Canadian family physician job satisfaction - is it changing in an evolving practice environment? An analysis of the 2013 National Physician Survey database

Job satisfaction has been widely studied in the medical literature, and various tools have been developed to measure physician satisfaction [1‐3]. Physicians as a group appear to be satisfied with their work [4‐7]. A number of determinants that have been shown to influence this satisfaction include the doctor-patient relationship, the provision of quality care, professional autonomy, academic involvement, and the number of hours worked [1, 8‐16]. Work-life balance has been well-researched [17‐24] as a determinant of job satisfaction in physicians as well, and it has also been recognized as an important contributor to burnout, and an important factor in physician recruitment and retention [17, 25, 26]. It is unclear whether different practice types contribute positively to satisfaction. Rural female physicians in particular report lower job satisfaction than their male or urban counterparts [27] and academic physicians report greater job satisfaction than their non-academic colleagues [11, 28, 29]. The impact of physician satisfaction on patient care has also been investigated [7]. Although there is no clear relationship between physician satisfaction and patient care outcomes, more satisfied physicians have more satisfied patients [9, 30], and there is a significant relationship between low physician satisfaction and higher attrition rates [9].

It is unclear if these practice differences improve or worsen a family physician’s job satisfaction. There has been little to no research looking at these practice factors and their effect on job satisfaction within the family physician community as a whole.

Less is known about factors that influence job satisfaction of family physicians as a subgroup of all physicians [16, 31‐33]. The literature is even more scarce in the Canadian context [33]. Lepnurm et al. in 2007 provided the most comprehensive analysis of family physician satisfaction in Canada with an emphasis on the variation between rural and urban practitioners [33].

Knowledge about job satisfaction of Canadian family physicians is important as more than four million Canadians lack access to a regular family physician [34], and recruitment and retention of physicians to family medicine is essential to improving access to primary care medicine in this country. Additionally, as the landscape of Canadian family medicine changes with more females entering the profession [35], more family medicine graduates choosing additional third-year training, or focused practices within family medicine (e.g. sports medicine, emergency medicine) [36], and increasing adoption of electronic medical records [37, 38], an adequate understanding of the determinants affecting Canadian family physicians’ job satisfaction may inform health system and policy changes that may keep the current family physician workforce satisfied and consequently aid in recruitment and retention [39].

This study aims to address the current research gap in the field of family physician job satisfaction by investigating the determinants of professional satisfaction and the determinants of satisfaction with work-life balance of family physicians.

This study was a secondary analysis of the 2013 National Physician Survey (NPS), a collaborative partnership between the Canadian Medical Association (CMA), the College of Family Physicians of Canada (CFPC) and the Royal College of Physicians and Surgeons of Canada (RCPSC) with the goal of compiling a comprehensive database of the physician workforce in Canada [40]. The survey was developed for the Canadian physician population with input from internal physician committees, external sources (such as the Canadian Institute for Health Information), medical associations and researchers [32]. The 2013 survey had a specific focus, addressing physician employment and workload [32]. It can be viewed in Additional file 1.

Canadian family physicians are overall satisfied with their work, and less satisfied with their work-life balance.

This study found that older physician age, geographic location, teaching involvement, urban practice population, capitated or salaried remuneration model, fewer hours worked per week and remuneration model satisfaction were associated with professional satisfaction in family physicians.

With respect to work-life balance satisfaction, this study found that male gender, older physician age, geographic location, number of years in practice, urban or inner city population, fee-for-service or capitated/salaried remuneration model, lack of on-call provision, fewer hours worked per week and remuneration model satisfaction were associated with work-life balance satisfaction in family physicians.

The above-mentioned variables are consistent with variables identified within the current existing literature on physician job satisfaction [28, 48, 1, 3, 5, 6, 9, 12, 14‐16, 20, 30, 31, 41, 49‐57].

