Practice Organization Characteristics Related to Job Satisfaction Among General Practitioners in 11 Countries

Christine Cohidon; Pascal Wild; Nicolas Senn

doi:10.1370/afm.2449

Article Figures & Data

Tables

Additional Files

View popup

Table 1

Characteristics of Respondents and GP Satisfaction in the 11 Countries

	AU 747	CA 2,284	FR 502	DE 559	NL 618	NZ 503	NO 864	SE 2,905	CH 1,065	UK 1,001	US 1,001
Sex, female, %	37.0	43.8	35.0	44.3	45.3	45.0	40.0	51.5	32.9	49.1	39.9
Age, y, %
<35	11.3	9.5	7.8	1.0	4.5	9.0	13.1	9.1	0.8	13.8	5.5
35-44	28.8	22.1	15.8	35.7	28.1	29.0	31.7	26.6	18.1	30.9	20.3
45-54	32.1	27.5	28.1	27.6	31.3	40.0	22.0	24.3	31.3	30.0	30.1
55-64	17.3	26.3	39.0	28.6	33.3	18.0	27.0	28.1	36.4	19.2	28.8
≥65	10.5	14.5	9.3	7.1	2.7	4.0	6.2	11.8	13.5	6.2	16.1
Urban area, %	71.8	66.7	70.4	52.9	46.6	69.7	37.7	52.4	51.5	68.0	72.1
GPs FTE in the practice (median)	5	4	1	1	2	4	4	4	2	5	3
GP Satisfaction at work, %
Very satisfied	35.1	29.3	9.2	11.5	16.6	33.0	39.5	26.9	27.6	13.6	19.0
Satisfied	53.0	55.0	57.1	52.1	67.8	53.5	52.4	48.5	58.7	53.2	46.5
Somewhat dissatisfied	10.8	14.5	24.0	30.5	14.6	12.1	7.5	20.5	11.7	29.0	28.6
Very dissatisfied	1.1	1.1	9.8	6.9	1.0	1.4	0.6	4.1	2.0	5.9	5.9

AU = Australia; CA = Canada; CH = Switzerland; DE = Germany; FR = France; FTE = full-time equivalent; GP = general practitioner; NL = Netherlands; NO = Norway; NZ = New Zealand; SE = Sweden; UK = United Kingdom; US = United States.
Note: Urbanity was self-reported.

View popup

Table 2

Practices’ Main Characteristics in the 11 Countries

Practice organizational & functioning features	AU 747	CA 2,284	FR 502	DE 559	NL 618	NZ 503	NO 864	SE 2,905	CH 1,065	UK 1,001	US 1,001
Consultation duration (median, min)	15	15	20	10	10	15	20	20	20	10	15
Weekly workload (median, hours)	40	40	50	50	45	36	40	40	48	44	45
Part dedicated to admin task (% total, median)	10	15	15	20	20	20	20	22	20	20	10
Offering home visits, %
Frequently	25.1	19.5	56.1	57.1	88.3	20.6	20.3	24.7	42.8	84.0	6.0
Occasionally	59.6	49.4	34.2	30.0	11.7	74.8	77.8	70.1	45.4	15.1	28.6
No	25.1	31.1	9.7	13.0	0.0	4.6	2.0	5.2	11.8	0.8	65.4
Working with case manager, %
In practice	75.4	42.9	12.9	20.6	83.0	83.0	31.8	75.8	8.4	87.4	43.9
External	6.2	21.5	83.3	6.8	14.9	7.4	33.9	9.8	52.2	8.3	22.8
No	18.4	35.6	3.8	72.2	2.1	9.6	34.3	14.4	39.3	4.3	33.3
Use of EHR, %	92.4	72.9	75.6	85.5	99.3	99.8	99.5	99.3	54.3	98.4	84.5

AU = Australia; CA = Canada; CH = Switzerland; DE = Germany; EHR = electronic health record; FR = France; NL = Netherlands; NO = Norway; NZ = New Zealand; SE = Sweden; UK = United Kingdom; US = United States.

View popup

Table 3

Associations Between Work Dissatisfaction and Physician and Practice Characteristics

