State primary health care : addressing medical manpower needs.

Abstract

Reason for the research: It has been suggested that the lack of general practitioners (GPs) working in government health centres in Malta is a result of poor job satisfaction. This situation impedes the Health Division's plans to strengthen primary health care. This project set out to investigate this hypothesis and recommend solutions. Method: A mixed methodology was used. The quantitative method measured GPs' job satisfaction using the Spector 'Job Satisfaction Survey'. The qualitative procedure involved analysis of replies to open questions put to GPs to express their feelings about the GP service, suggest reasons for shortages and propose solutions. The implementation of these solutions was then discussed during focus group and elite interviews. Results: Quantitative analysis: Seventy-one questionnaires out of 136 were returned, giving a response rate of 52%. Job dissatisfaction was confirmed among health-centre doctors during 1998-2003. Taking significance as p<0.05, univariate regression analysis revealed that doctors formerly working in health centres were significantly more dissatisfied (p=0.033) than present state GPs, and that working part-time is significantly more satisfying (p=0.007) than working full time. The categories of being male and of doing private practice were negatively related to satisfaction, 5 although such relationships only approached statistical significance (p=0.082 and p=0.076 respectively). Multiple regression analysis showed that the only category having a statistically significant relationship with total satisfaction was that of working part-time (p=0.039). Qualitative analysis: A few respondents did share positive feelings about being a government GP. However, the great majority of GPs revealed overwhelmingly negative feelings, experiencing job dissatisfaction to stress and depression; feeling unappreciated, neglected and disrespected and also verbally and physically used, misused and abused. Doctors believed that the top three causes of the lack of government GPs were poor pay and ancillary benefits (cited 50 times), poor training prospects/career progression (38 times) and poor working conditions (33 citations). Discussion: Doctors have no doubt that job dissatisfaction is the sole cause of the shortage of state GPs. The following solutions for this shortage were discussed: • Direct solutions: enhancement of working conditions through remuneration, non-monetary benefits and working environment; development of training in family medicine and of specialist status with career progression. • Indirect solutions: introduction of continuity of information and care; implementation of better management, organisation of service delivery, curtailment of client abuse; optimisation of health-centre use and raising of GPs' status through educational campaigns.

Recommendations and conclusion: Recommendations include: • Improving and maintaining the supply of GPs: through appropriate remuneration, training in family medicine (undergraduate, vocational and continuing) with career progression to specialist posts. • Reducing demand on GPs by job facilitation: through improving working arrangements and conditions (mainly by flexible working patterns, interdisciplinary teamwork and continuity of care through information technology); educational campaigns to combat client abuse and raise the profile of the state GP; better management. Such human resource management policies (appropriate remuneration, professional development schemes and improved working arrangements and conditions) have the potential to enhance job satisfaction, reduce turnover and improve the care that state general practitioners provide to patients. KeyWords: State primary health care; medical manpower; recruitment and retention; human resources management; job satisfaction; general practitioners. Word Counts: Dissertation: 21,805 words (including figures and tables). Executive Summary: 500 words.