Developing and Testing a Model of Burnout at Work and Turnover Intensions among Doctors in Pakistan

This paper examines the impact of burnout at work (BO), work life balance (WLB), work life conflict (WLC) and job satisfaction (JS) on turnover intensions (TOI) among doctors in Pakistan. The research team developed a conceptual model to test the hypothesized relationships between the variables. Simple random sampling method was used to distribute 300 questionnaires among MBBS qualified doctors working in the private and public sector hospitals in major cities of Pakistan, such as Peshawar, Lahore, Rawalpindi and Islamabad. With a response rate of 58.3%, 175 valid responses were received which comprised sample size of this study. The research team used SPSS 15.0 and Amos 16.0 for data analysis and model testing. The study concludes that there is no significant effect of burnout at work, work life balance and work life conflict on doctors’ turnover intentions. There is no significant affect of burnout at work on doctors’ work life balance whereas it has a significant effect on the work life conflict and job satisfaction of doctors. Moreover, work life balance has no significant affect on job satisfaction of doctors whereas work life conflict does have a significant effect on job satisfaction of doctors. Lastly, job satisfaction has a significant effect on turnover intentions of doctors.


Introduction
Burnout is one of the important issues discussed in the organizations across globe.The researchers have carried out many researches globally to curtail the level of burnout to minimize the negative consequences in the organization.Burnout and turnover are common in the life cycle of any organization and burnout is one of the reasons for employees to leave the organization.The rapid turnover of skilled labor harms the organizations in terms of excessive cost (Weisberg, 1994).Burnout is the outcome of occupational pressures and stress.The people who are in the service industry are more exposed to burnout because they experience more demanding job requirements (Pines & Kafry, 1978).The causes of burnout suggested by the researchers may include the low pay package, excessive work, lack of support from supervisor and colleagues, lack of equipment to work with and public criticism (Weisberg, 1994).
Earlier researches (e.g.Lazaro, Shinn & Robinson, 1984;Shirom, 1989) revealed that burnout incites employees to leave the organization.Besides, it is also responsible for low employee job satisfaction in a service industry (Jackson, Schwab & Schuler, 1986).
Work life balance (WLB) plays a positive role in minimizing the dissatisfaction among employees with respect to their jobs (Eikhof, Warhurst & Haunschild, 2007;Osterman, 1995).The determined organizations provide WLB opportunities to their employees to manage work and life activities comfortably (Eikhof, et.al, 2007), that leads to increased job satisfaction of the employees and helps in reducing the turnover rate (Burke, 2000).Eikhof, et.al, (2007) expressed that job satisfaction is the most important factors which effect life more than the work hours.Work life balance provide an opportunity to employees to freely able to use flexible working hour programs, to balance their work and other commitments like family, hobbies, art, traveling, studies etc. instead of only focusing on work (Frame & Hartog, 2003).
Previous studies (Butt and Lance, 2005;Cabrita and Heloísa, 2006) also reveal that improving company's employee work life balance, leads not only to greater productivity but greater company loyalty and job satisfaction.According to Osterman, (1995) organizations introduce family friendly policies to respond to the practical problems associated with the recruitment and retention of the employees.Healthy practices of work life balance leads to downward trends in job dissatisfaction and turnover.
In study carried out by McGillis Hall (2003), the factors influencing nurses' job satisfaction were associated with the work itself and with the work environment such as autonomy and control over practice, relationships with supervisors and peers, job stress, organizational commitment, and organizational climate.Professional job satisfaction was predictive of staff nurse retention, turnover, and intent to leave their positions (Lynn & Redman, 2005), similarly many of the researchers found out, turnover intentions as the consequence of job burnout (Valentine, Sean, Greller, Martin & Richtermeyer, Sandra, 2006).
Burnout is a combination of three types of exhaustion such as physical, mental and emotional exhaustion that leads to employee turnover and low job satisfaction (Weisberg, 1994).The current study undertakes the same concept but with few adjustments.This study is based on examining the relationship of burnout among MBBS doctors with work life balance, work life conflict, job satisfaction and ultimately the turnover intentions that is, to leave their current job.Doctors being an integral part of the society provide health care services to the community.In Pakistan there is only one doctor available to 1212 persons to get health care facilities (Economic survey of Pakistan 2008 -09).This ascertain the burnout affects on their job satisfaction, work life balance, work life conflict and turnover intentions.This study will provide the insight for the doctors to manage their burnout level by availing maximum work life balance facilities and to maximize the job satisfaction in a developing country like Pakistan.This study also examines the interrelationship of different variables included in the model.Moreover this is an essential attempt in a developing country like Pakistan to test the model based on burnout at work, job satisfaction, work life balance, work life conflict and turnover intentions.

