Turning the winter of doctor discontent to summer : tackling GP needs in state primary care

Abstract

Introduction: A study on job satisfaction among state General Practitioners (GPs) in Malta addressed the problem of the inadequate number of doctors within the government GP service. It investigated the hypothesis that this is due to poor job satisfaction, and allowed GPs to suggest other reasons and propose solutions. Method: A mixed methodology was used, with both quantitative (the Spector `Job Satisfaction Survey') and qualitative methods (3 open questions) in a questionnaire sent to current and former government GPs, followed by focus group/elite interviews. Results: 71 out of 136 questionnaires were returned, giving a 52% response rate. (a) Quantitative analysis: Job dissatisfaction was confirmed among health-centre doctors during 1998-2003. Taking significance as p<0.05, regression analysis revealed that doctors formerly working in health centres were significantly more dissatisfied than present ones (univariate p=0.033), and working part-time is significantly more satisfying than working full-time (univariate p=0.007, multiple p=0.039). (b) Qualitative analysis: 41% of GPs felt unappreciated, neglected and disrespected; 39% experienced job dissatisfaction, stress and depression; while 31% felt verbally and physically used, misused and abused. The top causes cited for the lack of government GPs were poor pay and ancillary benefits (70%), poor training prospects/ career progression (54%) and poor working conditions (46%). Discussion: As former state GPs during 1998-2002 were significantly more dissatisfied than those in employment in 2003, this corroborates the hypothesis that job dissatisfaction is associated with the shortage of government GPs. Direct solutions (enhanced remuneration/conditions and professional development) and indirect measures (organisational, management and educational initiatives to improve working arrangements) were proposed and discussed.