Beyond job security and money : Driving factors of motivation for government doctors in India

Background
Despite many efforts from government to address the shortage of medical officers (MOs) in rural areas, rural health centres continue to suffer from severe shortage of MOs. Lack of motivation to join and continue service in rural areas is a major reason for such shortage. In the present study, we aimed to assess and rank the driving factors of motivation important for in-service MOs in their current job.

Methods
The study participants included ninety two in-service government MOs from three states in India. The study participants were required to rank 14 factors of motivation important for them in their current job. The factors for the study were selected using Herzberg’s two-factor theory of motivation and the data were collected using an instrument that has an established reliability and validity. Test of Kendall’s coefficient of concordance (W) was carried out to assess the agreement in ranks assigned by participants to various motivation factors. Next, we studied the distributions of ranks of different motivating factors using standard descriptive statistics and box plots, which gave us interesting insights into the strength of agreement of the MOs in assigning ranks to various factors. And finally to assess whether MOs are more intrinsically motivated or extrinsically motivated, we used Kolmogorov-Smirnov test.

Results
The (W) test indicated statistically significant (P < 0.01) agreement of the participants in assigning ranks. The Kolmogorov-Smirnov test indicated that from policy perspectives, MOs place significantly more motivational importance to intrinsic factors than to extrinsic factors. The study results indicate that job security was the most important factor related to motivation, closely followed by interesting work and respect and recognition. Among the top five preferred factors, three were intrinsic factors indicating a great importance given by MOs to factors beyond money and job security.

Conclusion
To address the issue of motivation, the health departments need to pay close attention to devising management strategies that address not only extrinsic but also intrinsic factors of motivation. The study results may be useful to understand the complicated issue of work motivation and can give some useful insights to design comprehensive management strategies that are based on motivational needs of MOs.