Physician Characteristics	No.	Single Independent Variables OR (CI 95%)	Multiple Analysis Final Model OR (CI 95%)
			(N = 10’191)
GP sex
Male	6,693
Female	5,324	1.06 (0.94-1.22)	1.05 (0.90-1.22)
GP age, y
<35	1,162
35-44	2,921	1.01 (0.90-1.13)	1.02 (0.94-1.11)
45-54	3,155	1.35 (1.19-1.53)	1.32 (1.17-1.49)
55-64	3,561	1.27 (1.13-1.43)	1.25 (1.10-1.42)
≥65	1,230	0.69 (0.54-0.89)	0.67 (0.52-0.88)
Rural/Urban area
Rural	5,065
Urban	6,898	1.08 (0.98-1.18)	1.12 (1.03-1.22)
Practice organizational & functional features
Weekly workload (hours/week)
≤40	6,150
41-50	3,444	1.11 (0.97-1.26)	1.14 (1.01-1.27)
>50	2,315	1.26 (1.09-1.47)	1.26 (1.12-1.42)
Administrative task (% total workload)
≤10	4,044
11-20	3,957	1.10 (0.97-1.25)	1.14 (1.01-1.29)
>20	3,839	1.55 (1.39-1.74)	1.55 (1.37-1.73)
GP FTE in the practice
1	2,351
2	2,150	0.90 (0.78-1.05)	0.97 (0.80-1.17)
3-5	4,009	0.74 (0.64-0.86)	0.83 (0.69-0.99)
6-10	2,321	0.68 (0.52-0.88)	0.76 (0.60-0.96)
>10	804	0.77 (0.55-1.06)	0.82 (0.62-1.08)
Same-day appointment, %
>50	7,704
About 50	1,607	1.20 (0.98-1.47)	1.15 (0.96-1.37)
20-40	1,275	1.51 (1.31-1.74)	1.49 (1.29-1.71)
<20	1,047	2.01 (1.48-2.93)	1.83 (1.34-2.50)
Home visits
No	4,080
Yes	7,824	1.23 (1.11-1.36)	0.89 (0.83-0.96)
Inter-visit contacts with patients
No	1,493
Yes	10,427	0.72 (0.60-0.87)	0.83 (0.70-0.98)
Information on clinical targets
No	5,771
Yes	6,118	0.73 (0.59-0.91)	0.80 (0.66-0.98)
Involved in coordinated care with hospital
No	1,744
Yes	10,139	0.71 (0.63-0.80)	0.84 (0.76-0.93)
Working with case manager
No	2,914
Yes, external	2,759	0.92 (0.71-1.19)	1.01 (0.81-1.25)
Yes, in practice	6,261	0.74 (0.62-0.90)	0.84 (0.75-0.95)
Delay discharge
≤2 days	3,757
2 days-2 weeks	6,473	1.30 (1.15-1.47)	1.23 (1.07-1.41)
3-4 weeks	960	1.92 (1.64-2.25)	1.66 (1.39-1.98)
>1 month or never	558	2.00 (1.79-2.23)	1.82 (1.52-2.19)
Use of EHR
No	1,621
Yes	10,364	0.78 (0.71-0.85)	0.82 (0.68-0.98)
Electronic drug prescription alerts
No	2,486
Yes, routinely	8,049	0.89 (0.73-1.07)	1.11 (0.89-1.38)
Yes, occasionally	1,343	1.19 (0.99-1.44)	1.43 (1.17-1.75)
Consultation duration	11,934	0.99 (0.97-1.01)	...
Information about hospital admissions			...
No	7,441
Yes	4,375	0.80 (0.70-0.91)
Patient satisfaction surveys			...
No	6,046
Yes	5,848	0.76 (0.63-0.92)
Preventive targets to reach			...
No	8,056
Yes	3,732	0.78 (0.66-0.93)
Performance comparisons			...
No	5,742
Yes	6,098	0.87 (0.76-1.00)
Coordinated care with social workers			...
No	709
Occasionally	5,218	0.77 (0.67-0.90)
Routinely	6,016	0.62 (0.48-0.80)
Contacts with home care provider			...
Never	352
Occasionally	5,710	0.79 (0.62-1.00)
Routinely	5,243	0.65 (0.49-0.87)
Information on changes in patient health			...
Never	316
Occasionally	4,903	0.79 (0.62-0.99)
Routinely	6,117	0.59 (0.44-0.79)
Country variance			0.35

EHR = electronic health record; FTE = full time equivalent; GP = general practitioner; OR = odds ratio.
Note: The final multivariate model was built in 2 steps: first, we retained from the univariate analyses, the variables associated at a P value of .2 or less. Next, we performed a manual, backward, stepwise selection (removal of the least significant variable at each step) to obtain a final model (variables associated at a P value ≤05).

Additional Files

Tables

Supplemental Tables

Supplemental Tables

Files in this Data Supplement:

Supplemental data: Tables - PDF file
The Article in Brief

Practice Organization Characteristics Related to Job Satisfaction Among General Practitioners in 11 Countries

Christine Cohidon , and colleagues

Background Organizational and functional features of general practitioner practices in 11 countries were studied in search of underlying reasons for job dissatisfaction.

What This Study Found This was done by conducting a secondary analysis of 12,049 subjects in the 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians. Job dissatisfaction was measured on a four-point Likert scale using the question: "How satisfied are you regarding your practicing of medicine?" The findings revealed dissatisfaction at work ranged from 8.1% in Norway to 37.4% in Germany. Greater dissatisfaction was noted among middle-aged (45 to 54 years old) GPs, those practicing in urban areas and those working alone. Also, high weekly workloads (greater than 50 hours), heavy administrative burdens, long delays in hospital discharge notices (greater than one month), and limited possibilities of offering same-day appointments added to the dissatisfaction.

Implications

Using electronic health records and having an in-practice case manager were linked to higher satisfaction. Creating changes such as forming group practices, employing case managers, using electronic health records, and reducing workloads could reduce dissatisfaction levels.