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Job and Career Influences on the Career Commitment of Health Care Executives: The Mediating Effect of Job Satisfaction Author Details: Robert Myrtle University of Southern California, School of Policy, Planning, and Development, Los Angeles, USA Duan-Rung Chen National Taiwan University, Institute of Health Care Organization Administration, Taipei, Taiwan Caroline Liu National Central Library, Taipei, Taiwan Daniel Fahey California State University, Health Science and Human Ecology, San Bernardino, California, USA Corresponding Author: Robert Myrtle myrtle@usc.edu Structured Abstract: Purpose While there is considerable evidence supporting the relationship between job satisfaction and organizational commitment the relationship between the antecedents of job satisfaction, organizational commitment and career commitment are not clearly understood. This study seeks to clarify whether these antecedents have an effect independent of job satisfaction on career commitment or whether these antecedents are mediated by job satisfaction Design/methodology/approach Twenty seven hundred and ninety nine questionnaires were mailed out to members of the American College of Healthcare Executives (ACHE). Six hundred and forty-three responses were received (22.9%) and after eliminating retirees or students, a sample of 456 respondents, currently employed in the health care industry was obtained. Path analysis was conducted to test the hypothetical relationships between work situation, career experiences and career commitment. Findings We found that job satisfaction mediated the influences of job tenure and career pattern on career commitment. Job satisfaction partially mediated the influences of perceived job security and one's satisfaction with career on career commitment. Both of these measures had a direct influence on career commitment. Career experience such as sector change was also positively associated with career commitment. Research limitations/implications While our research offers some insights into the factors affecting the career commitment of health care executives, our sample was limited to respondents who were members of the American College of Healthcare Executives, and thus may not represent the views of all managers in the health care sector. Practical implications To retain high valued health care workers it is important than an organization has a work environment that enhances their commitment to their occupation as well as their careers. Originality/value This study clarifies the influence of job satisfaction on the career commitment of health care managers during a very dynamic period. Keywords: Job satisfaction, Health care, commitment, environment, workers Article Classification: Research paper

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Job and Career Influences on the Career Commitment of Health Care Executives: The Mediating Effect of Job Satisfaction Introduction The health care industry, like many other industries, has been undergoing significant transformation and change (Kumar, Subramanian, Strandholm, 2002; Gaynor and Hass-Wilson, 1999). Not surprisingly, as the health care industry has changed so to have the careers of health care executives (Fahey and Myrtle, 2001). As a result it is not uncommon to hear some health care managers say, If I knew what I know now about this job I probably would not have entered this field in the first place. With some reports noting that the career commitment of health care executives is lower than other industries (Runy, 2003), this paper seeks to study the influence of current employment contexts, job satisfaction and career experiences on the career commitment of health care managers working in the five western states. The literature on organizational commitment is extensive (e.g. Lee et. al, 2000; Mathieu and Zajak, 1990), yet Goulet and Singh (2002) note there is a paucity of research focusing on career commitment. Career commitment is defined as the relative strength of an individuals identification with and involvement in a particular profession or vocation (Blau, 1985; Lee et al., 2000; Mowday et al., 1982). Career commitment has been found to be positively correlated with job satisfaction (Goulet and Singh, 2002). They found that when employees are content with the nature of the work itself, are satisfied with their supervisor and co-workers, and perceive current pay policies and future opportunities for promotion, within their firm, to be adequate, they will generally be satisfied with their jobs and thus high career commitment can be expected. Their findings were in contrast to the work of Rhodes and Doering (1983) who show that the effects of various antecedents on career commitment are