Literature Review
One of the issues that can harm the overall organizational performance and job satisfaction of employees is employee burnout during working hours.Many researchers have highlighted the issue of burnout time and again (Weisberg, 1994;Lazaro, Shinn & Robinson, 1984;Shirom, 1989;Jackson, Schwab, & Schuler, 1986).Burnout affects activities of doctors in many ways: including enhancing turnover intentions and lowering job satisfaction.
Emotional exhaustion, a form of burnout, is also a common factor among those who are actively involved in people caring professions (Cordes & Dougherty 1993).The burnout is classified as a discrete factor, having physical and emotional indicators linked with a tendency to exhaust or become exhausted by using energy, strength and resources (Freudenberger, 1974).Dolan (1987) carried out a research on nurses by using the job satisfaction.The study and found out that a relationship existed between job satisfaction and burnout that is high job satisfaction resulted in low burnout and vice versa.Kumar, et al., (2007) estimated the existence of burnout and the level of job satisfaction among New Zealand psychiatrists.It also ascertained relationships between socio-demographic variables, job satisfaction and burnout by using the Maslach Burnout Inventory (MBI), and a Job Diagnostic Survey (JSS) along with the demographic questionnaire.After performing regression analysis, the author has found out that the prevalence of burnout in New Zealand psychiatrists was a cause for concern.Two-thirds of all psychiatrists described moderate to severely high levels of emotional exhaustion, with a similar proportion describing low levels of personal accomplishment.
Moreover, job satisfaction remained relatively high despite the high prevalence of burnout, although there was a relationship between burnout and job satisfaction scores.
In another study Evans et al., (2006) examined the prevalence of stress and burnout, and job satisfaction among mental health social workers (MHSWs) and the author has examined the factors responsible for prevalence of stress and burnout by using a combination of questionnaires.Author has found out that of those, 610 only 237 respondents reported high levels of stress and emotional exhaustion and low levels of job satisfaction.Feeling undervalued at work, excessive job demands, limited latitude in decision-making, and unhappiness about the place of MHSWs in modern services contributed to the poor job satisfaction and most aspects of burnout.Prosser et al., (1996) compared stress and job satisfaction between community and hospital-based staff by using Maslach Burnout Inventory (MBI) and a job satisfaction measure, to study 160 inner London staff.Authors found out that community staff scored significantly higher 'emotional exhaustion' component of the Maslach Burnout Inventory than hospital-based in-patient, day care or out-patient staff and satisfaction was not found vary significantly between settings.Knudsen, Ducharme and Roman, (2006) assessed the associations between job burnout, turnover intention, and three aspects of organizational culture that are centralized decision making, procedural justice, and distribution justice.Employee's turnover intentions were a concern for most types of organizations which have high turnover intentions of employees and may be more responsive in job burnout.Jamal (2008) examined the relationship of job stress and burnout level and job satisfaction in two developing countries such as Pakistan and Malaysia.After using regression analysis the author revealed the significant relationship between the job stress and job burnout with job satisfaction.Another study by Jamal (2007) examined the difference in the level of burnout among the organizational employees and the self employed individuals.A sample of 306 respondents was used to analyze the turnover intentions and dimensions of the burnout such as emotional exhaustion, lack of accomplishment and depersonalization.In Pakistan, self-employed individuals were reported to have high level of turnover intensions and burnout in terms of its dimensions.Teng, Lotus and Chang (2007) investigated the moderating effects of professional commitment on relationships among job burnout, job satisfaction, and turnover intentions and found out that professional commitment moderated the influence of job burnout on job satisfaction, but not the influence of job satisfaction on turnover intentions.
A study of 1187 employees of 25 different organizations in New Zealand revealed that employees who engenders feelings that employers are providing them with the facility to better manage their work and life, were more satisfied with their work and were having low work pressures that resulted in low turnover intentions (Forsyth & Debruyne, 2007).
There is significant evidence that those working in construction industry are at risk of poor health and well-being due to long working hours, job insecurity, poor work-life balance, low professional worth and temporary teams (Sang, Dainty and Ison, 2007), which result in low job retention, job satisfaction and high stress among employees.
Job satisfaction was found to have many significant relationships with different variables including employee turnover intentions such as Steijn ( 2004) revealed that higher job satisfaction was found to have positive association with better organizational and individual performance, increased productivity, lower absenteeism, and lower employee turnover.
The jobs associated with high responsibilities and obligations were hypothesized to be related to elevated emotional exhaustion, one of the types of burnout.The importance of the burnout concept is suggested by its relationships with organizational outcomes, such as absenteeism, turnover, job dissatisfaction, and a decrease in the quality of job performance; with personal outcomes, such as alcohol and drug use, physical and mental disorders, and the disintegration of family and social relationships (Maslach & Jackson, 1981).
