Profile of health professionals who completed a master's, doctoral, or post-doctoral degree in one Brazilian pediatric program

OBJECTIVE: This study aimed to determine the personal and professional characteristics, and the physical, psychiatric/psychological, and professional issues that exist among master's-, doctoral-, and post-doctoral-level health professionals. METHODS: A cross-sectional, online, self-reported survey of 452 postgraduates who completed master's, doctoral, or post-doctoral degrees in one graduate program in pediatrics in São Paulo, Brazil, was conducted. RESULTS: The response rate was 47% (211/453). The majority of participants were women (78%) and physicians (74%), and the median age was 47 years (28-71). Master's, doctoral, and post-doctoral degrees were reported by 73%, 53%, and 3%, respectively. High workload (>40 hours/week) occurred in 59%, and 45% earned ≥15 minimum wages/month. At least one participation in scientific meeting in the past year was reported by 91%, and 79% had published their research. Thirty-nine percent served as a member of a faculty of an institution of higher learning. The data were analyzed by two age groups: participants aged ≤48 years (group 1) and participants aged >48 years (group 2). The median rating of overall satisfaction with the profession in the past year [8 (0-10) vs. 9 (1-10), p=0.0113]; workload >40 hours/week (53% vs. 68%, p=0.034); and ≥15 minimum wages/month (37% vs. 56%, p=0.0083) were significantly lower in group 1. Further analysis by gender revealed that the median rating of overall satisfaction with the profession in the past year [8 (0-10) vs. 9 (3-10), p=0.0015], workload >40 hours/week (53% vs. 83%, p=0.0002), and ≥15 minimum wages/month (37% vs. 74%, p=0.0001) were significantly lower in women compared with men. The median rating of overall satisfaction with the mentorship supervision provided was significantly higher among the women 10 (5-10) vs. 10 (2-10), p=0.0324]. CONCLUSIONS: The majority of master's-, doctoral-, and post-doctoral-level health professionals were women and physicians, and had published their thesis. Younger postgraduates and women reported low salaries, less likelihood of working >40 hours/week, and less overall satisfaction with their profession. Further longitudinal and qualitative studies are warranted to assess career trajectories after graduation.

In Brazil, the University of São Paulo is a major producer of highly qualified members of the workforce for teaching, research, and science and technology. The university is responsible for educating a significant portion of the country's master's, doctoral, and post-doctoral students (15). The Pediatric Department at the university has a master's/ doctoral and post-doctoral program, which is responsible for epidemiological, translational, and clinical research in children and adolescent health, focusing on primary, secondary, and tertiary care; subspecialties; and transplantation. The program includes professors and students and involves physicians and non-physicians (e.g., physiotherapists, dietitians, nurses, physical educators, biomedicals, and dentists).
Previous research has shown that personal, professional, and educational characteristics, ratings of overall satisfaction, physical/psychological stress, and professional issues after undergraduate, fellowship, and residency training are different around the world (5,6,(16)(17)(18). However, to the best of our knowledge, simultaneous analysis of these data has not been carried out among health professionals in Latin America, after master's, doctoral, and post-doctoral degree completion.
Thus, the objective of the present study was to evaluate postgraduate reports regarding demographic characteristics, overall satisfaction, salary, teaching, publishing, patient care profiles, and main physical, psychiatric/psychological and professional issues related to clinical practice. Additionally, personal, professional, and educational characteristics and issues were compared by age and gender.