mediated through job satisfaction. There have been a few studies relevant to establishing the relation between job satisfaction and organizational commitment. Porter et al. (1974) suggested that satisfaction and commitment were related but distinguishable attitudes. More specifically, they proposed that commitment represents a global evaluative link between the employee and the organization, with job satisfaction among commitment's specific components. Porter et al. (1974) further offered that satisfaction would be associated with aspects of the work environment and thus would develop more quickly than commitment, which would require a worker to make a more global assessment of his or her relationship to the organization. Whereas the instability and rapid formation of satisfaction would suggest it as a cause of commitment, rather than vice versa, Bateman and Strasser (1984) note that the validity of this perspective has not been established. Londons career motivation model (1983) suggests that career commitment emerges from interaction between individual characteristics, situational characteristics and career decisions and behaviors. He suggests that the nature of the situation and the individual characteristics affect career decisions and behaviors. Goulet and Singh (2002) followed Londons career motivation model and consider job satisfaction is one of the antecedents on commitment. None of these models has specifically examined the relationship between job satisfaction and other aspects of the work environment and thus influences a workers global assessment of his or her career. Since one study (Runy, 2003) reported that nearly two-thirds of health care workers reported thinking about leaving the health care field, this research examined some of the work related factors that are believed to influence how health care executives view their jobs, their careers and ultimately may affect their commitment

to the career they are pursuing. In this study, the responses of 456 hospital managers to a questionnaire designed to examine the relationship between their current work situations, their job satisfaction and career commitment are reported. Using the conceptual framework proposed by London (1983), this investigation builds on and adds to the situational characteristics and career events that are believed to affect career commitment. This framework and the work situation and career experiences to be tested is presented in Figure 1. -----------------------Insert Figure 1 about Here ------------------------

Influences on Career Commitment Current Work Situation Goulet and Singh (2002) found that a number of factors including job security, job involvement, job satisfaction and organizational commitment would influence career commitment. Chang (1999) observes that people bring a set of expectations to an employment setting. Therefore, if an individuals perceived expectations for his or her present job is fulfilled, he or she will have higher career commitment (Bedeian et al., 1991; Farrell & Rusbult, 1981). Therefore, it is expected that, Hypothesis 1: Health care managers who report their current job is meeting their career expectations (MET_EXP) will have higher levels of career commitment than workers whose current job is not meeting their career expectations. Position tenure has been found to be negatively related to job satisfaction and positively associated with career commitment (Gregersen & Black, 1992; Mathieu &

Zajac, 1990). Research on job tenure among managers has shown that employees who remain in the same jobs for a number of years are less satisfied with their careers than those who are more mobile (Veiga, 1981). However, Lee et al. (2000) in their metaanalysis did not find an association between organizational tenure and occupational commitment. Since the health care field continues to grow and develop it is logical to expect that job mobility would increase. Fahey and Myrtle (2001) found that health care executives changed jobs as part of their career progression. Since changing jobs provide individuals opportunities to learn and to grow it is expected that, Hypothesis 2: Position tenure (LONG) has a negative relationship with career commitment. Darney (2003) reported that during the last decade the number of hospitals has declined by approximately 20 percent. These changes have been accompanied by similar changes in the number of administrative positions. As a result, the hospital administrator turnover rate has been averaging around 15 percent (Khaliq, Walston, and Thompson, 2006). Sieveking and Wood (1992) noted that that these changes in the health care industry have led health care administrators to express apprehension about the future. As a result it is believed that, Hypothesis 3: Perceived job security (SECURE) will have a positive relationship with career commitment. Mathieu and Zajac (1990) found that job level was positively correlated with organizational commitment. Aryee et al. (1994) suggest that the extent to which a persons job is seen as contributing their career objectives will influence their career commitment. Blau (1985) notes that individuals seek to grow on their jobs and to meet challenges. This suggests that the position one attains in an organization reflects a sense of movement in their career as well as a return on their career investment.

Thus administrators in senior level positions are likely to perceive a higher expected utility from their job, face more demanding challenges and to allow for greater growth. Hence, Hypothesis 4: The higher the level of the managerial position attained (MANG) in an organization will be positively related with career commitment. Career Experiences Career theory emphasizes the sequence of work-role experiences over time (Latack & Dozier, 1986). In this research, career is defined as the sequence of workrelated experience and attitudes that the individual has over the span of his or her work life (Yan et al., 2002). This suggests that over ones work life, these career experiences evolve over time. Career stage theory recognizes that individual careers change throughout ones working life and that different stages are marked by different needs, concerns, and commitments (Bowen & Hisrich, 1986). Super (1957) characterized these stages as 1) the exploration stage; 2) the establishment stage and 3) the maintenance stage. Aryee et al. (1994) found that career commitment had a positive relationship with skill development. Since each of the career stages reflects a progression in the development and application of ones knowledge and skills, that the following is expected, Hypothesis 5: Career stage (STAGE) is related to the career commitment. Casson and Bennison (1984) suggest that career outcomes are shaped by the opportunities that are available within an organizational context. Gattiker and Larwood (1988) found that the type of business a person was in influenced their perceptions of career success. The Bureau of Labor Statistics (BLS 2006) notes that health care is both the largest industry in the nation and the industry that will create more jobs than any other industry sector. They report that 41 percent of all jobs in the

