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Research ArticleOriginal Research

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

Christine Cohidon, Pascal Wild and Nicolas Senn
The Annals of Family Medicine November 2019, 17 (6) 510-517; DOI: https://doi.org/10.1370/afm.2449
Christine Cohidon
1Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
MD, PhD
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  • For correspondence: christine.cohidon@hospvd.ch
Pascal Wild
1Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
2INRS - National Research and Safety Institute, Vandoeuvre les Nancy, France
PhD
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Nicolas Senn
1Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
MD, PhD
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Article Figures & Data

Tables

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    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, %37.043.835.044.345.345.040.051.532.949.139.9
    Age, y, %
     <3511.39.57.81.04.59.013.19.10.813.85.5
     35-4428.822.115.835.728.129.031.726.618.130.920.3
     45-5432.127.528.127.631.340.022.024.331.330.030.1
     55-6417.326.339.028.633.318.027.028.136.419.228.8
     ≥6510.514.59.37.12.74.06.211.813.56.216.1
    Urban area, %71.866.770.452.946.669.737.752.451.568.072.1
    GPs FTE in the practice (median)54112444253
    GP Satisfaction at work, %
     Very satisfied35.129.39.211.516.633.039.526.927.613.619.0
     Satisfied53.055.057.152.167.853.552.448.558.753.246.5
     Somewhat dissatisfied10.814.524.030.514.612.17.520.511.729.028.6
     Very dissatisfied1.11.19.86.91.01.40.64.12.05.95.9
    • 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 featuresAU
    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)1515201010152020201015
    Weekly workload (median, hours)4040505045364040484445
    Part dedicated to admin task (% total, median)1015152020202022202010
    Offering home visits, %
     Frequently25.119.556.157.188.320.620.324.742.884.06.0
     Occasionally59.649.434.230.011.774.877.870.145.415.128.6
     No25.131.19.713.00.04.62.05.211.80.865.4
    Working with case manager, %
     In practice75.442.912.920.683.083.031.875.88.487.443.9
     External6.221.583.36.814.97.433.99.852.28.322.8
     No18.435.63.872.22.19.634.314.439.34.333.3
    Use of EHR, %92.472.975.685.599.399.899.599.354.398.484.5
    • 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 CharacteristicsNo.Single Independent Variables OR (CI 95%)Multiple Analysis Final Model OR (CI 95%)
    (N = 10’191)
    GP sex
     Male6,693
     Female5,3241.06 (0.94-1.22)1.05 (0.90-1.22)
    GP age, y
     <351,162
     35-442,9211.01 (0.90-1.13)1.02 (0.94-1.11)
     45-543,1551.35 (1.19-1.53)1.32 (1.17-1.49)
     55-643,5611.27 (1.13-1.43)1.25 (1.10-1.42)
     ≥651,2300.69 (0.54-0.89)0.67 (0.52-0.88)
    Rural/Urban area
     Rural5,065
     Urban6,8981.08 (0.98-1.18)1.12 (1.03-1.22)
    Practice organizational & functional features
    Weekly workload (hours/week)
     ≤406,150
     41-503,4441.11 (0.97-1.26)1.14 (1.01-1.27)
     >502,3151.26 (1.09-1.47)1.26 (1.12-1.42)
    Administrative task (% total workload)
     ≤104,044
     11-203,9571.10 (0.97-1.25)1.14 (1.01-1.29)
     >203,8391.55 (1.39-1.74)1.55 (1.37-1.73)
    GP FTE in the practice
     12,351
     22,1500.90 (0.78-1.05)0.97 (0.80-1.17)
     3-54,0090.74 (0.64-0.86)0.83 (0.69-0.99)
     6-102,3210.68 (0.52-0.88)0.76 (0.60-0.96)
     >108040.77 (0.55-1.06)0.82 (0.62-1.08)
    Same-day appointment, %
     >507,704
     About 501,6071.20 (0.98-1.47)1.15 (0.96-1.37)
     20-401,2751.51 (1.31-1.74)1.49 (1.29-1.71)
     <201,0472.01 (1.48-2.93)1.83 (1.34-2.50)
    Home visits
     No4,080
     Yes7,8241.23 (1.11-1.36)0.89 (0.83-0.96)
    Inter-visit contacts with patients
     No1,493
     Yes10,4270.72 (0.60-0.87)0.83 (0.70-0.98)
    Information on clinical targets
     No5,771
     Yes6,1180.73 (0.59-0.91)0.80 (0.66-0.98)
    Involved in coordinated care with hospital
     No1,744
     Yes10,1390.71 (0.63-0.80)0.84 (0.76-0.93)
    Working with case manager
     No2,914
     Yes, external2,7590.92 (0.71-1.19)1.01 (0.81-1.25)
     Yes, in practice6,2610.74 (0.62-0.90)0.84 (0.75-0.95)
    Delay discharge
     ≤2 days3,757
     2 days-2 weeks6,4731.30 (1.15-1.47)1.23 (1.07-1.41)
     3-4 weeks9601.92 (1.64-2.25)1.66 (1.39-1.98)
     >1 month or never5582.00 (1.79-2.23)1.82 (1.52-2.19)
    Use of EHR
     No1,621
     Yes10,3640.78 (0.71-0.85)0.82 (0.68-0.98)
    Electronic drug prescription alerts
     No2,486
     Yes, routinely8,0490.89 (0.73-1.07)1.11 (0.89-1.38)
     Yes, occasionally1,3431.19 (0.99-1.44)1.43 (1.17-1.75)
     Consultation duration11,9340.99 (0.97-1.01)...
    Information about hospital admissions...
     No7,441
     Yes4,3750.80 (0.70-0.91)
    Patient satisfaction surveys...
     No6,046
     Yes5,8480.76 (0.63-0.92)
    Preventive targets to reach...
     No8,056
     Yes3,7320.78 (0.66-0.93)
    Performance comparisons...
     No5,742
     Yes6,0980.87 (0.76-1.00)
    Coordinated care with social workers...
     No709
     Occasionally5,2180.77 (0.67-0.90)
     Routinely6,0160.62 (0.48-0.80)
    Contacts with home care provider...
     Never352
     Occasionally5,7100.79 (0.62-1.00)
     Routinely5,2430.65 (0.49-0.87)
    Information on changes in patient health...
     Never316
     Occasionally4,9030.79 (0.62-0.99)
     Routinely6,1170.59 (0.44-0.79)
     Country variance0.35
    • 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

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  • Supplemental Tables

    Supplemental Tables

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    • 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.
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The Annals of Family Medicine: 17 (6)
The Annals of Family Medicine: 17 (6)
Vol. 17, Issue 6
November/December 2019
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Practice Organization Characteristics Related to Job Satisfaction Among General Practitioners in 11 Countries
Christine Cohidon, Pascal Wild, Nicolas Senn
The Annals of Family Medicine Nov 2019, 17 (6) 510-517; DOI: 10.1370/afm.2449

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Practice Organization Characteristics Related to Job Satisfaction Among General Practitioners in 11 Countries
Christine Cohidon, Pascal Wild, Nicolas Senn
The Annals of Family Medicine Nov 2019, 17 (6) 510-517; DOI: 10.1370/afm.2449
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