While looking at the WLB policies including pay policies Lum et al. (1998) assessed the direct and indirect impact of certain pay policies upon the turnover intentions of pediatrics nurses.The two major questions investigated by the authors were, what was the relative impact of job satisfaction, pay satisfaction, and organizational commitment upon the turnover intentions of pediatrics nurses eligible for pay policies?What model accurately portrays the relationship among these three independent variables and turnover intentions?They have revealed that job satisfaction had only an indirect influence on the intention to quit, whereas organizational commitment had the strongest and most direct impact on the intentions to quit.Moreover, pay satisfaction had both direct and indirect effects on turnover intent.Burke (2000) examined the relationship of managerial and professional men's perception of organizational values supporting work-personal life balance in their workplace and their work experiences, indicators of work and life satisfaction and psychological well-being and revealed that managerial men reporting organizational values more supportive of work-personal life balance.It also reported working fewer hours extra hours, less job stress, greater joy in work, lower intentions to quit, greater job career, life satisfaction, fewer psychosomatic symptoms, more positive emotional and physical well-being effects positively on satisfaction.Burke (2002) examined the relationship of managerial and professional gender's perceptions of organizational values, supportive of work-personal life balance and their job experiences, work and non-work satisfactions and psychological well-being.It revealed that women managers reporting organizational values more supportive of work-personal life balance, greater job and career satisfaction, less work stress, less intention to quit, greater family satisfaction, fewer psychosomatic symptoms and more positive emotional well-being.
The indicators of work life balance are associated with greater commitment, job satisfaction and work life imbalance that is work life conflict is associated with lower job satisfaction, lower organizational commitment, greater turnover intentions, greater burnout and job related stress (Allen at al., 2000).Moreover, employee's perceptions that the employers provided them with work life balance policies and facilities including policies programs supportive of families have no influence on their turnover intentions (Haar, 2003).The scholar also mentioned that male managers reporting organizational values are more supportive of work-personal life balance.
While examining the relationship among work-family conflict, policies, job and life satisfaction Kossek and Ozeki, (1998) revealed that regardless of the type of measure used that there are bi directional work family conflict, work to family, family to work, a consistent negative relationship exist among all forms of work family conflict and job-life satisfaction.Noor and Maad (2008) examined the relationship between stress, one of the causes of burnout, and work life conflict with turnover intentions, have revealed that work life conflict and stress have a significant positive relationship with turnover intentions.Ronen and Pines, (2008) investigated the gender differences in burnout, style of coping and the availability of peer support among high-tech engineers and have revealed that there was a significant gender difference in burnout, with women engineers reporting higher levels of burnout than men.The gender differences in burnout were interpreted as related to other findings such as among women, there was a greater tendency to utilize emotion-focused coping, their smaller peer support and greater work-family conflict.Conversely, it can be assumed that higher level of burnout there will be higher tendency of work life conflict and lower will be the work life balance.Lambert, Hogan and Barton (2001) developed and tested a model including the variables such as demographic characteristics, work environment, job satisfaction, and turnover intent.Authors have carried out a study in a sample of American workers, revealing that the work environment was more important in shaping worker job satisfaction than were demographic characteristics, and that job satisfaction was a highly salient antecedent of turnover intent.Moreover, they have found out that job satisfaction was a key mediating variable between the work environment and turnover intent.Forsyth and Polzer-Debruyne (2007) found out that employees' perceptions that their employers were supporting them in balancing work and life role increased job satisfaction and reduced work pressures.George and Jones (1996) found that the relationship between job satisfaction and turnover intentions was jointly moderated by value attainment and positive mood.They also revealed that the job satisfaction-turnover intention relationship was strongest when workers' jobs did not help them to attain terminal values and positive moods were experienced, and the relationship was weakest when jobs helped workers to attain terminal values and positive moods were experienced.Tett and Meyer (2006) estimated the six relations among job satisfaction, organizational commitment, turnover intention/ withdrawal cognitions, and turnover using meta-analysis and assessed the effects of several psychometric moderators on those relations.Moreover, they have compared the influences of satisfaction and commitment in the turnover process by applying path analysis to the meta-analytic correlations.Authors have revealed that satisfaction and commitment each contribute independently to the prediction of intention/cognitions and intention/cognitions were predicted more strongly by satisfaction than by commitment and intention/cognitions mediated almost all of the attitudinal linkage with turnover.Hellman (1997) carried out a meta -analysis to determine the relationship between job satisfaction and intent to leave revealing that there was a positive relationship between job satisfaction and intent to leave the organization.
They have also revealed that United States federal agency employees were less likely to leave the organization as compared to the private sector organizations.Further they have revealed that age and tenure were the factors to moderate the relationship between job satisfaction and intent to leave the organization.

