National survey of job satisfaction and retirement intentions among general practitioners in England
BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7379.22 (Published 04 January 2003) Cite this as: BMJ 2003;326:22All rapid responses
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We surveyed 171 GPs between 39 and 61, in different setting, by
submitting a questionnaire. Over 30% declared their thinking to change
job. This was mainly when 47 - 55 years old and working in urban setting.
The GPs showed problems about:
a) feeling emotionally drained from work
b) feeling used at the end of the workday
c) feeling frustrated with the job
A relevant number of GPs, indipendently if they live in urban, rural
or mixed setting, are showing marriage problems.
This situation about job satisfaction and burn out is clearly
increasing in the Country, because of bureaucracy, progressive loss of
role and possibility to sharpness, caused by uncertainty on the future for
the National Health System and contrasting interests in the political
field.
Competing interests:
None declared
Competing interests: No competing interests
To test findings of a postal survey of English general practitioners (GPs) conducted in 2001 [1], 1397 members of Medix UK (http://www.medix.to) were offered a questionnaire from 6 to 10 January 2003. 81 (6%) deferred doing it but did not return in time to complete it and 33 explicitly rejected it (2%). 1283 completed the questionnaire, but 248 responses (19%) were removed because they were incompatible with the postal survey.
There are significant differences in the gender compositions of the two cohorts (postal survey 71% male cf. internet survey 84% male). There are marginally significant differences in age groups (Table 1; χ2=11.1, 6df, 0.084) and significant differences in patient type (Table 2 χ2=13.8, 4df, 0.008). Practice location (Table 3; χ2=5.2, 4df, 0.27) compares more closely.
In terms of retirement intentions and job satisfaction, the internet survey agrees (Table 1) with the postal survey and finds that GPs in the UK as a whole have similar intentions.
Table 1 "Do you intend to quit direct patient care in the next five years"
Internet GPs (England) |
Internet GPs
(UK) |
|||
No of doctors |
% |
No of doctors |
% |
|
Yes |
23% |
137 |
22% |
|
No |
307 |
62% |
379 |
62% |
Uncertain |
75 |
15% |
96 |
16% |
GPs surveyed by internet indicate that 70% intend to retire because of reduced job satisfaction (Table 2), confirming the postal survey.
Table 2 "If you intend to quit within the next five years, is it primarily because of reduced job satisfaction?"
Internet GPs (England) |
Internet GPs
(UK) |
|||
No of doctors |
% |
No of doctors |
% |
|
Yes |
89 |
70% |
108 |
79% |
No |
17 |
17% |
20 |
15% |
Uncertain |
9 |
13% |
9 |
7% |
The internet survey includes responses from doctors who are not general practitioners; they express a significantly lower intention to quit (Table 3) than GPs (Table 2). This suggests that this group may have greater job satisfaction than GPs.
Table 3 "Do you intend to quit direct patient care in the next five years"
Non-GPs (England) |
Non-GPs
(UK) |
|||
No of doctors |
% |
No of doctors |
% |
|
Yes |
52 |
12% |
63 |
12% |
No |
331 |
78% |
423 |
79% |
Uncertain |
42 |
10% |
51 |
9% |
Reference
[1] Sibbald B, Bojke C, Gravelle H. National survey of job satisfaction and retirement intentions among general practitioners in England. BMJ 2003;326:22.
Competing interests:
The author has material financial interests in Medix UK and is a director.
Competing interests: 115
Sir,
I note with interest that the number of GPs intending to retire in
the next five years has risen from 14%, the rate expected for steady
state, to 22% a rate for increasing depletion, at a time when we are
already under-doctored.
Michael Balint taught us about the “doctor patient mutual investment
company”. If this is real we would expect that personal doctoring to have
had some impact upon retirement intentions but the researchers conclude,
“Doctors personal and practice characteristics, however, explained only a
small part of the overall variance in job satisfaction ” which was
inversely correlated with retirement intentions.
However as approximately 50% of single handed GPs are from overseas
and as Prof Sibbald et. Al paper tells there was an increase in the
likelihood of quitting with “ethnic minority status, then by subtraction
it appears that comparing like with like that GPs in single handed
practice when compared with their colleagues in larger practice are likely
to retire at a later date. This can be seen as giving some credence to
Michael Balint’s hypothesis.
It is worrying that the National Primary Care Research and
Development Centre, which undertook this study, did not think to look at
the personal doctoring component of interpersonal skills as being of
sufficient importance for comment from the data readily available.
If the Mandarins at the Department of Health think personal doctoring
does not matter, and the researchers neglect those areas of general
practice where measurement is difficult, it will not be long before James
McCormick’s article prophesying the death of the personal doctor becomes
true. Then we UK GPs will be left twiddling serum chemicals rather than
treating people. This in turn is part of my hypothesis for the flight of
our young colleagues away from doctoring in general and general practice
in particular.
Yours sincerely,
Dr Michael B Taylor
Chairman
1 National survey of job satisfaction and retirement intentions among
general practitioners in England
Bonnie Sibbald, Chris Bojke, and Hugh Gravelle BMJ 2003; 326: 222
Death of the Personal Doctor. James McCormick BJoGP
Competing interests:
None declared
Competing interests: No competing interests
Sibbald et al found that GPs with children under 18 were less likely
than those without them to be considering quitting their job. They suggest
the possible explanation that this may be because GPs with young children
are more likely to be financially dependent on their job.
