Family Practice Vol. 19, No. 3, 300-303
© Oxford University Press 2002
Australian GPs are satisfied with their job: even more so in rural areas
School of Population Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
Ulmer B and Harris M. Australian GPs are satisfied with their job: even more so in rural areas. Family Practice 2002; 19: 300–303.
Received 1 May 2001; Revised 22 October 2001; Accepted 7 January 2002.
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Abstract |
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Background. Australia has seen a constriction of the scope of practice and of professional prerogatives for GPs in the 1990s, which is said to have led to lower job satisfaction, particularly for rural GPs.
Objective. The aim of this study was to determine levels of job satisfaction and mental health in a rural and an urban sample of GPs, and to correlate population and practice characteristics with lower job satisfaction and morale.
Methods. A postal survey of GP members of two urban and four rural Divisions of General Practice in New South Wales was carried out using the Wall–Cook–Warr scale and the 12-item General Health Questionnaire (GHQ-12). The overall response rate was 74%.
Results. Both urban and rural Australian GPs were generally satisfied with their jobs; however, rural GPs had significantly higher job satisfaction scores. The highest levels of satisfaction were recorded for factors denoting autonomy. The lowest ranked factors were hours of work, income and government policy in general practice. GPs without psychological disturbance were significantly more satisfied with their work than those who were disturbed. Lower job satisfaction was significantly associated with urban GPs, GPs who worked full-time and those who used a language other than English during consultations. Poor mental health and working in an urban area were predictive of lower job satisfaction in men, and bulk-billing all patients (i.e. not charging patients a co-payment, but making a consolidated claim to the government funder Medicare) and working full-time were predictive of lower job satisfaction in women.
Conclusions. Both urban and rural GPs derive a large measure of satisfaction from their job. In particular, rural GPs are satisfied, especially so with their autonomy. Poor mental health was the strongest predictor of lower job satisfaction. The high percentage of GPs with psychological disturbances raises the problem of their access to appropriate mental health services, in particular in rural areas.
Keywords. GP, job satisfaction, mental health, urban, rural.
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Introduction |
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During the 1990s, Australian Medicare rebate rises for GPs were restricted, GPs were required to become vocationally registered and local geographic networks called Divisions of General Practice were established. Quality assurance, continuing medical education and accreditation of practices were introduced; the use of modern information technology was strongly promoted.
Many GPs now claim that they work more for less reward, have lost their independence and the respect of their patients, making them suffer high levels of stress and low job satisfaction. Practice administration issues and the fear of litigation may also weigh on the minds of urban GPs.1 Rural GPs have higher workloads, lack peer and specialist support and have insufficient access to back-up and locum services; their recruitment and retention remains problematic. Both rural and urban GPs have witnessed an erosion of their role and a loss of procedural skills.2,3
Using validated tools, we aimed to determine levels of job satisfaction and mental health in a rural and urban sample of GPs, and to correlate population and practice characteristics with lower morale and job satisfaction.
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Method |
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A postal questionnaire survey was undertaken of two Divisions of General Practice in the greater Metropolitan area of Sydney, and four in the rural and remote north of New South Wales. The combined response rate was 74% (n = 406).
The survey included the validated self-report job satisfaction questionnaire developed by Warr, Cook and Wall,4 as adapted for use in general practice.5 Psychological symptoms were measured with the 12-item General Health Questionnaire (GHQ-12). This is one of the most thoroughly tested mental health questionnaires, with high reliability and validity.6 Demographic and practice information was sought.
Chi-square and 95% confidence intervals were used to express univariate analysis. Stepwise multiple regression was performed to analyse the relationship between the dependent outcome factors (job satisfaction, mental health measure) and independent study variables (personal and job demographic factors). Only results statistically significant at the 5% level are reported. The Statistical Package for Social Scientists version 9.0 for Windows was used.
Demographic differences between the urban and rural samples are shown in Table 1
.
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Results |
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Rural GPs were more satisfied than urban GPs in seven out of 10 job satisfaction factors, namely variety, responsibility, opportunity to use ability, freedom to choose method of working, recognition for good work, income and general feeling about the job (see Fig. 1
). When adjusted for the SES of the areas, the differences continued to be significant.
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Using regression analysis, poor mental health was strongly predictive of lower job satisfaction, as were using a language other than English during consultations, working full-time and working in an urban area (see Table 2
).