' METHODS
A cross-sectional, online, self-reported survey of 452 individuals who had successfully completed a master's, doctoral, or post-doctoral degree in a pediatric postgraduate program at a university in São Paulo, Brazil, was conducted to collect data on demographic, professional, and educational characteristics and physical, psychiatric/psychological, and professional issues among postgraduate health professionals. In this postgraduate program, 3 years are required to complete the master's degree, and up to 4 years are required to complete the doctoral degree. The program focuses on epidemiological, translational, and clinical research in pediatric primary, secondary, and tertiary care; subspecialties; and transplantation.
The survey was carried out using Research Electronic Data Capture (REDCap; Vanderbilt University, Nashville, TN, USA), which is a safe Web application for developing research databases that can also be used for building, managing, and accessing electronic surveys. Between January and February 2019, all health professionals that had completed their master's, doctoral, or post-doctoral degree in the pediatric postgraduate program between 1995 and 2018 were invited to participate in the survey. The ethics committee of the university hospital approved this study (CAAE: 93564518.5.0000.0068).
Invitations to participate in the anonymous, self-reported survey were distributed by email. The survey included 22 questions on demographic, professional, and educational characteristics, and physical, psychiatric/psychological, and professional issues. The formats of the questions were multiple choice, dichotomous (yes/no), or horizontal visual analog scale. The questions referred to events during and after degree completion. Estimated time to complete the questionnaire was approximately 15 minutes.
The topics of the 22 items were as follows: obsessive-compulsive symptoms, low salary, legal issues, workplace violence, stress induced by chief/professor, and stress induced by patient health insurance issues).
The respondents were divided into two age groups according to the mean of current age (aged p48 years [group 1] and aged 448 years [group 2]) and by gender.

Statistical analysis
The Statistical Package for the Social Sciences version 13.0 (SPSS Inc, Chicago, IL, USA) was used in the analysis of the data. Results for the continuous variables were reported as median (minimum-maximum values) or mean± standard deviation, and compared by Mann-Whitney test and Student's t-test, respectively. The results for categorical variables were reported as frequency (percentage) and compared by Fisher'́s exact test or Pearson chi-square test, as appropriate. Pearson or Spearman rank correlation coefficients were employed for correlations between overall satisfaction, current age, and year of degree completion. A p-value less than 0.05 was considered statistically significant.
The proportion of women among those who completed the questionnaire (n=211) was equal to that among those who did not participate (n=214) ([164/211 (78%) vs. 167/214 (78%), p=1.000]. Table 1 shows the data on the demographic characteristics, region of Brazil, postgraduate degree, current profession, overall satisfaction rate, location of practice, workload in hours/week, number of patients/week, salary, and patient health insurance issues reported by 211 master's-, doctoral-, and post-doctoral health professionals. The majority of the postgraduates were women (78%), and the mean age was 47.61 ± 10.4 years. Eighty-two percent lived in Southeastern Brazil, and 74% worked as physicians. Master's degrees were reported by 73%, doctoral degrees by 53%, and postdoctoral degrees by 3%. The majority of postgraduates (65%) had worked as public service professionals within the past year, followed by those who worked as private practice pediatricians (50%), and those who worked as public/private university professors (20%). Approximately one half of postgraduates earned X15 minimum wages/ month (Table 1).
Participation in at least one scientific meeting was reported by almost 91% of postgraduates. Seventy-nine percent reported having published research papers in health science, and 39% were faculty members at an institution of higher learning. The most prominent physical, psychiatric/psychological, and professional issues (440%) were physical inactivity and long working hours ( Table 2).
The data on the participants were also analyzed by age. Two age groups were used in the analysis: participants aged p48 years (group 1, n=120) and participants aged 448 years  Results are presented as n (%) and median (range) or mean ± standard deviation, IRB-institutional review board.
Spearman rank correlations revealed that current age was positively correlated with overall satisfaction with one's profession in the past year (r=0.168, p=0.015), and years since completion of master's, doctoral, or post-doctoral degree also was positively correlated with overall satisfaction with one's profession in the past year (r=0.160, p=0.019). No other correlation was observed among current age, years since completion of master's, doctoral, or post-doctoral degree, and overall satisfaction rating (written research project/ scientific manuscript, submitting the paper, mentorship supervision, profession in the past year, postgraduate program, p40.05).

