Date of Award

Spring 3-8-2021

Degree Type


Degree Name

PhD Health Sciences


Health and Medical Sciences


Genevieve Pinto-Zipp, Ed.D.

Committee Member

Ning J. Zhang, Ph.D.

Committee Member

Fortunato Battaglia, Ph.D.


physician engagement, psychological contract fulfillment, physician employment, hospital-physician relationship, hospital-physician alignment, work engagement



While physician employment by healthcare organizations (HCO) in the United States continues to rise and private practice ownership continues to decline, many physicians are disengaged and leaving their organization as their job expectations are not fulfilled. Concurrently, some are changing practice patterns that may lead to decreased access to care despite the forecasted shortage of 84,900 fewer physicians and the aging US population's project growth by 2033. Prior work on physician work engagement has been practitioner-based, never using the widely accepted validated Utrecht work engagement scale. Also, there has been little work on psychological contract fulfillment (PCF ) in US physicians, hence the need for scholarly work. A survey was undertaken to explore the relationship between work engagement and psychological contract fulfillment in health care organization-employed physicians. The study was conducted on a random sample of 1,100 U.S. licensed HCO-employed physicians providing direct patient care for at least six months with representation from the four regions of the U.S., 42 specialties/subspecialties, seven practice settings, work hours, gender, marital status, and work experience. Primary data was collected via an online survey using two instruments: the Utrecht Work Engagement Scale (UWES-9) to assess physicians' relative work engagement levels and a psychological contract survey to measure the psychological contract's fulfillment.

The results showed strong evidence for a significant positive association and a significant positive predictive effect of PCF on work engagement and each of its dimensions: vigor, dedication, and absorption. Physicians' work hours were found to significantly affect dedication and absorption levels dimensions of work engagement. Furthermore, years of work experience were found to have significant predictive effects on the absorption dimension. Thus, it is inferred that PCF perception is positively associated with work engagement in HCO-employed physicians and that PCF has a significant positive predictive effect on work engagement and each of its dimensions. This study's results can inform HRM practices in the retention of physicians. Furthermore, the study contributes empirical data lacking in the work engagement literature.

Keywords: Physician employment, work engagement, psychological contract fulfillment, hospital-physician relationship, Utrecht Work Engagement Scale (UWES-9), physician engagement, job demands, job resources. Psychological contract breach, health care organization