FAMILY DOCTORS’ JOB SATISFACTION AND CONDITIONS OF PROFESSIONAL PRACTICE André Biscaia AGO, IHMT Paulo Ferrinho AGO, IHMT Maria José Colaço Portugal

THE PORTUGUESE FAMILY PRACTICE National Health Service funded by taxes since 1979 Family Doctors: are civil servants and are paid with a fixed salary in charge of a list of 1500 to 2000 patients, including children and pregnant women work in Health Centres run by the State with very normative and bureaucratic working model

Job satisfaction A positive individual attitude towards the profession and the conditions of its execution Is associated with overall satisfaction with life mental well-being professional performance doctor-patient relationship prescription

Objectives Evaluation of professional practice conditions in the health centres family doctors’ job satisfaction in the Portuguese Health Region of Lisbon and the Tagus Valley Assessment of the correlation between these two areas

Methods health centres were randomly selected A validated job satisfaction questionnaire was presented to all 448 family doctors on those HC with a response rate of 69% Conditions of professional practice were evaluated by a Technical Commission of the Medical Council and the Regional Health Authority, through direct observation using a standard schedule for data collection Statistical analysis - SPSS - Pearson chi-square test, the Fisher exact test, the likelihood ratio test, the Student t test, correlation coefficient

22 statements with a 5 point Likertt scale, ranging 1 - “Strongly disagree” to 5 - “Strongly agree” (dissatisfaction) (satisfaction) Factor Analysis grouped the 22 itens into 7 Factors The average level of job satisfaction was neutral Score3.02 Doctors are neither satisfied nor dissatisfied Relatively negative

Factors associated with reduced job satisfaction Pressure at work (2,14) Doctors’ assessment of poor working conditions (2,86) Reward for the work done (2,70) All extrinsic factors The importance of the extrinsic factors is confirmed when we correlate job satisfaction with aspects of work conditions assessed by the Technical Commission of the Medical Council and the Regional Health Authority

Aspects of work conditions assessed by the Technical Commission of the Medical Council and the Regional Health Authority that correlate with doctors’ job satisfaction need to share a consultation room less overall job satisfaction (r= - 0,55) less interest for the work (r= - 0,70) more work pressure (r= - 0,51) greater proportion of nurses / doctors greater overall job satisfaction (r= 0,48) greater satisfaction with working conditions (r= 0,55) greater interest for what they are doing (r= 0,53) less work pressure (r= 0,48) p‹ 0,05

greater proportion of administrative staff / doctors greater overall job satisfaction (r= 0,49) less work pressure (r= 0,59) greater proportion of patients in the practice / doctors less satisfaction in relation to the possibility of professional development (r= - 0,49) poorer relationship with the chiefs (r= - 0,44) greater number of overtime hours better relationship with the chiefs (r= 0,44) p‹ 0,05

In a 5 point scale, 47,5% of Family Doctors assesss their own health in the two worst classes Individual worse health perceptions job dissatisfaction (r= - 0,33) considered to have worse work conditions (r= - 0,33) feel less adequate for the job (r= - 0,40) degraded HC facilities (r= - 0,47) Individual health perceptions associates with morbility and mortality Miilunpalo S. Self-rated health status as a health measure. J clin Epidemiol. 1997;5: p‹ 0,05

This study innovates as it achieves to correlate job satisfaction and individual health perceptions with externally assessed work conditions Factors that can be addressed by managers and policy makers in order to correct job dissatisfaction, with impact on doctors’ performance and ultimately quality of care were identified

Job Satisfaction could be improved if attention is paid to ratio patients per family physician ratio of nurses per physician ratio of administrative staff per physician individualized consulting rooms general physical and hygienic conditions of the facilities remuneration

André Biscaia Centro de Saúde de Cascais AGO – Associação Garcia de Orta PORTUGAL