Family Physician Job Satisfaction

1. UNSW School of Public Health and Community Medicine, April 11, 2007

2. Family Physician Job Satisfaction Is there an association with doing procedures in practice? Christine Rivet MD, Moira Stewart PhD, Bridget Ryan M.Sc.

3. Why is this important? • Anything which increases job satisfaction is useful for recruitment and retention of family physicians

4. Objective • To determine whether doing procedures is associated with job satisfaction for family physicians • Canadian Trivia Quiz

6. What factors affect job satisfaction for FPs? • Solo versus group practice • Variety of the work • Ability to obtain services for their patients • Teaching • Urban versus rural practice • Relationship with their patients • Job control

7. What about procedures? Only one reference (quoted repeatedly) referred to procedures increasing job satisfaction in family medicine

8. Design • Secondary data analysis of a cross-sectional survey, the National Family Physician Workforce Survey (NFPWS) sent to all Canadian family physicians in 2001 • 28,340 FPs surveyed; 14,319 replied with response rate of 51.2% • 30% weighted random sample used for this project, provided by the College of Family Physicians of Canada

9. Participants’responses included if main practice setting: • Private office/clinic • Community clinic/community health center • Academic family medicine teaching unit

10. Variables • Predictor: range of procedures • Outcome: overall job satisfaction • Seven confounding variables: age, solo versus group practice, population served (urban, semi-urban, rural); number of medical services offered; teaching; constraints to medical care services; balance of personal and professional commitments

11. What is ‘overall job satisfaction’? • This variable included three measures of satisfaction on the survey that we combined: 1-your relationship with hospital 2-your relationship with specialist physicians 3-your current professional life

12. Canadian Trivia Quiz Part I

13. What is Canada’s national animal, eh?

14. What is Canada’s national animal, eh?

15. Which is NOT a Canadian place name? • Come By Chance • Head Smashed-in Buffalo Jump • Dildo • Gun Barrel City • St Louis de Ha! Ha!

16. Which is NOT a Canadian place name? • Come By Chance • Head Smashed-in Buffalo Jump • Dildo • Gun Barrel City • St Louis de Ha! Ha!

17. Analysis • Statistical software: SPSS version 11 • Bivariable and multivariable analysis

18. Characteristics of the sample • Private office or clinic: 87.7% • Largest age group: 45 to 54 • Majority male: 65.1% • Most worked in a group: 73.8% • Majority in an urban setting: 61.9% • Teaching: 21%

19. Characteristics of sample cont’d • Three quarters of FPs found moderate to severe constraints to medical services • Balance of personal and professional commitments reported ‘about right’ by one quarter of FPs; the remainder wanted more time for family, career or themselves

20. 95.6% did Pap smears 82.2% did suturing 67.3% did MSK injections or aspirations 60.8% did skin biopsies 49.5% inserted IUDs 43.9% did casting or splinting 42.6% did needle aspirations 34.6% did anoscopy Eight most commonly done procedures

21. Overall job satisfaction • From a total of 3086 physicians: • 15.2% were dissatisfied • 53.5% were moderately satisfied • 31.3% were very satisfied

22. Multivariable results • Greater range of procedures was significantly associated with overall satisfaction (p=0.0001) when controlling for the seven confounding variables • Among physicians who did few procedures, 28.1% very satisfied; among physicians who did >10 procedures, 33.5% very satisfied

23. Results • The more satisfied family physicians were: solo, rural, teachers, those who reported fewer constraints and those who reported balance was ‘about right’

24. What specific procedures are associated with job satisfaction? • MSK (including joint) injection/aspiration • Casting/splinting • Skin biopsy

25. Canadian Trivia Quiz Part II

26. What 2 animals are on the Canadian coat-of-arms? • Polar Bear and Arctic Fox • Moose and Beaver • Kangaroo and Emu • Lion and Unicorn

27. What 2 animals are on the Canadian coat-of-arms? • Polar Bear and Arctic Fox • Moose and Beaver • Kangaroo and emu • Lion and Unicorn

28. What is the name of Ottawa’s ice hockey team? • The Maple Leafs • The Senators • The Icebergs • The Lynx

29. What is the name of Ottawa’a ice hockey team? • The Maple Leafs • The Senators • The Icebergs • The Lynx

30. Discussion • Increased job satisfaction for rural and solo FPs not consistent in literature and may relate to job control which is a major determinant of job satisfaction • Teaching is associated with increased job satisfaction: good news in an era of expanding family medicine residency programs.

31. Implications • Family medicine clinicians can improve job satisfaction by: • Teaching • Particularly ensuring that balance in personal & professional life ‘about right’ • Perhaps by increasing range of procedures

32. Systems issues need to be addressed to increase job satisfaction and retention of FPs: • Constraints to obtaining medical care services for their patients • The majority of FPs reported that the balance in their life was not ‘about right’

33. Strengths: • Based on 30% random sample of large national survey of family physicians • Any true relationships and differences likely to be found stat. significant • Use of multivariable analysis and thorough search for confounding variables • Sample is weighted: more females and Northern respondents

34. Limitations • Cross-sectional survey means one cannot attribute causation or direction of the relationship • Self-report bias possible

36. Which is NOT a Canadian invention? • Telephone • Superman • Zipper • Wine-in-a-box • Air-conditioned vehicle

37. Which is NOT a Canadian invention? • Telephone • Superman • Zipper • Wine-in-a-box • Air-conditioned vehicle

38. Thank You!