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These four variables together only explained 12% of the variance. Following a stepwise multiple regression performed on men and women separately, it was found that poor mental health and working in an urban area were significantly predictive of lower job satisfaction for men, explaining 20% of the variance. Bulk-billing all patients and working full time were significantly predictive of lower job satisfaction in women.
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Discussion |
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Both urban and rural GPs were satisfied with their job, but job satisfaction in rural GPs was significantly higher. Rural GPs were very satisfied with four job satisfaction factors which may be seen as components of autonomy (variety in the job, responsibility, freedom to choose own way of working and opportunity to use ability). Because of their restricted number, GPs in rural areas have a more varied type of practice, which includes procedures. They are able to organize their work largely as they wish, leading to satisfaction with autonomy. Urban GPs were also satisfied, but significantly less so, with the factors denoting autonomy.
Rural GPs were also clearly satisfied with factors such as recognition for good work, hours of work and general feeling about their job. Rural GPs were significantly more satisfied with income. Most rural GPs have an opportunity to earn additional income through their hospital work, and they are more likely to bulk-bill patients selectively (i.e. not always making a consolidated claim to the government funder Medicare, but charging patients a co-payment), in contrast to fully bulk-billing urban practices.
Government policy in general practice was a concern shared by both groups. While GPs will admit privately to the benefits of government reform (such as upgrading skills, setting up Divisions of General Practice), there is deep resentment by some at the way in which the reforms were implemented.
Low job satisfaction is recognized to be closely correlated with poor mental health,7 and it is believed that poor mental health has negative consequences for patient care and ultimately for the GPs themselves.8
We found that working in an urban area, bulk-billing all patients and using a language other than English during consultations were predictive of low job satisfaction. In particular, male GPs in urban areas seem to suffer from poor mental health and attendant lower job satisfaction. Women feel a different kind of pressure when they work full time, or when they bulk-bill all patients. Women often work part time as they try to accommodate conflicting pressures from family and work, and they tend to have a higher number of longer consultations which attract lower remuneration in relative terms.9
It appears that the conditions which exist in general practice in urban areas lead to lower job satisfaction than conditions in rural areas, and are exacerbated by lower mental health. They include a lack of control over resources, as GPs feel obliged to bulk-bill all patients in the fear of losing patients to a competing GP. GPs who used another language were most likely themselves to be of migrant background and would have chosen to practise in an area with a high migrant population to obtain a comparative cultural and linguistic advantage over English-only speakers.
The high percentage of GPs with psychological disturbances raises the problem of access to appropriate mental health services, in particular in rural areas, and queries how GPs who themselves are psychologically disturbed can offer good care to their patients.
In conclusion, we find that Australian general practice can often be satisfying, in particular in rural areas. This fact should be communicated to young men and women starting out in general practice, as it may counteract the negative information that usually dominates the discourse.
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References |
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1 Schattner PL, Coman GJ. The stress of metropolitan general practice. Med J Aust 1998; 169: 133–137.[Web of Science][Medline]
2 Department of Health and Aged Care (DHAC). General Practice in Australia: 2000. Canberra: Commonwealth Department of Health and Aged Care, 2000.
3 Dua JK. Level of occupational stress in male and female rural general practitioners. Aust J Rural Health 1997; 5: 97–102.[Medline]
4 Warr P, Cook J, Wall T. Scales for the measurement of some work attitudes and aspects of psychological well-being. J Occup Psychol 1997; 52: 129–148.
5 Cooper CL, Rout U, Faragher B. Mental health, job satisfaction and job stress among general practitioners. Br Med J 1989; 298: 366–370.
6 McDowell I, Newell IC. The general health questionnaire. In Measuring Health: A Guide to Rating Scales and Questionnaires, 2nd edn. New York: Oxford University Press, 1996: 225–237.
7 Sutherland VJ, Cooper CL. Identifying stress among general practitioners: predictors of psychological ill-health and job dissatisfaction. Soc Sci Med 1993; 37: 575–581.
8 Arnetz BB. Psycho-social challenges facing physicians of today. Soc Sci Med 2001; 51: 203–213.
9 Winefield H, Farmer E, Denson L. Work stress management for women general practitioners: an evaluation. Psychol Health Med 1998; 3: 163–170.
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