Their suggestion seems reasonable, but I would like to suggest an
alternative explanation for this finding. Could it be that the strain of
bringing up children and having a GP job is such that only the most
committed GPs are still doing their job under those circumstances? In
other words, perhaps many GPs with young children have already left their
job, and therefore did not take part in Sibbald et al's study. The GPs
with young children that remained may therefore represent an unusually
committed population.
The finding that having young children predicted a decreased
probability of intention to quit may therefore have been an artefact due
to selection bias.
Competing interests:
None declared
Competing interests: No competing interests
I noted that in "The Guardian" last week, when this article was
reported in the said newspaper, a reader wrote to "The Guardian"
expressing the view that GPs surveyed were deliberately reported that they
had intention to leave to bring pressure on the Government. This reader
also thought that in contrary, doctors must be the happiest profession in
the country.
Anyone beg to differ?
Competing interests:
None declared
Competing interests: No competing interests
The results of this survey are hardly surprising. What with
relentless political micro-management, admin burdens, targets and more
targets, endless hassle and an increasing workload with no pain relief in
sight.
To add insult to injury, GPs' representatives seem to be on a
different planet: "come in, BMA, GPs are calling".
The BMA, through its GPs' committee, the GPC, have bent over
backwards to acquiesce to government demands. They were given a loaded
gun by GPs to negotiate with a year ago, they went and shot themselves in
the foot. They have failed GPs time and again, and have no intention of
desisting.
The time has come for a new paradigm: a paradigm that puts the
interests and welfare of GPs as its primary objective.
This is why we set up the General Practitioners' Union
to make the interests and welfare of GPs the
heart of the matter.
Competing interests:
Chair of the Interim Executive Committee of the General Practitioners' Union
Competing interests: No competing interests
As a recent appointee to general practice, I am all too aware of the
seemingly vast chasm between the daily realities of a working GP and the
infinite spin and rhetoric which comes off the government PR conveyor
belt.
I have hopes for the future, but I am dubious whether the new
contract in its existing form can and will deliver the substantial change
on the ground that is needed
Competing interests:
None declared
Competing interests: No competing interests
We surveyed 197 GPs aged 55 or over by telephone in 1984/5 about
their retirement intentions and the reasons for these (Wakeford R, Roden
M, Rothman A: BMJ 292 1307-1309, 17 May 1986). This represented a response
rate of 89% of the working GPs drawn in a national random sample of 250
names. Job satisfaction was even then easily the dominant influence
regarding early or later retirement. Plans to continue in practice after
'normal' retirement age were relatively high, however, and their attitudes
are interesting to contrast with current ones. 3% of respondents "wanted
out soon", 38% planned a "clean break" with practice, 48% wanted a gradual
retirement, and 11% planned never to retire.
For such topics, telephone interviews may be better than
questionnaire surveys in obtaining high response rates (cf 47% in the
present study): respondents may equivocate and not respond so neatly, of
course, but perhaps this more nearly reflects truth.
Competing interests:
None declared
Competing interests: No competing interests
I rose early this morning and heard about this article on Radio 4 at
05.25. The headline was "1 in 5 GPs considering quitting over next 5 years
because of reduced job satisfaction". The government had already issued a
rebuttal and said that the number of GPs was rising, that they had
improved GPs working lives with flexible working etc.
I quit after 17 years as a GP 4 months ago and am now fully employed
doing other satisfactory work in healthcare. My levels of stress are much
reduced and people tell me I look better. My wife is delighted.
I have discovered that the GP recruitment and retention crisis is
more widespread than I thought and friends and aquaintances from several
English counties, including one of my brothers who lives in a very wealthy
area, tell me they are finding it very difficult to get to see a GP
because of shortages, early retirement, and the fact that many if not most
new GPs are working part time only. It is this last fact that allows the
DoH to get away with spinning the numbers when they should be talking
about full time equivalents, the press do not seem to be holding them to
account over this. Also, the constant referral to "hospitals", as in
"schoolsandhospitals" does nothing to encourage doctors to enter primary
care when resources seem to be disproportionately directed to the
hospitals.
I write this not so much as to get something off my chest but because
it seems to me disconcerting that a serious and significant piece of
research in a respected journal has been denied within hours of
publication by a government which has a responsibility to do something
about a problem which it (and it's predecessor) largely created and which
threatens to unravel their plans for the NHS, if not the NHS itself.
If the new GP contract does not delliver an improved quality of
professional life for GPs, many 50 year old GPs who have been holding on
may take their pensions and go. The recent announcement that the already
overdue contract was to be delayed by another 7 weeks will not help. This
research, which tends to agree with the anecdotes on the ground, should
not be so peremptorily dismissed by government.
Competing interests:
recently resigned GP
Competing interests: No competing interests
criteria
sir, we want to know that,
which are the criteria used for assesment of job satisfaction
thank you
Competing interests:
which are the criteria used for assesment of job satisfaction
Competing interests: No competing interests