Novel findings in this study include the increased satisfaction that “focused” practice family physicians had compared to those with non-focused practices in both their professional satisfaction and work-life balance satisfaction. Additionally, the use of electronic medical records was a negative predictor of both professional and work-life balance satisfaction in the studied family physicians. We are not aware of previous reports of either of these findings in existing literature.

This study highlighted the need for future research in a number of areas. Firstly, the relationship between professional satisfaction and work-life balance should be investigated further. Previous research has focused on work-life balance as a separate determinant of professional satisfaction [17‐24]. However, the consequences of high and low professional versus work-life balance satisfaction on physician employment, burnout, retention and specialty selection could be important to physician access for patients across this country.

Given the increasing proportion of female family practitioners across the country, the finding that female physicians are more dissatisfied with their work-life balance than their male counterparts may have consequences for the overall family physician work force in Canada. It may mean that a change in approach to recruitment and retention efforts will be required in order to avoid future burnout. Primary care reform policies, which are being drafted across the country [58, 59] should take into account physician-specific concerns and satisfaction factors.

The finding that “focused” practice family physicians have greater professional and work-life satisfaction is novel within the current literature and merits further investigation given the increasing number of specialized family physicians in this country [36]. The heterogeneity of the “focused” practice family physician population in this study specifically warrants further research to explore what practice characteristics of family physicians who have one or more clinical areas of focus contribute to greater satisfaction. It is possible that a “focused” practice in a particular area of interest to the physician gives that physician increased satisfaction in his/her field of practice and thus increased profession and work-life balance satisfaction. For example, a physician who chooses to work in palliative care may have greater satisfaction in both her work and her work-life balance because palliative care holds a specific interest to her. It is also possible that the increased control inherent in choosing a focus of practice contributes to physician satisfaction in the same way that overall practice autonomy contributes to physician job satisfaction [1, 3, 9, 10, 56, 60‐63].

There is a dearth of research that compares focused practice family physicians to non-focused practice family physicians, perhaps because focused practice family physicians form a relatively new group in Canada, with a three-fold increase in focused practice family physicians from 1996 to 2011 [36]. The factors responsible for this increased satisfaction could potentially improve job and work-life balance satisfaction for all family physicians.

Electronic medical record use is increasing across Canada, and its adoption is essential for improved communication amongst physicians, patients and community health services. Recent research in this area does suggest that physician satisfaction increases with improved quality of electronic medical records [9, 64‐66]. The finding that the use of EMRs was associated with family physician job dissatisfaction warrants further inquiry, especially given the increasing prevalence of EMR use in Canada. Whether this dissatisfaction is related to the quality of electronic medical records, or to other factors needs to be investigated. Given our current era of computerization, further research is needed to determine the causes of the association between EMR use and family physician job dissatisfaction in order to more fully understand the potential consequences. As EMR adoption continues, evaluating EMR use as a single satisfaction variable may become less meaningful. However, our finding that EMR use is associated with dissatisfaction is important in directing future research in this area. Investigating EMR use in greater depth and confirming this association could be very helpful in addressing the potential impact of EMR use on physician burnout, recruitment and retention. More research could help us develop strategies to mitigate physician dissatisfaction by improving EMR design, and improving physician education regarding healthy EMR use in their practices.

Overall, Canadian family physicians are satisfied with their work, and less satisfied with their work-life balance. Female family physicians are less satisfied than their male counterparts with their work-life balance. Focused-practice family physicians are more satisfied with both their work and with their work-life balance than generalist family physicians. Family physicians who use electronic medical records are less satisfied with both their work and with their work-life balance than their colleagues who do not use electronic medical records.

This research confirmed a number of variables that contribute to family physician job satisfaction and work-life balance satisfaction in Canada. Further research can focus on exploring the practice characteristics of focused practice family physicians and the impact of focused practice versus comprehensive practice on family physician job satisfaction. Additionally, the usage of electronic medical records use on family physician job satisfaction is an area that requires further investigation.