health care industry were in hospitals, 22 percent in nursing and residential care facilities and 16 percent in the offices of physicians (BLS 2006). In spite of this growth, Runy (2003) found that the health care industry has a work force commitment index that is well below that of other industries. She reports that hospital workers have slightly higher work force commitment scores than ambulatory care centers and both have commitment scores that are higher than workers in long-term care facilities. Not surprising, Fahey and Myrtle (2001) found that slightly more than one-third of the administrators changed their jobs. While most job changers remained in the same service delivery sector (e.g. hospitals) one third moved to a difference service delivery sector in the health care industry (e.g. hospital to medical group) (Fahey and Myrtle, 2001). Since increased mobility can provide managers with personal or career growth opportunities, it is believed that, Hypothesis 6: Health care managers who change service delivery sectors (SECT_CHG) (e.g. from ambulatory care to hospital administration) will have a higher career commitment than those who did not change their service delivery sector. Vardi (1980) noted that most research on careers has focused on management and professional careers and has tended to characterize career mobility in terms of upward movement. He suggests that career mobility should extend beyond promotions to include horizontal job movement as well. Arthur (1994) argues that as the nature of organizations change our understanding of careers also needs to change. While he notes that many careers will continue to reflect movement within and between organizations, these patterns will not be as clearly defined as they have in the past. Even so, Kanchier and Unruh (1989) found that most people tend to remain in the same occupational category when they change jobs.

In their study of the career patterns of health care executives, Fahey and Myrtle (2001) identified four different job change patterns. The most common pattern was one of multiple changes between different sectors of the health care industry. They found that while most job changes did not lead to a career change, nearly 40 percent of them indicated that their job change was also a career change. Since, Shamir and Arthur (1989) found that career change was strongly related to job change, the following is suggested, Hypothesis 7: The job change patterns (PATTERNS) of health care managers is positively related career commitment. Research suggests that most people tend to remain in the same occupational category when they change jobs (Kanchier and Unruh, 1989; Fahey and Myrtle, 2001). Since Rhodes and Doering (1983) view a career change as movement to a new occupation that is not part of a typical career progression, a change from one industry (e.g. banking) to another (e.g. health care) is likely to involve, or to be described as a career change. Because Cherniss (1991) and Chang (1999) found that persons who changed their career were less committed to their present careers than were those who had not changed their careers, it is hypothesized that, Hypothesis 8: Managers, who moved from a management position in non-health care industry (ANOTHER_) to one in the health care industry, will have lower career commitment than managers who have not held a management job outside the health care industry. Hall (1971) suggests career commitment was influenced by the extent to which a person feels they are competent and successful in their career role. Ayree and Tan (1992) found that there was a significant and positive relationship between career satisfaction and career commitment. Ng, Eby and Sorensen (2005) point out that

people assess their career success through a number of different mechanisms including their satisfaction with their careers and how their career has progressed relative to others. Thus, Hypothesis 9: Career satisfaction (SATISFY) will have a positive association with the career commitment. The Role of Job Satisfaction as a Mediator Variable Career commitment has been found to be positively correlated with job satisfaction (Goulet and Singh, 2002). When employees are content with the nature of the work itself, are satisfied with their supervisor and co-workers, and perceive current pay policies and future opportunities for promotion, within their organization, to be adequate, they will generally be satisfied with their current jobs and thus high commitment can be expected. Some studies show that the effects of various antecedents on career commitment are mediated through job satisfaction (Rhodes and Doering, 1983). Similarly, Farrell and Rusbult (1981) described job satisfaction as an intervening variable to be a function of rewards and costs associated with the job, with job commitment resulting from job satisfaction, investments, and alternatives. Rusbult and Farrell (1983) found support for their model in a longitudinal investigation with nurses and accountants and, thus, identified satisfaction as an antecedent of commitment. However, the Rusbult and Farrell (1983) model is based on a behaviorally oriented commitment, whereas the present research takes an attitudinal focus. However, others find that job satisfaction doesnt mediate the effects of other antecedents on commitment; rather these antecedents influence career commitment directly (Goulet and Singh, 2002). Hypothesis 10: Job satisfaction (JOBSAT) has a positive relationship with the career commitment.

