BMJ 2003;326:22 ( 4 January )

Primary care

National survey of job satisfaction and retirement intentions among general practitioners in England

Bonnie Sibbald, professor of health services research, ^a Chris Bojke, research fellow, ^b Hugh Gravelle, professor of economics. ^b

^a National Primary Care Research and Development Centre, University of Manchester, Manchester M13 9PL, ^b National Primary Care Research and Development Centre, Centre for Health Economics, University of York, York YO10 5DD

Correspondence to: B Sibbald Bonnie.Sibbald{at}man.ac.uk

Objectives: To measure general practitioners' intentions to quit direct patient care, to assess changes between 1998 and 2000, and to investigate associated factors, notably job satisfaction.
Design: Analysis of national postal surveys conducted in 1998 and 2001.
Setting: England.
Participants: 1949 general practitioner principals, of whom 790 were surveyed in 1998 and 1159 in 2001.
Main outcome measures: Overall job satisfaction and likelihood of leaving direct patient care in the next five years.
Results: The proportion of doctors intending to quit direct patient care in the next five years rose from 14% in 1998 to 22% in 2001. In both years, the main factors associated with an increased likelihood of quitting were older age and ethnic minority status. Higher job satisfaction and having children younger than 18 years were associated with a reduced likelihood of quitting. There were no significant differences in regression coefficients between 1998 and 2001, suggesting that the effect of factors influencing intentions to quit remained stable over time. The rise in intentions to quit was due mainly to a reduction in job satisfaction (1998 mean 4.64, 2001 mean 3.96) together with a slight increase in the proportion of doctors from ethnic minorities and in the mean age of doctors. Doctors' personal and practice characteristics explained little of the variation in job satisfaction within or between years.
Conclusions: Job satisfaction is an important factor underlying intention to quit, and attention to this aspect of doctors' working lives may help to increase the supply of general practitioners.

What is already known on this topic Early retirement is one of the factors contributing to a shortage of general practitioners in the NHS What this study adds The proportion of general practitioners intending to quit direct patient care within five years rose from 14% in 1998 to 22% in 2001 A decrease in overall job satisfaction is the most important factor underlying this rise Improving the quality of doctors' working lives might help improve retention

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