Job satisfaction has a strong impact on the intention to stay which is an important aspect to counter skills shortage in academic medicine. In an interview study combining qualitative and quantitative methods we investigated how the mental representation of working conditions influences job satisfaction and its impact on the intention to stay. In a first study chief physicians participated in interviews about job satisfaction in academic hospitals. Answers were segmented into statements, ordered by topics and rated according to their valence. In a second study assistant physicians (residents) during and after their training period talked about strength, weaknesses and potential improvements of working conditions. Again, answers were segmented, ordered, rated and used to develop a ‘job satisfaction scale’. In a third study, assistant physicians participated in a computer-led repertory grid procedure composing ‘mental maps’ of job satisfaction factors, filled in the job satisfaction scale and rated if they would recommend work and training in their clinic as well as their intention to stay. Comparing the interview results with recommendation rates and intention to stay show that a negative attitude is linked to high workload and poor career perspectives. A positive attitude towards work environment and high intention to stay are linked to sufficient personnel and technical capacities, reliable duty scheduling and fair salaries. The third study using repertory grids showed that the perception of current teamwork and future developments concerning work environment were the main aspects to improve job satisfaction and the intention to stay. The results of the interview studies were used to develop an array of adaptive improvement measure. The results support prior findings that job dissatisfaction is mostly based on generally known “hygiene factors” and whereas job satisfaction is due to individual aspects.