Hypothesis 11: Job satisfaction (JOBSAT) also mediates the association of current work situation and career experiences with career commitment. Control Variables A number of demographic and individual characteristics have been found to influence the needs and expectations a person seeks from the job, their satisfaction with their work and ultimately their career commitment. For instance, education has been found to have a positive relationship with career change (Cabral, et al., 1985); ones career identity, goals and values (Colarelli and Bishop, 1990); career success (Melamed, 1996). Since most health care managers are college educated and many have advanced degrees we will use education as one of our control variables. The relationship between gender and career commitment has not been consistently demonstrated. For instance, Judge et al. (1995) report that gender has been found to be a factor in the levels of career attainment, with women having lower levels of career success than men. However, Korabik and Rosin (1995) note that while women are perceived to be less career oriented than men, and that women with dependent children are even less likely to be committed to their careers than women who are childless, they did not find these factors to be associated with a reduced commitment to their work or to their organizations. On the other hand, Melamed (1996) pointed out that marriage, home roles and responsibilities reduced a womans work experience and ultimately her career success. Since many women work in health care organizations as nurses and health care providers and, as a result hold many supervisory and management positions in different health care organizations, we will control for gender in our analysis of career commitment. Judge et al. (1995) note that married individuals achieve higher levels of objective success than their unmarried counterparts. Melamed (1996) notes that while

women have different patterns in achieving career success than men, marital status was not found to be a factor explaining the career success of women although it was a predictor of career success of men. On the other hand, Cherniss (1991) found that married people were more committed to their present careers than those who were not. Fahey and Myrtle (2001) did not find marital status to be associated with career satisfaction of either gender, although they did find that married health care executives had different career patterns than non-married executives. For this reason, we will control for marital status in our analysis. Having dependents can strengthen career commitment indirectly by making it harder for an employee to think about changing occupations (Neapolitan, 1980). Conversely, Hart et al. (1993) in their study of health care managers found that those who had children had lower job turnover rates than those that did not. More recently, Myrtle et al. (2008) did not find an association between the number of dependents on career commitment. Since most studies have treated these individual characteristics as control measures, this approach was used in this study as well. A number of authors (London, 1983, Judge et al., 1995) report that race has been found to be a factor in the levels of career attainment with minorities having lower levels of career success than non-minorities. In the health care field, a recent study conducted by the American College of Healthcare Executives (ACHE) found that disparities in the proportions of top level management positions persist (ACHE, 2002). Since Lee et al. (2000) found a strong relationship between organizational commitment and occupational commitment. Consequently; we will control for individual variables in our examination of the relationships between work factors, job satisfaction and career commitment. Methods

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Variables and Measurement Education (EDU) was a measure that asked respondents to indicate their highest educational level (1=less than baccalaureate, 2=baccalaureate, 3=masters, 4=doctorate). Gender was coded as 0=female, 1=male Ethnicity (ETHNIC) was measured as 1=Asian, 2=Black, 3=Caucasian, 4=Hispanic, 5=Other. Because of the small number of minority respondents, the measure was recorded with 0=Minority, 1=Non-Minority. Dependents (CHILD) were measured as the actual number of children at home. Married (MARRY) was coded as 0=not married, 1=married. Met Expectations (MET_EXP) measures the extent to which the current job meets the respondents career expectations. Following an approach used by Hrebiniak and Alutto (1972) we constructed a met expectations measure (Cronbach 0.87) by computing the absolute magnitude of the difference between two scales. The first scale asked the respondents a set of questions about the importance of selected items, derived from the Job Satisfaction Survey (Spector, 1985), in deciding to enter the health care. These items were rated using a 5 point scale ranging from 1=not important, 5=very important. Later in the survey, respondents were presented with these items again and asked to indicate their satisfaction with these items on their current job with 1=not satisfied and 5=very satisfied. Job satisfaction (JOBSAT) was measured using 10 items from the Job Diagnostic Survey developed by Hackman and Oldham, (1974). In this research, healthcare executives rate their satisfaction on a scale from 1 = very dissatisfied to 5 = very satisfied. Items included autonomy, challenge, and professional growth. By using principle component factor analysis, we found that these items formed one factor,