Conceptual Model and Hypothesis
On the basis of relationships among variables of interest, as discussed in the literature review, the research team proposed the conceptual model: [Insert figure 1 here].
The research team developed the following hypothesis on the basis of literature review: H 1 : There is a significant effect of burnout at work on turnover intensions among doctors working in hospitals.
H 2 : There is a significant effect of burnout at work on work life balance among doctors working in hospitals.
H 3 : There is a significant effect of burnout at work on work life conflict among doctors working in hospitals.
H 4 : There is a significant effect of burnout at work on job satisfaction among doctors working in hospitals.
H 5 : There is a significant effect of work life balance on turnover intensions among doctors working in hospitals.
H 6 : There is a significant effect of work life balance on job satisfaction among doctors working in hospitals.
H 7 : There is a significant effect of work life conflict on turnover intensions among doctors working in hospitals.
H 8 : There is a significant effect of work life conflict on job satisfaction among doctors working in hospitals.
H 9 : There is a significant effect of job satisfaction on turnover intensions among doctors working in hospitals.

Sample
Data were collected by distributing 300 questionnaires among MBBS qualified Doctors randomly, who worked in the public and private sector hospitals across Pakistan, mainly from the major cities including Peshawar, Islamabad, Rawalpindi and Lahore.The both male and female Doctors participated in the survey and provided their responses.Out of 300 distributed questionnaires, researchers received back only 175 completely filled questionnaires that were used for the analysis.The response rate calculated was 58.3 %.The questions asked in the questionnaire were relevant to the model to be tested for the study.Non -probability random sampling (convenience sampling) was used to collect the data from Doctors.

