3.1 Sociodemographic characteristics and workplace

More than two thirds of the enrolled professionals were internists (66.1%), and 33.9% were surgeons. Just less than two thirds had dual government-private jobs (63.4%), whereas some had only one job at the governmental (27.2%) or private (9.4%) sector (Table 1).

Table 1 Sociodemographic characteristics and workplace of medical professionals in Egypt, 2021 (n = 959)3.2 Satisfaction with job and salary at governmental and private work

More than half of professionals at the private sector reported being satisfied or very satisfied with their private job (58.7%), whereas less than half were satisfied or very satisfied with their private salary (43.3%). On the contrary, the majority of professionals at the governmental sector were dissatisfied or very dissatisfied with the government job (72.8%) and salary (93.7%) (Fig. 1 A, B).

Fig. 1

A Level of satisfaction with job at the governmental (n = 827)a and private (n = 698) health sectors among medical professionals in Egypt, 2021. B Level of satisfaction with salary at the governmental (n = 827)a and private (n = 698) health sectors among medical professionals in Egypt, 2021. aAmong professionals at governmental sector (n = 869), 827 reported level of satisfaction, whereas 42 did not

Dissatisfaction with the government salary was independently predicted by working at the MoHP (OR = 5.54, 95%CI = 2.39, 12.8; p < 0.001). The multivariate logistic regression model correctly classified 93.7% of professionals for dissatisfaction with government salary (Tables 2 and 3). As for private work, significant association was found between job satisfaction and working with colleagues of the same or different specialties (OR = 1.56, 95%CI = 1.07, 2.26; p = 0.01).

Table 2 Factors associated with dissatisfaction with job and salary at the governmental public health sector (n = 827) (Professionals at governmental sector who reported level of satisfaction)Table 3 Multivariate logistic regression analysis of independent predictors of dissatisfaction with government salary (n = 827)b3.3 Pros and cons of working at governmental and private sectors

Regarding the governmental sector, the most reported pros (addressed by 640 professionals) were providing health services to a large number of deprived populations (18.28%); opportunity to develop skills (10.5%), cooperation of colleagues at work (8.1%); and stable job with guaranteed slowly rising salary, insurance, and pension (5.1%). On the contrary, 659 professionals reported the following cons: jobs are underpaid with a lack of appreciation and recognition by the government (37.8%), insufficient resources (28.37%), corruption of the healthcare system, and bad management and abusive supervision (24.6%).

Regarding the private sector, the most reported pros (addressed by 534 professionals) were well-paid jobs relative to governmental jobs (45.9%), availability of resources (9.5%), and appropriate workplace environment (7.7%). On the other hand, 526 professionals reported the following cons: jobs are underpaid (28.3%), exhausting work both physically and psychologically (19.8%), and capitalism in management that interferes with principles of the profession (13.8%).

3.4 Potential solutions to improve medical practice in Egypt

Professionals’ proposed solutions were organized according to the World Health Organization health systems framework into six building blocks (24) (Fig. 2).

1)

Leadership and governance

Fig. 2

Potential solutions* to improve medical practice in Egypt (n = 959). Abbreviations: MoHP, Ministry of Health and Population; ENB, Egypt national budget; HCS, health care system; MP, medical professionals. *More than one solution could be suggested by the participant

It would be important to build a culture of respect and appreciation for medical professionals by the higher authorities and public (15.2%), restructure administration at MoHP (13.1%), ensure political commitment for the healthcare system reform (12.4%), and enact and enforce Medical Liability Law with continuous supervision (11.8%)

2)

Financing

Wage increase for physicians at the governmental health sector (to reduce their need to join the private sector) was the most frequently reported solution (46.1%). In addition, rising the percentage of Egypt National Budget allocated for health and education sectors (8.3%)

3)

Workforce

It was highly suggested to mandate continuous training of physicians (18.1%), engage the community in health services (5.1%), and manage human resources (0.9%)

4)

Medicines

Management of non-human resources (medical equipment, pharmaceuticals, and materials) was recommended by 14.4% of professionals

5)

Information

Professionals recommended the dissemination of standardized diagnosis and treatment protocols at all healthcare facilities (0.6%)

6)

Service delivery

It was recommended to improve the workplace environment (5.9%) and develop the poorly functioning governmental sector (with respect to quality, access, safety, and coverage) and to gradually eliminate the private sector and stop the segmentation of the healthcare system “institutionalization” (5.2%).

3.5 Telemedicine perception and practice

During the COVID-19 pandemic, 90.6% of professionals practiced telemedicine. Regarding perception of telemedicine, 9.8% of professionals were not interested (or did not know about it) and 34.1% found it not beneficial at all. On the contrary, 45.2% found it beneficial or has some benefits and some limitations (10.9%) (Fig. 3). A significant association was found between the perception of the benefits of telemedicine and gender and medical specialty. The odds of perception of benefits of telemedicine were two times higher in women than in men (OR = 2.00, 95%CI = 1.49, 2.67; p < 0.001) and 1.39 times higher in internists than in surgeons (OR = 1.39, 95%CI = 1.05,1.86; p = 0.02).

Fig. 3

Perception of the benefits of telemedicine by the medical professionals in Egypt, 2021 (n = 959)

3.6 Benefits and disadvantages of telemedicine

As stated by professionals who found telemedicine beneficial or has some benefits (n = 548), benefits were grouped into three categories (Fig. 4).

1)

Benefits for the patients

Fig. 4

A Benefits* of telemedicine, as perceived by medical professionals in Egypt, 2021 (n = 548^). ^Professionals who found telemedicine beneficial or has some benefits; *More than one benefit could be addressed by the participant. B Disadvantages# of telemedicine, as perceived by medical professionals in Egypt, 2021 (n = 432&). &Professionals who found telemedicine challenging or has some limitations; #More than one disadvantage could be addressed by the participant

Telemedicine saves patients’ time (23.6%), money (14.9%), and effort (13.6%) especially when patient transfer is difficult. In addition, it reduces infection transmission during epidemics (8.6%).

2)

Benefits for the health care providers

Telemedicine saves doctors’ time (23.6%), allows follow up on mild stable cases with known medical history and who have previously been clinically examined (23.2%), and follow up of laboratory and imaging results (12.5%).

3)

Benefits for the profession

Telemedicine utilizes modern communication technology, especially the interactive ones such as “video conferencing” (4.3%) and helps to disseminates general medical advice and health education (2.8%), so people gain knowledge from specialists instead of seeking misleading sources (4.1%).

On the other hand, potential limitations indicated by professionals who found telemedicine challenging or has some limitations (n = 432) were organized into three categories (Fig. 4).

1)

Disadvantages/limitations for the patients

Telemedicine necessitates greater public awareness and trust; people should be able to effectively describe their symptoms, complains, and needs (3.5%). In addition, some patients find it a substitute for visiting the clinic, and others might abuse it (2.8%).

2)

Disadvantages/limitations for the health care providers

The most frequently stated disadvantage was the inability to perform clinical examination; web-based consultations do not replace face-to-face physician-patient communication (27.0%).

3)

Disadvantages/limitations for the profession

Telemedicine is suitable only for general medical issues (5.8%) and in certain (not all) medical specialties (3.7%).

Fifty-four professionals stated that telemedicine in Egypt needs to be practiced within a legal framework that ensures licensing of medical personnel and authentication of users, by means of applications that regulate time and payment issues, and integrates services provided by physicians, laboratories, and imaging centers.