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which explains 53.8 percent of the total variance. The internal reliability Cronbach is 0.90. Factor loading structure can be found in Table 1 -----------------------Insert Table 1 about Here -----------------------Position Tenure (LONG) was obtained from a question asking how long the respondent had held his or her current position. Job Security (SECURE) was obtained from a question asking them to indicate how secure they felt in their current position (1=quite insecure, 5=very secure). Management Level (MANG) was based on the position title provided by the respondents. The lead investigators separately coded the 19 different job titles provided by the respondents into 5 management levels (1=supervisory level, 2= lower level managemente.g. department head, 3=mid-level managemente.g. director, 4=senior levele.g. COO and 5=executive levele.g. CEO). In the several instances were there some disagreement as to the proper level, it was resolved by identifying the sector the respondent worked in and comparing their reported job titles to the job titles by level that are commonly used in that industry sector. Career Stage (STAGE) was based on the respondents selection of the career stage that best described their view of their career. Respondents were provided with a description of three different career stages (establishment, advancement and maintenance) and then were asked to indicate the career stage they felt they had achieved. Sector Change (SECT_CHG) was determined by comparing the sector the respondent was currently employed in (hospital, ambulatory care, long term care, and other health care) with the sector of their first health care job. If the current sector

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was different from their initial employment sector, this difference was recorded as a sector change (0=no change in sector, 1=change in sector). Career Patterns (PATTERN) were based on the different career patterns noted by Fahey and Myrtle (2001). They identified 4 different patterns (traditional, change of sector, back and forth movement between two sectors and, multiple sector moves). The survey instrument described these 4 patterns and respondents were asked to identify the pattern that characterized their career. Industry Change (ANOTHER_) as part of the questionnaire, respondents were asked if they held a management position in another industry prior to their entering the health care field (1=yes, 0=no). Career Satisfaction (SATISFY) was based on a scale created by the summation of responses to two questions about their careers (Cronbach 0.68). The first asked respondents to rate their satisfaction with their career progression (1=very dissatisfied, 5=very satisfied) and the second asked that they consider the satisfaction of their career progression relative to others with similar backgrounds (1=very much worse, 5=very much better). Career Commitment (COMMIT) was measured using a scale initially developed by Blau (1985). Sample items used in this research include "if I could do it all over again, I would choose a management career in healthcare; I would recommend a healthcare management career to others; If I could get a management job outside of healthcare that paid the same as my current job, I would probably take it (reversed scored). These measures were assessed using a five-point scale (ranging from 1 = strongly disagree to 5 = strongly agree). The total score of career commitment ranged from 3 to 15 (Cronbach 0.74). Sample and Procedure

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Twenty seven hundred and ninety nine questionnaires were mailed out to members of the American College of Healthcare Executives (ACHE) residing 5 western states (Arizona, California, Nevada, Oregon and Washington). Six hundred and forty-three responses were received (22.9%) and after eliminating those who were retired or were students, a sample of 456 respondents who were currently employed in the hospital or health systems industry was obtained. A comparison of the age and gender differences of the ACHE members the survey was mailed to and those responding did not reveal any marked differences between the two groups. The average age of the ACHE members in the mailed sample was 47.66 years compared to an average age of 48.13 for the respondents. Forty-one percent of the ACHE members in the mailed sample were female compared to 41.4 percent of the respondents who identified themselves as female in their responses. These results suggest the demographic characteristics of those sampled were quite similar to those who responded to the survey. Statistical Methods Path analysis was conducted to test the hypothetical models, as shown in Figure 1. Path analysis determines whether our theoretical model successfully accounts for the actual relationships observed in the sample data. Path analysis dealt with models with manifest (observed) variables. Several modifications to the original theoretical model were conducted to test whether the model chi-squire statistics improved if a given path were added to the model (MacCallum et al., 1992). The modification procedures continued till an acceptable fit is obtained. We reviewed several fit statistics to assess our revised model. The RMSEA and the normed fit index (NFI) were reported. We also examined the goodness-of-fit index (GFI), and the comparative fit index (CFI). Standardized path coefficients were