Data collection/measures
Questionnaires are considered to be a major source of data collection tool within work-related health and well-being literature (Symon and Cassell, 2006), and are useful for measuring individuals' attitudes.We collected the data using an adopted questionnaire(s) to measure the different variables.Besides the independent and dependent variables, the demographic variables are also used for the analysis.Different types of statistical tests are used to analyze the data.SPSS 15.0 and Amos 16.0 are used for data analysis.

Burnout at work
Burnout is defined by the researchers as "a syndrome of emotional exhaustion and cynicism that occurs frequently among individuals who do 'peoples work' of some kind" (Maslach & Jackson, 1981, p. 99).
Questions are taken from Burnout questionnaire which was adopted from the study carried out by Weisberg, (1994) including physical, emotional, and mental burnout measures.A burnout scale composed of 21 items, which represent physical, emotional, and mental factors.Respondents were asked to mark the responses on seven point scale ranging from 1 = Never, 2 = Once, 3 = Rarely, 4 = sometimes, 5 = often, 6 = Usually, 7 = Always.

Work -life balance
According to Crooker, Smith, and Tabak (2002) "Work-life balance is the stability characterized by the balancing of an individual's life complexity and dynamism with environmental and personal resources such as family, community, employer, profession, geography, information, economics, personality, or values." The work-life balance scale developed by Brough, Timms and Bauld (2009) having four items, was used for the study.Five-point Likert type scales was used (1=strongly disagree, 5=strongly agree).Alpha coefficient for the scale was α = .81.

Work -life conflict
Work-life conflict is a form of inter-role conflict whereby the role demands of one domain interfere with meeting the demands of a role in another domain (Greenhaus & Beutell, 1985).
The scale was adopted from the study of Sang, Dainty and Ison (2007) having seven items.Respondents were asked to rate the extent to which they agreed with a number of statements regarding work-life conflict using a five-point Likert scale which ranged from 1 = 'strongly agree' to 5 = 'strongly disagree'.The coefficient alpha for work-life conflict was α = 0.89, indicating reliability of the scale.

Job satisfaction
Job satisfaction is the degree that people like their jobs (Lambert & Hogan, 2008;Spector, 2003).The tool for Job satisfaction was adopted from the study carried out by Warr, Cook, and Wall (1979).This research tool inquired from informants to rate their satisfaction on a seven-point Likert scale ranging from 1 = extremely satisfied to 7 = extremely dissatisfied and 4 = neither satisfied, nor dissatisfied.It included the job characteristics like working conditions, rate of pay, relationship with colleagues including subordinates, and seniors, working hours, promotion opportunities and job security etc.Little changes have been made to the original scale for this study.
The global job satisfaction scale (Warr, Cook & Wall, 1979) has previously been demonstrated to have a high degree of reliability (Fields, 2002).The coefficient alpha for this scale was α = 0.91, indicating high reliability.

Turnover intention
The researchers have defined turnover intention as one's propensity to leave (Lyons, 1971).The tool was adopted from the study of Sang, Dainty and Ison (2007) having four items, two items asking the doctors about the intention to leave, their current job and two questions asking to leave their profession.First two items were used for the study emphasizing the intentions to leave the current job because it seems really difficult to quit from the profession for a doctor.The coefficient alpha for turnover intentions was α = 0.83.Items were assessed on a five point Likert type scale ranging from 1 = strongly agree to 5 = strongly disagree and 3 = neither agree, nor disagree.