' DISCUSSION
To our knowledge, this was the first study to explore the profile of postgraduate professionals from a Latin American postgraduate program in children and adolescent health.
The strength of the present study was the simultaneous analysis of personal, professional, and educational characteristics, and physical, psychiatric/psychological, and professional issues. The inclusion of measurements of six overall satisfaction rates, linked to the postgraduate program, scientific research and publishing, and current satisfaction with one's profession also allowed a better understanding of the quality of the program and the current impact of the program on the professional lives of its graduates. The self-report and anonymous survey allowed confidentiality of data.
The main goal of our Pediatric Postgraduate Program is career development of the faculty and researchers in the area of child and adolescent health, accompanied by great innovation. This program focuses mainly on studies dedicated to epidemiologic and patient-oriented research from the fetal period to adolescence, involving socio-economic, cultural, and biological problems. In our university, master's and/or doctoral degrees are usually pursued after an undergraduate degree has been obtained for a non-physician career and after completion of a residency for physician careers.
The majority of our postgraduates live in Southeastern, Brazil, which is the richest region of the country; this region generates approximately 60% of the Brazilian gross domestic product. Forty percent of the postgraduates in the present study serve on a faculty at an institution of higher education and have careers that are research-and teaching-oriented with a true academic trajectory. However, the majority of postgraduates work as health professionals in both private and public services (dual practice), which is common in Brazil (19), and do not focus their careers on academia. The results are different in other countries in terms of the physician-scientists model. The mentor program includes both basic sciences and clinical integration research, thus promoting student development as physician-scientists who are engaged in translational research (13,20).
In the present study, physician was the profession most reported, and the vast majority of professionals were women, in agreement with past research that has observed increased numbers of women in medical schools and residency programs around the world (21,22). The result of the present study was different from that of research on MD/PhD programs in Canada and the United States, which found that men were the predominant gender (9,10,13,20).  (5) Results are presented as n (%), HRQL-health-related quality of life, STI-sexually transmitted infection.
Analysis of the data from the postgraduate program evaluation measurements, including the five ratings of overall satisfaction, indicated that the overall rating was good, because the median rating was above 8. Almost 80% of postgraduates reported that their thesis was published, reinforcing the efficiency of our program. Overall satisfaction with one's profession in the past year was low in young health professionals after degree completion. This low enthusiasm is possibly related to high workload and low salaries. In contrast, MD-PhD students of one medical school reported optimism for their future, with up 80% of the respondents describing excellent job opportunities for physician-scientists (10).
The overall satisfaction with one's profession in the past year was also low in women, who reported low salaries and workload. Interestingly, overall satisfaction with mentorship supervision was high among women, probably due to engagement, proactiveness, commitment, and a fairly good relationship with their mentor.
It is worth noting that continuing education after degree completion was found to be an important factor. The majority of participants reported attending professional conferences regularly. In fact, this population has a notable interest in scientific knowledge (1).
There were problems related to clinical practice among the postgraduates, involving sedentarism, long work hours, and poor social life that may decrease health-related quality of life. Additionally, these health professionals may be at risk for anxiety, depression, and burnout. Future studies that clarify these issues are warranted (16)(17)(18)23). Furthermore, improvements in health professionals' training and preventive programs, targeted at enhancing overall satisfaction, and psychological/psychiatric issues diagnosis should be implemented.
This study had several limitations. One limitation was the moderate response rate (47%) to the online, self-reported survey. The long length of the questionnaire, and electronic address problems might have been reasons for dropout. The cross-sectional study design and the absence of validated tools to evaluate physiological/psychiatric issues were also limitations.
In conclusion, the quality of the postgraduate program was found to be reasonable. The program's postgraduate professionals were primarily women and physicians, and had published their thesis. Young postgraduates and women reported low salaries, low workloads, and less overall satisfaction with their profession. Further longitudinal and qualitative studies are needed to assess career trajectories after graduate degree completion. Table 3 -Demographic data, ratings of satisfaction, workload, patients/week, salary, scientific meeting participation, published research paper, faculty service and main issues related to profession according to years of clinical practice in two groups of master's-, doctoral-, or post-doctoral-level health professionals: group 1 (p48 year) and group 2 (448 year).