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reported to determine which independent variable has the largest effect on career commitment. Data and Descriptive Analysis

Two hundred and thirty-five (235) of the 456 respondents in this study were male (52%). Of these, 297 were married (65%) and 196 had children (48%). Most respondents (367) were White (82%); with 39 reporting their race as Black (9%), 23 were Asian (5%), 10 were Hispanic (2%) and 9 were other racial categories (2%). The average age was 48.13. Three hundred and sixty-five respondents (80%) had masters degrees, 44 had bachelor degrees (10%) and 36 had doctoral degrees (8%). Upon entering the most frequently mentioned position held was nursing (62) and the first sector most people (345 individuals) worked was the hospital/health system. The positions held by respondents included senior management (CEO, CIO, CFO, CMO, CNO, and COO) 38% (n = 172), 43% in middle management positions (Assistant Administrator, Director, Department Head) (n= 195), 10% held first line management positions (n = 47) and 4% (n = 20) were in staff roles. On average, they have been in their current position for 5.5 years (s.d. 5.80343). Most respondents (218 individuals) characterized their career as traditional, i.e., remain in the same sector they started their careers in, while 76 indicated that their careers had multiple changes, (i.e., movement among multiple sectors). Most (41%, n = 183) felt secure in their current position although 17% (n = 77) were not. Most (36%, n = 164) said they were very satisfied with their careers while 16% (n = 73) were not. While most said they would choose this career again, less than half (48%) indicated they would remain in the field even if they could get a similar job elsewhere. Results

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The model in Figure 2 summarizes the direct relationships between individual variables, current work situation, career experiences and career commitment. None of the individual characteristics were found to have statistically significant relationships with career commitment, and were not further modeled. Since some studies have also reported similar results, the lack of a relationship between these demographic characteristics and career commitment is not surprising. However, the lack of a statistically significant relationship between education and career commitment is interesting. It is probably due to the fact that many respondents are college graduates or have advanced degrees. -----------------------Insert Figure 2 about Here -----------------------Based on previous research, the researchers expected that all of the current work situation measures would have a statistically significant direct relationship with career commitment. As shown in the model in Figure 2, two measures, job security (SECURE), and management level (MANG), were found to have a statistically significant association with career commitment. Hence support for Hypotheses 2 and 4, and 10 were found. Although the relationship between position tenure (LONG) and career commitment was not statistically significant, it was in the predicted direction. On the other hand the extent to which the current job fulfilled career expectations (MET_EXP) was neither statistically significant or in the expected direction. Thus support for Hypotheses 1 and 2 not found. Only two of the career experiences were found to have a statistically significant relationship with career commitment. As expected, the respondents satisfaction with their career (SATISFY) was positively associated with career

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commitment. The relationship between changes from one management position to another in a different sector of the health care field (SECT_CHG) was also statistically significant. Thus Hypothesis 6 and Hypothesis 9 were supported. Contrary to the investigators expectations, a statistically significant relationship between ones career stage (STAGE), their career pattern (PATTERN) and career commitment was not found. Thus hypotheses 5 and 7 were not supported. The variable of holding a management position in another field (ANOTHER) did not show significant association with career commitment although it was in the hypothesized direction thus Hypothesis 8 was also not supported. Lastly, Job Satisfaction was found to have a statistically significant relationship with Career Commitment. Thus, Hypothesis 10 was also supported. To obtain a parsimonious model, only significant variables were further examined for testing the mediator role of job satisfaction on career commitment. After several modifications, a revised model was obtained (Figure 3). All standardized coefficients in -----------------------Insert Figure 3 about Here -----------------------the model are statistically significant at p<0.05. As the model in Figure 3 indicates, job satisfaction was found to mediate the relationship between tenure (LONG), career pattern (PATTERN) and career commitment. Thus Hypothesis 11 is partially supported. While job satisfaction also mediated the relationship between job security (SECURE) and career satisfaction (SATISFY), these measures also had an association with career commitment independent of job satisfaction. The results suggest that changing health care sectors (SECT_CHG) had a direct influence on career