Procedure
Most of the data were collected through the questionnaires.People were contacted by telephone to complete the incomplete responses.The contact numbers were requested by the respondents in the questionnaire to deal with such situations.Questionnaires for the study were mostly distributed by visiting the hospitals personally except for few that were sent via e -mail or by post.Data collection took almost three months before undergoing the process of analysis.Data were processed through SPSS and Amos by using different types of statistical tests.Results are compared to previous researches to look into the cultural differences and to test the model.

Results and Analysis
Table 2 reveals the demographic profile of the respondents.Maximum respondents were married (69.7 %) males (74.3%) and worked full time (80.6 %) in some private hospital (62.3 %).More than half of the doctors (53.1 %) were having tenure from 1 to 5 years.Maximum of the respondents belonged to two groups of ages such as 25 -30 years (26.3 %) and 36 -40 years (21.1 %).These figures show that the doctors actively took part in the survey and this leads to thinking that in future this sector (MBBS doctors) may be examined for different aspects of research The research team used Amos 16.0, to test the proposed model.Amos implements Structural Equation Modeling (SEM) approach to data analysis which includes the techniques of general linear model and common factor analysis (Arbuckle, 2005).The error terms (e1 to e8) represent the errors associated with variables in the model.The value of chi-square (20.822) is significant (p<0.05).The research team used two measures such as Comparative Fit Index (CFI) and Goodness of Fit Index (GFI) to assess fit of the model.Values of CFI (0.887) and GFI (0.957) are close to 1 which shows the goodness of the model fit (Manoux, Clarke, & Marmot, 2002;Sacker, Bartley, Firth & Fitzpatrick, 2001).

Table 4 reveals the result of hypothesis testing based on regression weights [Insert table 4 here].
In BOW-TOI regression model, the value of regression coefficient (β=-0.202) is not significant (p>0.05) which shows that there is no significant effect of burnout at work (BOW) on turnover intentions (TOI).The hypothesis H 1 is therefore rejected.
In BOW-WLB regression model, the value of regression coefficient (β=0.16) is not significant (p>0.05) which shows that there is no significant effect of burnout at work (BOW) on work life balance (WLB).The hypothesis H 2 is therefore rejected.
In BOW-WLC regression model, the value of regression coefficient (β=-0.265) is significant (p<0.05) which shows that there is a significant effect of burnout at work (BOW) on work life conflict (WLC).The hypothesis H 3 is therefore accepted.
In BOW-JS regression model, the value of regression co-efficient (β=0.716) is significant (p<0.05) which shows that there is a significant effect of burnout at work (BOW) on job satisfaction (JS).The hypothesis H 4 is therefore accepted.
In WLB-TOI regression model, the value of regression coefficient (β=0.099) is not significant (p>0.05) which shows that there is no significant effect of work life balance (WLB) on turnover intensions (TOI).The hypothesis H 5 is therefore rejected.
In WLB-JS regression model, the value of regression coefficient (β=0.006) is not significant (p>0.05) which shows that there is no significant effect of work life balance (WLB) on job satisfaction (JS).The hypothesis H 6 is therefore accepted.
In WLC-TOI regression model, the value of regression coefficient (β=0.006) is not significant (p>0.05) which shows that there is no significant effect of work life conflict (WLC) on turnover intensions (TOI).The hypothesis H 7 is therefore rejected.
In WLC-JS regression model, the value of regression coefficient (β=-0.161) is significant (p<0.05) which shows that there is a significant effect of work life conflict (WLC) on job satisfaction (JS).The hypothesis H 8 is therefore accepted.
In JS-TOI regression model, the value of regression coefficient (β=-0.522) is significant (p<0.05) which shows that there is a significant effect of job satisfaction (JS) on turnover intensions (TOI).The hypothesis H 9 is therefore accepted.

