, and interpersonal
conflicts. Non-academic seniors experience less conflict,
are happy with working hours but are usually less satisfied
with their monthly income and feel less motivated for
participating in scientific meetings. Academic seniors,
work in technically more advanced laboratories and express
higher job satisfaction, but complain about the workload
In conclusion; despite all the discouraging conditions
described in this study and their feeling of “invisibility”,
most pathologists in Turkey are satisfied with their
career choice, mainly because of their dedication to the
importance of pathology for patient management. However
serious improvements and innovation in the current
system are necessary to overcome the feeling of burn-out
and especially to foster junior pathologists’ hope and work
motivation, and, therefore, to be able to offer a better future
both to the pathologists and the patients.
CONFLICT of INTEREST
The authors declare they have no conflict of interest.
No funding was received.
The authors would like to thank Dr. Serpil Dizbay Sak, Dr.
Alp Usubutun, and the Federation of Turkish Pathology
Societies for their support for reaching the participants.
Concept: BP, BD, Design: BP, BD, HH, Data collection or
processing: BP, GG, UA, BD, Analysis or Interpretation:
BP, HH, Literature search: BP, Writing: BP, BD, HH, GG,
UA, Approval: BP, BD, HH, GG, UA
1) Hopkins FG: Some aspects of biochemistry: The organising
capacities of specific catalysts (Second Purser Memorial Lecture).
Irish Journal of Medical Science. 1932;79:333-57.
2) Locke EA. The Nature and Causes of Job Satisfaction. In:
Dunnette, M D, Handbook of Industrial and Organizational
Psychology 1st ed. Chicago, IL: Rand McNally; 1976:1297-349.
3) Maslow AH. A theory of human motivation. Psychological
4) Jenkins D, Philips Z, Grisaffii K, Whynes DK. The boundaries
of cellular pathology: How pathologists see their clinical role. J
5) Howell LP, Lyons ML, Thor A, Dandar V. Sex differences in
workplace satisfaction and engagement of academic pathologists:
Opportunities to enhance faculty diversity. Arch Pathol Lab Med.
6) Xu H, Remick DG. Pathology: A satisfying medical profession.
Acad Pathol. 2016;3:1-4.
7) Pehlivanoglu B, Hassoy H, Calle C, Dendooven A, Nalbantoglu
I, Reshchikova L, Gul G, Doganavsargil B. How does it feel to be
a pathology resident? Results of a survey on experiences and job
satisfaction during pathology residency. Virchows Arch. 2017;
8) Kelly M, Soles R, Garcia E, Kundu I. Job stress, burnout, worklife
balance, well-being, and job satisfaction among pathology
residents and fellows. Am J Clin Pathol. 2020;153:449-69.
9) National Academies of Sciences, Engineering, and Medicine;
National Academy of Medicine; Committee on Systems
Approaches to Improve Patient Care by Supporting Clinician
Well-Being. Taking action against clinician burnout: A systems
approach to professional well-being. Washington, DC: The
National Academies Press, 2019.
10) Doble SE, Santha JC. Occupational well-being: Rethinking
occupational therapy outcomes. Can J Occup Ther. 2008;
11) Yeo H, Viola K, Berg D, Lin Z, Nunez-Smith M, Cammann C,
Bell RH Jr, Sosa JA, Krumholz HM, Curry LA. Attitudes, training
experiences, and professional expectations of US general surgery
residents: A national survey. Jama. 2009;302:1301-8.
12) Ford JC. If not, why not? Reasons why Canadian postgraduate
trainees chose-or did not choose-to become pathologists. Hum
13) Minnesota Satisfaction Questionnaire-Short Form. available
14) Ýllerin ve bölgelerin sosyo-ekonomik geliþmiþlik sýralamasý
araþtýrmasý: SEGE-2017. Accessed on June 6, 2020. Available from:
15) Martha C, Griffet J. Brief report: How do adolescents perceive the
risks related to cell-phone use? J Adolesc. 2007;30:513-21.
16) The Age Discrimination in Employment Act of 1967. Available at:
1967. Accessed on May 31, 2020.
17) Türkiye’de Saðlýk Eðitimi ve Saðlýk Ýnsan Gücü Durum Raporu,
2014. Available at: https://sbu.saglik.gov.tr/Ekutuphane/Yayin/
467 (Accessed on 24.03.2020).
18) Yu J, Gao J, Chen J, Sun Y. Academic versus non-academic
neurosurgeons in China: A national cross-sectional study
on workload, burnout and engagement. BMJ Open. 2019;
19) Busis NA, Shanafelt TD, Keran CM, Levin KH, Schwarz HB,
Molano JR, Vidic TR, Kass JS, Miyasaki JM, Sloan JA, Cascino
TL. Burnout, career satisfaction, and well-being among US
neurologists in 2016. Neurology. 2017;88:797-808.
