| Summary: | 碩士 === 國立陽明大學 === 醫務管理研究所 === 103 === Abstract
Background
Since then there has been great changes in the society as well as in the medical environment. According to a recent survey questionnaire, physicians in Taiwan have rated their job satisfaction pretty low. More than half of the physicians take a pessimistic view toward their career. The objects of the above survey questionnaire are mostly physicians who work in hospitals; therefore we have limited understanding of primary care physicians’ attitude toward this issue. In recent years, instead of solo, more and more physicians have changed their ways and started performing group practice. Till now, group practice have developed into many types. The relationships between physicians and clinics have become more complicated. Specialist in primary care has also changed in a certain degree. Therefore, this study aimed to assess the association between type of practice models, ownerships, specialist, and physician job satisfaction among primary care physicians in Taiwan, a typical Asian country with universal health insurance system.
Methods
This study was conducted in the Northern Taiwan. All 2,367 primary care physicians who are currently practicing in the New Taipei City and registered with the New Taipei City Medical Association were included in the study in December 2014. We adopted the Physician Worklife Survey Questionnaire, which consists of 3 general measures of job satisfaction, career satisfaction and specialty satisfaction, and 10 specific facets (autonomy, personal time, relationship with patients, patient care issues, relationships with staff, relationships with community, income, administration, and resources.) Likert scale was used to measure satisfaction. The content validity of the questionnaire was also assess by the experts and pre-tested by a group of primary care physicians. The results showed that the survey has good validity and reliability where each facet’s Cronbach's Alpha are > 0.6. Linear regression–modeled satisfaction (on 1–5 scale) as a function of practice models, ownerships, specialty, gender, age, seniority and. Survey was tested and suggested by experts then pre-tested by primary care physicians.
Results
There are 415 valid questionnaires respond rate is 20.57%. Within 415 responders, 33.73% of them are in solo practices, 47.47% of them are in group practices and 18.80% of physicians are in large group and franchises practices. Ownerships between physicians and clinics, 50.1% of them are both contracted clinic physician and owner of clinic, 13.1% of them are contracted clinic physician and not owner of clinic, 12.05% of them are non-contracted clinic physician and owner of clinic, 24.82% of them are non-contracted clinic physician and not owner of clinic. Specialist, 33.49% of them work in Family Medicine, 15.42% in General internal medicine and 14.7% in Pediatrics. The study results show many aspects. First of all, when it comes to interpersonal relations, primary care physicians give their job satisfaction higher ratings than others. In their relations with their physician colleagues, non-physician colleagues and patients, primary care physicians have an average rating of 3.89, 3.87 and 3.73. Secondly, when in different practice models, physicians who practices in group practice have higher rating in job satisfaction than solo physicians. In addition, physicians practicing in large group and franchises practices rated higher than those in smaller groups. Lastly, the study result shows that factors such as Ownerships between physicians and clinic of specialist do not effect much on job satisfaction ratings, whether in general measures of job satisfaction, career satisfaction, specialty satisfaction and most specific facets.
Disscussion, Implications for Policy Delivery or Practice
As the above result, primary care physicians in New Taipei City give high ratings in our job satisfaction survey questionnaire, especially in interpersonal relations. The survey questionnaire shows a similar result to the outcomes of recent national as well as international surveys of job satisfaction: physicians in group practices have higher ratings than physicians in solo practices. Physicians practicing in big group and franchises have better ratings than those who are in small group in most facets such as medical resources, managements as well as income. In Ownerships between physicians and clinics and clinic of specialist do not effect much on job satisfaction ratings. Type of practice models in primary care is significantly associated with physician’s job satisfaction, but not Ownerships between physicians and clinics and clinic of specialist. The results may help our understanding of physician job satisfaction in primary care and provide more information to physicians for their choice of practice type.
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