Analysis
Associations between the variables were assessed using AMOS and the results are discussed in the light of previous studies.Our first hypothesis was that there is a significant effect of burnout at work on turnover intensions among doctors working in hospitals which has not been proved after applying the statistical tests.Many researchers have tested the same relationship and supported the comment that burnout at work is one of the reasons for employee intentions to leave the organization (Lazaro, Shinn, & Robinson, 1984;Shirom, 1989;Jackson, Schwab & Schuler, 1986;Valentine et al., 2006;Knudsen, Ducharme, & Roman, 2006;Teng, Lotus, & Chang, 2007).This may be due to the excessive work load which doctors may not be able to handle within the available given time and want to quit the current job or place, in pursuit to find out a place with some flexible work arrangements.Few other research studies found out that burnout and exhaustion as factors responsible for employee turnover (Kim, 2004;Samantrai, 1992).
Second and third hypothesis are interrelated.Second hypothesis explained that there was a significant effect of burnout at work on work life balance among doctors working in hospitals which is also not acceptable after the statistical analysis.This means that burnout has no significant effect on balancing the work and life of doctors.The possible reasons may be that the presence of work life balance policies may affect the doctor's work and life in such a way that they don't experience burnout.
Third hypothesis was relating to the effect of burnout at work on work life conflict which is supported after data analysis.The more a doctor feel burnt out at work more there will be a conflict in managing their work and life activities.The earlier researches also supported the same concept (Ronen & Pines, 2008).
Forth hypothesis demonstrates that there is a significant effect of burnout at work on job satisfaction which is also supported by the statistical analysis resulting in the acceptance of the hypothesis.Many other studies carried out by different researchers supported this idea (Lazaro, Shinn, & Robinson, 1984;Shirom, 1989;Jackson, Schwab, & Schuler, 1986;Dolan, 1987;Kumar, et al., 2007;Evans, et al., 2006).Many authors found out that burnout is responsible for low job satisfaction (Lazaro, Shinn & Robinson, 1984;Shirom, 1989;Jackson, Schwab & Schuler, 1986).Another study carried out by Dolan (1987) demonstrated that a relationship existed between job satisfaction and burnout that is high job satisfaction resulted in low burnout and vice versa.Burnout causes a feeling of discomfort while doing a job and that results in job dissatisfaction.
Fifth hypothesis explains that there is a significant effect of work life balance on turnover intensions of doctors working in the hospitals which is not accepted after analysis.It means that work life balance facilities provided by the organization have no effect on the turnover intention of doctors.This may be due to heavy workload or any such reason, that once the doctor decide to leave the organization, he or she may not change that decision again even in the presence of the work life balance practices.The doctors leaving the hospital may be attracted by the attractive pecuniary and non -pecuniary benefits offered by the other hospital.Researches carried out in this regard include the researches of Osterman, (1995) and Forsyth & Debruyne, (2007).Osterman (1995) found out that healthy practices of work life balance lead to downward trends in job dissatisfaction and turnover.Forsyth & Debruyne, (2007) also found out that employees who had the feeling that employers were providing them with the facility to better manage their work and life, were more satisfied with their work and were having low work pressures that resulted in low turnover intentions.Haar (2003) revealed that work life balance policies/ practices has no effect on employees turnover intentions which promotes the idea that the presence of work life balance policies/ practices may support employees to better manage their work and life roles rather than an essential factor that make employees not to leave the organization.
The analysis supports our hypothesis six which says that there is no significant effect of work life balance on job satisfaction among doctors working in hospitals.It means doctors' job satisfaction is not affected by the work life balance facilities provided by the hospitals.This very finding of our study is inconsistent with the earlier researches carried out by Forsyth andDebruyne, (2007), Burke, (2000) and Burke, (2002).
Seventh hypothesis of our study states that there is significant effect of work life conflict on turnover intensions among doctors working in hospitals.This hypothesis is rejected after applying statistical test which means that work life conflict has no effect on doctors' intention to leave the hospital.Noor and Maad, (2008) revealed that work life conflict and stress have a significant positive relationship with turnover intentions.
Eighth hypothesis states that there is a significant effect of work life conflict on job satisfaction among doctors working in hospitals which is accepted after the statistical analysis.It means that work life conflict effects doctors' job satisfaction.Kossek and Ozeki, (1998) revealed that a consistent negative relationship existed among all forms of work family conflict and job -life satisfaction.
Ninth, the last hypothesis of the study, states that there is a significant effect of job satisfaction on turnover intensions among doctors working in hospitals which is accepted after applying statistical tests.It means that more the employees are satisfied with their jobs less would be chances to quit the job and vice versa.Generally employee have low tendency to quit the job if they are happy with their job and work environment.Earlier research studies in relation to this concept include the researches of Hellman, (1997), Lynn & Redman, (2005), Tett & Meyer, (2006), Teng, Lotus, & Chang, (2007), and Lambert, Hogan, & Barton, (2001).
Hellman, (1997) revealed a positive relationship between job satisfaction and turnover intentions.Posthuma, Joplin, and Maertz Jr, (2005) revealed job satisfaction as one of the predictors of turnover intentions in the United States.Another research study indicated that employee attitude toward their jobs and work environment are associated with lower job turnover intentions (Roe et al., 2000).
The higher the degree of job dissatisfaction the higher will be the turnover rate (Mardanov, Heischmidt, and Henson, 2008).Job satisfaction is one of the main variables that predicts employee turnover (Mossholder, Settoon, & Henagan, 2005).