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commitment independent of job satisfaction. These relationships have a goodness of fit statistic (GFI=0.95; RMSEA=0.04, and NFI=0.98, CFI=0.98) suggesting that this model provides a good fit for the data explaining the career commitment of healthcare managers. Discussion These results suggest that a persons commitment to their career is a function of several different influences. Certainly ones personal situation may play a role for some although in this research it does not emerge as a significant influence. This is consistent with findings from other industries where education, gender and ethnicity do not appear to have a direct influence on career commitment. Inasmuch as most health care managers, especially at the more senior levels, have advanced degrees in management, the influence of education may provide them with greater flexibility in responding to the opportunities that the diversification of the health care industry appears to be creating. As others have noted, careers are changing and thus perhaps our view of our career and the degree of commitment to those choices is changing as well. These changes in the health care industry may explain the lack of relationships between gender, marital status, dependents, ethnicity and career commitment. Fahey and Myrtle (2001) found that while female managers had different career patterns than males, there was no difference in their satisfaction with their careers, or their satisfaction with their career progression relative to others. With increased mobility between different sectors of the health care industry, coupled with the overall growth of the industry, it is possible that these changing career opportunities may influence the lack of differences in their commitment to their careers. These changes in the industry may also provide more career alternatives to managers who are married, have

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dependents, or may be a member of a minority group. In contrast to the expected lack of relationships between individual characteristics and career commitment, several statistically significant predictors of career commitment emerged from the situational influence and career experience categories. Job satisfaction was found to have a positive relationship with career commitment. Career satisfaction and job security express themselves partly through job satisfaction on career commitment. Contrary to previous research, neither position tenure nor the extent to which the current job met the career expectations of the respondent was predictors of career commitment in the unmediated model. However, in the mediated model, tenure emerged as a predictor of job satisfaction while met expectations did not. In addition to these situational influences, it was hypothesized that different career experiences would have an influence on career commitment. In the unmediated model, sector change and career satisfaction were found to have a statistically significant relationship with career commitment. In the mediated model sector change was found to have a direct effect on career commitment. This is consistent with the researchers belief that changing employment sectors (e. g. moving from an administrative position in long term care to an administrative position in an ambulatory care setting) would increase career options and hence lead to increased career commitment. While the investigators also believed that satisfaction with ones career would have a direct effect on career commitment, this study also found that job satisfaction mediated the influence of career satisfaction on career commitment. This finding helps clarify the relationships between career satisfaction, job satisfaction and career commitment. It also underscores the complexity of the patterns of experiences that

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influences career commitment. In the health care field the organizational and interorganizational changes that are occurring appear to be creating opportunities for people to find career satisfaction by moving into other sectors and new challenges. This increased mobility, as measured by the patterning of changes across different health care sectors, increases ones satisfaction with their jobs and ultimately their career commitment. Neither career stage, career pattern and industry change were found to influence career commitment. A post-hoc analysis found that only respondents in the maintenance stage of their career had a positive association with career commitment. However, neither this stage nor the other two career stage measures were found to have statistically significant associations with career commitment. A similar post-hoc analysis of career pattern and career commitment found that respondents with traditional careers were associated with lower levels of career commitment than were those who either made a single sector change or who moved between multiple sectors. Neither of these differences were statistically significant however. It can be conjectured that reliance on a traditional career in an ever changing industry may produce a degree of insecurity with ones career choice and hence commitment to ones career. Unfortunately, ACHE does not collect data from individuals who elect to terminate their membership (Personal correspondence, February, 2009), thus the authors are unable to examine this relationship. The study found that job satisfaction mediated the influences between the length of time a respondent held their current position and their career pattern. Job satisfaction partially mediated the influence between perceptions of job security and ones satisfaction with their career. Both of these measures also had a direct influence