20) Bernal D, Snyder D, McDaniel M. The age and job satisfaction
relationship: Does its shape and strength still evade us? J Gerontol
B Psychol Sci Soc Sci. 1998;53:P287-93.
21) Boumans NP, de Jong AH, Janssen SM. Age-differences in
work motivation and job satisfaction. The influence of age on
the relationships between work characteristics and workers’
outcomes. Int J Aging Hum Dev. 2011;73:331-50.
22) Health Statistics Yearbook, Ministry of Health of Turkey, 2018.
Available at: https://dosyasb.saglik.gov.tr/Eklenti/36164, siy-
2018en2pdf.pdf?0 (Accessed on May 10th, 2020). 2018.
23) Patoloji Dernekleri Federasyonu. Türkiye’de patolojinin durumu
ve öneriler (Strateji raporu), 21 Mayýs 2010. 2010.
24) Patoloji Dernekleri Federasyonu. Türkiye’de patolojinin sorunlarý
ve çözüm önerileri: Bir durum saptamasý, 2017. Available at:
saptamasi_2017.pdf (Accessed on: 10 May 2020). 2017.
25) Usubutun A, Balci S, Yorukoglu K. The situation of consultation
practice in pathology in Turkey. Turk Patoloji Derg. 2012; 28:195-203.
26) Mukhopadhyay S, Feldman MD, Abels E, Ashfaq R, Beltaifa S,
Cacciabeve NG, Cathro HP, Cheng L, Cooper K, Dickey GE,
Gill RM, Heaton RP, Jr., Kerstens R, Lindberg GM, Malhotra
RK, Mandell JW, Manlucu ED, Mills AM, Mills SE, Moskaluk
CA, Nelis M, Patil DT, Przybycin CG, Reynolds JP, Rubin BP,
Saboorian MH, Salicru M, Samols MA, Sturgis CD, Turner KO,
Wick MR, Yoon JY, Zhao P, Taylor CR. Whole slide imaging
versus microscopy for primary diagnosis in surgical pathology:
A multicenter blinded randomized noninferiority study of 1992
cases (pivotal study). Am J Surg Pathol. 2018;42:39-52.
27) Guner G, Muderrisoglu C, Kosemehmetoglu K, Soylemezoglu
F. Professionalism in pathology: The turkish experience. Arch
Pathol Lab Med. 2018;142:433.
28) Domen RE. Ethical and professional issues in pathology: A
survey of current issues and educational efforts. Hum Pathol.
29) Domen RE, Johnson K, Conran RM, Hoffman RD, Post MD,
Steinberg JJ, Brissette MD, Gratzinger DA, McCloskey CB, Raciti
PM, Roberts CA, Rojiani AM, Powell SZ. Professionalism in
pathology: A case-based approach as a potential educational tool.
Arch Pathol Lab Med. 2017;141:215-9.
30) Schrijver I. Pathology in the medical profession? Taking the pulse
of physician wellness and burnout. Arch Pathol Lab Med. 2016;
31) Fritzsche FR, Ramach C, Soldini D, Caduff R, Tinguely M, Cassoly
E, Moch H, Stewart A. Occupational health risks of pathologists-
-results from a nationwide online questionnaire in Switzerland.
BMC Public Health. 2012;12:1054.
32) Garcia E, Kundu I, Kelly M, Soles R, Mulder L, Talmon GA. The
American Society for Clinical Pathology’s Job Satisfaction, Well-
Being, and Burnout Survey of Pathologists. Am J Clin Pathol.
33) Usubutun A, Uner S, Harorlu F, Ozer E, Tuzlali S, Ruacan A, Koc
O, Yorukoglu K. Pathology laboratories staff workload evaluation
in Turkey: A survey study. Turk Patoloji Derg. 2011;27:98-105.
34) Ruiter DJ, Roald B, Underwood J, Prat J. Histopathology training
in Europe: A lesson for other specialties? Virchows Arch. 2004;
35) Hernandez JS, Wu RI. Burnout in pathology: Suggestions for
individual and systemwide solutions. J Am Soc Cytopathol. 2018;
36) Clark AE. Job satisfaction and gender: Why are women so happy
at work? Labour Economics. 1997;4:341-72.
37) Grönlund A, Öun I. The gender-job satisfaction paradox and
the dual-earner society: Are women (still) making work-family
trade-offs? Work. 2018;59:535-45.
38) Bleidorn W, Arslan RC, Denissen JJ, Rentfrow PJ, Gebauer JE,
Potter J, Gosling SD. Age and gender differences in self-esteem-A
cross-cultural window. J Pers Soc Psychol. 2016;111:396-410.
39) Kukulu K, Korukcu O, Ozdemir Y, Bezci A, Calik C. Selfconfidence,
gender and academic achievement of undergraduate
nursing students. J Psychiatr Ment Health Nurs. 2013;20:330-5.