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

Family Physician Job Family Physician Job SatisfactionSatisfaction

Is there an association with Is there an association with doing procedures in practice?doing procedures in practice?Christine Rivet MD, Moira Stewart PhD, Christine Rivet MD, Moira Stewart PhD,

Bridget Ryan M.Sc.Bridget Ryan M.Sc.

Why is this important?Why is this important?• Anything which increases job Anything which increases job

satisfaction is useful for satisfaction is useful for recruitment and retention of family recruitment and retention of family physiciansphysicians

ObjectiveObjective• To determine whether doing To determine whether doing

procedures is associated with job procedures is associated with job satisfaction for family physicianssatisfaction for family physicians

• Canadian Trivia QuizCanadian Trivia Quiz

What factors affect job What factors affect job satisfaction for FPs?satisfaction for FPs?

• Solo versus group practiceSolo versus group practice• Variety of the workVariety of the work• Ability to obtain services for their Ability to obtain services for their

patientspatients• TeachingTeaching• Urban versus rural practiceUrban versus rural practice• Relationship with their patientsRelationship with their patients• Job controlJob control

What about procedures?What about procedures?Only one reference (quoted Only one reference (quoted

repeatedly) referred to repeatedly) referred to procedures increasing job procedures increasing job

satisfaction in family satisfaction in family medicinemedicine

DesignDesign• Secondary data analysis of a cross-Secondary data analysis of a cross-

sectional survey, the National Family sectional survey, the National Family Physician Workforce Survey (NFPWS) sent Physician Workforce Survey (NFPWS) sent to all Canadian family physicians in 2001to all Canadian family physicians in 2001

• 28,340 FPs surveyed; 14,319 replied with 28,340 FPs surveyed; 14,319 replied with response rate of 51.2%response rate of 51.2%

• 30% weighted random sample used for 30% weighted random sample used for this project, provided by the College of this project, provided by the College of Family Physicians of CanadaFamily Physicians of Canada

Participants’responses included Participants’responses included if main practice setting:if main practice setting:

• Private office/clinic Private office/clinic • Community clinic/community Community clinic/community

health centerhealth center• Academic family medicine Academic family medicine

teaching unitteaching unit

VariablesVariables• Predictor: range of proceduresPredictor: range of procedures• Outcome: overall job satisfaction Outcome: overall job satisfaction • Seven confounding variables: age, solo Seven confounding variables: age, solo

versus group practice, population versus group practice, population served (urban, semi-urban, rural); served (urban, semi-urban, rural); number of medical services offered; number of medical services offered; teaching; constraints to medical care teaching; constraints to medical care services; balance of personal and services; balance of personal and professional commitmentsprofessional commitments

What is ‘overall job What is ‘overall job satisfaction’?satisfaction’?

• This variable included three This variable included three measures of satisfaction on the measures of satisfaction on the survey that we combined:survey that we combined:

1-your relationship with hospital1-your relationship with hospital2-your relationship with specialist 2-your relationship with specialist

physiciansphysicians3-your current professional life3-your current professional life

Canadian Trivia Quiz

Part I

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

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

Which is NOT a Canadian place Which is NOT a Canadian place name?name?

• Come By Chance Come By Chance • Head Smashed-in Buffalo JumpHead Smashed-in Buffalo Jump• DildoDildo• Gun Barrel CityGun Barrel City• St Louis de Ha! Ha!St Louis de Ha! Ha!

Which is NOT a Canadian place Which is NOT a Canadian place name?name?

• Come By Chance Come By Chance • Head Smashed-in Buffalo JumpHead Smashed-in Buffalo Jump• DildoDildo• Gun Barrel CityGun Barrel City• St Louis de Ha! Ha!St Louis de Ha! Ha!

AnalysisAnalysis• Statistical software: SPSS version Statistical software: SPSS version

1111• Bivariable and multivariable Bivariable and multivariable

analysisanalysis

Characteristics of the Characteristics of the samplesample

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

Characteristics of sample Characteristics of sample cont’dcont’d

• Three quarters of FPs found Three quarters of FPs found moderate to severe constraints to moderate to severe constraints to medical servicesmedical services

• Balance of personal and Balance of personal and professional commitments reported professional commitments reported ‘about right’ by one quarter of FPs; ‘about right’ by one quarter of FPs; the remainder wanted more time the remainder wanted more time for family, career or themselves for family, career or themselves

Eight most commonly Eight most commonly done proceduresdone procedures

• 95.6% did Pap 95.6% did Pap smearssmears

• 82.2% did 82.2% did suturingsuturing

• 67.3% did MSK 67.3% did MSK injections or injections or aspirationsaspirations

• 60.8% did skin 60.8% did skin biopsiesbiopsies

• 49.5% inserted 49.5% inserted IUDsIUDs

• 43.9% did casting 43.9% did casting or splintingor splinting

• 42.6% did needle 42.6% did needle aspirationsaspirations

• 34.6% did 34.6% did anoscopyanoscopy

Overall job satisfactionOverall job satisfaction• From a total of 3086 physicians:From a total of 3086 physicians:

• 15.2% were dissatisfied15.2% were dissatisfied• 53.5% were moderately satisfied53.5% were moderately satisfied• 31.3% were very satisfied31.3% were very satisfied

Multivariable resultsMultivariable results• Greater range of procedures was Greater range of procedures was

significantly associated with overall significantly associated with overall satisfaction (p=0.0001) when satisfaction (p=0.0001) when controlling for the seven confounding controlling for the seven confounding variablesvariables

• Among physicians who did few Among physicians who did few procedures, 28.1% very satisfied; procedures, 28.1% very satisfied; among physicians who did >10 among physicians who did >10 procedures, 33.5% very satisfiedprocedures, 33.5% very satisfied

ResultsResults• The more satisfied family The more satisfied family

physicians were: solo, rural, physicians were: solo, rural, teachers, those who reported teachers, those who reported fewer constraints and those who fewer constraints and those who reported balance was ‘about right’reported balance was ‘about right’

What specific procedures are What specific procedures are associated with job associated with job

satisfaction?satisfaction?• MSK (including joint) MSK (including joint)

injection/aspirationinjection/aspiration• Casting/splintingCasting/splinting• Skin biopsySkin biopsy

Canadian Trivia Quiz

Part II

What 2 animals are on the What 2 animals are on the Canadian coat-of-arms?Canadian coat-of-arms?

• Polar Bear and Arctic FoxPolar Bear and Arctic Fox• Moose and BeaverMoose and Beaver• Kangaroo and Emu Kangaroo and Emu • Lion and UnicornLion and Unicorn

What 2 animals are on the What 2 animals are on the Canadian coat-of-arms?Canadian coat-of-arms?

• Polar Bear and Arctic FoxPolar Bear and Arctic Fox• Moose and BeaverMoose and Beaver• Kangaroo and emu Kangaroo and emu • Lion and UnicornLion and Unicorn

What is the name of Ottawa’s ice What is the name of Ottawa’s ice hockey team?hockey team?

• The Maple LeafsThe Maple Leafs• The SenatorsThe Senators• The Icebergs The Icebergs • The LynxThe Lynx

What is the name of Ottawa’a ice What is the name of Ottawa’a ice hockey team?hockey team?

• The Maple LeafsThe Maple Leafs• The SenatorsThe Senators• The Icebergs The Icebergs • The LynxThe Lynx

DiscussionDiscussion• Increased job satisfaction for rural and Increased job satisfaction for rural and

solo FPs not consistent in literature solo FPs not consistent in literature and may relate to job control which is and may relate to job control which is a major determinant of job satisfactiona major determinant of job satisfaction

• Teaching is associated with increased Teaching is associated with increased job satisfaction: good news in an era job satisfaction: good news in an era of expanding family medicine of expanding family medicine residency programs.residency programs.

Implications Implications • Family medicine clinicians can Family medicine clinicians can

improve job satisfaction by:improve job satisfaction by:• TeachingTeaching• Particularly ensuring that balance in Particularly ensuring that balance in

personal & professional life ‘about personal & professional life ‘about right’right’

• Perhaps by increasing range of Perhaps by increasing range of proceduresprocedures

Systems issues need to be Systems issues need to be addressed to increase job addressed to increase job

satisfaction and retention of FPs:satisfaction and retention of FPs:

• Constraints to obtaining medical Constraints to obtaining medical care services for their patientscare services for their patients

• The majority of FPs reported that The majority of FPs reported that the balance in their life was not the balance in their life was not ‘about right’‘about right’

Strengths:Strengths:• Based on 30% random sample of large Based on 30% random sample of large

national survey of family physiciansnational survey of family physicians• Any true relationships and differences Any true relationships and differences

likely to be found stat. significantlikely to be found stat. significant• Use of multivariable analysis and Use of multivariable analysis and

thorough search for confounding thorough search for confounding variablesvariables

• Sample is weighted: more females and Sample is weighted: more females and Northern respondentsNorthern respondents

LimitationsLimitations• Cross-sectional survey means one Cross-sectional survey means one

cannot attribute causation or cannot attribute causation or direction of the relationshipdirection of the relationship

• Self-report bias possibleSelf-report bias possible

Which is NOT a Canadian Which is NOT a Canadian invention?invention?

• TelephoneTelephone• SupermanSuperman• ZipperZipper• Wine-in-a-boxWine-in-a-box• Air-conditioned vehicleAir-conditioned vehicle

Which is NOT a Canadian Which is NOT a Canadian invention?invention?

• TelephoneTelephone• SupermanSuperman• ZipperZipper• Wine-in-a-boxWine-in-a-box• Air-conditioned vehicleAir-conditioned vehicle

Thank You!Thank You!