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on career commitment. Last, sector change had a direct influence on career commitment. Consistent with Goulet and Singh (2002) this research found job satisfaction to contribute to variations in career commitment. Consistent with Lee et al. (2000) and contrary to the investigators expectations, position tenure did not have a direct influence on career commitment. However, in contrast with Gregersen & Black, (1992); and Mathieu & Zajac, (1990) a negative relationship between position tenure and job satisfaction was not found. Nor did the research reveal a relationship between position tenure and career commitment. These results suggest that mobility between sectors and the length of time in ones position may have a positive influence on job satisfaction and ultimately career commitment. The findings suggest that factors influencing the career commitment of health care managers are varied and are influenced by a number of different conditions. Perhaps part of the explanation can be found in the nature of transformations that are occurring in the industry. While the industry has experienced consolidation and integration it has also experienced growthgrowth that is expected to continue for some time. These two changes, the growth of the industry and the blurring of mobility barriers between sectors, may be providing health care managers with more and perhaps different job and career opportunities than has been the case in the past. Unfortunately the cross-sectional nature of this study does not allow us to test for these influences. As the largest and perhaps one of the most occupationally diverse industries, health care provides an excellent laboratory to study the changing nature of occupations. While this research offers some insights into the factors affecting the career commitment of health care executives, the sample was limited to respondents who were members of the American College of Healthcare Executives, and thus may

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not represent the views of all managers in the health care sector. Since ACHE membership involves testing and continuing educational achievement it is possible that they may be more career-involved than non-members. Inasmuch as the respondents are very highly educated with most having advanced degrees, these factors may limit the generalizability of these findings. However, membership in ACHE is increasingly occupationally diverse, thus suggesting that these relationships may not be limited to this sample. These limitations notwithstanding, with the continuing growth and evolution of the field, longitudinal studies of how these changes are influencing professional and managerial careers, seem very appropriate. Perhaps these findings will offer a point of departure for future studies.

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Table 1: Factor Loading Structure of Job Satisfaction Component Matrix a Satisfaction with autonomy in current position Satisfaction with challenge in current position Satisfaction with responsibility in current position Satisfaction with advancement opportunity in current position Satisfaction with prestige in current position Satisfaction with creativity in current position Satisfaction with job security in current position Satisfaction with professional growth in current position Satisfaction with nature of work in current position Satisfaction with content of work in current position Extraction Method: Principal Component Analysis a 1 component extracted. .680 .778 .784 .667 .691 .780 .547 .803 .790 .777

Figure 1: A Conceptual framework of the Determinants of Career Commitment (Path diagram)

Current Work Situation Met Expectations Position Tenure Job Security Management Level

Controls Education Gender Marital Status Dependents Ethnicity

Job Satisfaction

Career Commitment

Career Experiences Career Stage Changed Service Sectors Mobility Pattern Changed Industry Career Satisfaction

Figure 2. Unmediated Model of the Determinants of Career Commitment

LONG SECURE STAGE
1.63

SATISFY MANG

3.41
0.55

5.69

PATTERN SECT_CHG

1.97
0.18

4.15

COMIT

JOBSAT MET_EXP ANOTHER_ GENDER_N MARRY CHILD

9.20
0.88 0.03 0.03 0.28 0.41 0.22 0.73

ETHNIC

EDU

Chi-square=0.00, df =0, P-value=1.00000, RMSEA=0.000

(T-values were shown. T-values with bold mark indicate significant association with career commitment.)

Figure 3: Path Diagram: A Parsimonious Model of the Determinants of Career Commitment

SECURE
0.15 0.13

LONG
0.12

JOBSAT PATTERN
0.10 0.24 0.26 0.15

0.45

COMIT

SATISFY

SECT_CHG Chi-Square=6.10, df=3, P-value<0.1075, RMSEA=0.048 (Standardized coefficients were shown. All standardized coefficients are statistically significant at p<0.05.)

Job and Career Influences on the Career Commitment of Health Care Executives: The Mediating Effect of Job Satisfaction

Duan-rung Chen, Ph.D Associate Professor Graduate Institute of Health Care Organization Administration College of Public Health National Taiwan University Taipei, Taiwan duan@ntu.edu.tw Robert C. Myrtle, DPA Professor of Health Administration, and Professor of Gerontology School of Policy, Planning, and Development University of Southern California Los Angeles, California, 90089-0626 myrtle@usc.edu Caroline H. Liu, Ph.D National Central Library Taipei, Taiwan zencaroline@gmail.com Daniel F. Fahey, MPH, Ph.D Professor of Health Services Administration Department of Health Science California State University San Bernardino, California dfahey@csusb.edu