Conclusions and Discussion
The purpose of the study was to test the relationship of different variables interrelated in a form of a model and ultimately to test the effect of different variables on the turnover intentions of the doctors working in different hospitals in Pakistan.
By looking at the demographic characteristics of the data collected, we can conclude that maximum of the respondents were married (69.7 %) males (74.3%) reason being the male dominant society of Pakistan, where male part of the society is generally considered responsible for earning bread and butter for their families, and worked full time (80.6 %) in some private hospital (62.3 %).The remunerations and other pecuniary and non -pecuniary benefits at the private hospitals are comparatively better as compared to the public sector hospitals, so the doctors generally prefer to work more in the private sector hospitals rather than public sector hospitals.There could be another reason for this factor is that the doctors coming back to Pakistan after completing their education from foreign countries may like to work independently and open their own hospitals instead of working in government sector hospitals.
The results of the study conclude that there is no significant effect of burnout at work, work life balance and work life conflict on doctors' turnover intentions.There is no significant effect of burnout at work on doctors' work life balance whereas it has a significant effect on the work life conflict and job satisfaction of doctors.Moreover, work life balance has no significant on job satisfaction of doctors where as work life conflict do have a significant effect on job satisfaction of doctors.Lastly job satisfaction has a significant effect on turnover intentions of doctors

Limitations of the Study
The researcher experienced certain limitations in conducting this study, whereby, data acquisition remained inconsistent with the planned activity which was delimited using personal relations.

Future Research
Work life balance is a new concept for the organizations.It has to be adopted by the organizations for betterment.In western countries, it's a part of most of the organizations policies and this is the reason that those organizations are more stable in terms of operations.Work life balance has to be studied in different sectors of the economy and to see its relationship with different variables like Life satisfaction and organizational commitment etc. to explore the better results.
Table 1.Hypothesized Relationships and Theoretical Support by different scholars
Hypothesized relationships and theoretical support by different scholars available in the literature Research model is tested after applying statistical tests using AMOS Figure 2 reveals testing of the research model.[Insert figure 2 here].The estimates of the variances of errors (e1 to e5) are 0.23, 0.59, 0.30, 0.61 and 0.31 respectively.

Figure 1 .
Figure 1.Proposed conceptual model Hypothesis are shown in the given figure to be tested for the study

Table 1
summarized the hypothesized relationships of the variables of interest and theoretical support [Insert table 1 here].

Table 3
reveals fit of the model [Insert table 3 here].