It is heartening to note that more than two out of every three family physicians in our sample said they were “very satisfied” with their current practice. These numbers are higher than those reported in the National Physician Survey (NPS) 2007, in which only 27% of interviewed family physicians reported being “very satisfied” with their current professional life. However, if one adds the “very satisfied” (27%) and “somewhat satisfied” (48%) response categories of the NPS 2007, the resulting rate is very similar to that of our survey. Differences between the NPS and our survey results could be due to the slightly different wording of the question (NPS: “satisfaction with current professional life”; our survey: “satisfaction with current practice”).
Irrespective of the caveats, these numbers attest to the fact that the practice of family medicine offers a fulfilling career in today's medical marketplace. These data can be used in efforts to increase the proportion of medical school graduates opting for family medicine residencies in the CaRMS match (vide supra).
The practice of medicine today is increasingly characterized by a team-based approach, both within and outside the confines of a family practice. A crucial linkage in this approach is the two-way communication between the team members within a family practice and outside providers (e.g., specialists), as would occur when a family physician makes a referral to a specialist and then awaits the specialist's opinion and recommendations. Our findings – that difficulty in referring patients to specialists, and lack of timely response, have a negative impact on family physician satisfaction – should be examined in this light. Both these factors may impede provision of optimal patient care and can be seen as impediments to the professional autonomy of the family physician, thus adversely affecting professional satisfaction (DeVoe et al. 2002
; Williams et al. 2002
). In an analysis of family physicians practising in the Seattle area, Grembowski and colleagues (2003)
found that ease of referral in the context of managed care was associated with greater job and referral satisfaction, and they posit that this could be a proxy for an office that manages patient flow well. Other literature suggests that constraints on the provision of medical care provision or the inability to obtain services for patients can lead to lower physician satisfaction (Landon et al. 2003
; Rivet et al. 2007
; Stoddard et al. 2001
Our analyses do not allow us to tease out the causal mechanisms of this interaction. In an analysis of barriers to older cancer patients' being referred to oncologists, Townsley and colleagues (2003)
found that the most commonly cited difficulties by primary care physicians making oncologist referrals were length of waiting lists, the oncologists' desire to have a tissue diagnosis before referral and the belief that oncologists seldom relate to primary care physicians. Although there is evidence to show that wait times for particular specialist visits or procedures are a problem (Esmail et al. 2006
), other explanations are possible. For example, there could be a relative paucity of specialists in southwestern Ontario, or specialists might require specific procedures to be followed prior to accepting a referral, increasing the “hassle factor” for the family physician. Similarly, obtaining a timely response from a specialist may depend on the tests or procedures that he or she wants done, which could be affected by the waiting times for such tests or procedures.
Assuming that our findings are replicated in other studies, policies that encourage development of greater family physician–specialist interaction on a personal level may help to improve satisfaction with consultations and result in more appropriate referrals. Common referral forms that are developed with both family physician and specialist input may expedite the transmission of all relevant information and improve consultations as well. Continued support is required for the addoption of electronic medical records by family practices and for systems to support electronic communication between family physicians and specialists.
Other factors affecting satisfaction included marital status, teaching activities and volume of patients seen per week, findings that are consonant with the literature. Being married/partnered may provide additional support and a refuge from the day-to-day stresses of a busy practice, and involvement in undergraduate or postgraduate teaching may provide a reward or satisfaction in terms of educating the physicians of tomorrow (Eliason et al. 2000
; Rivet et al. 2007
). A low practice volume was positively associated with satisfaction and could be due to the fact that this allows family physicians to have greater control over their day, and ensure that adequate time is available for patient encounters (Keeton et al. 2007
; Stoddard et al. 2001
; Whalley et al. 2006
Our analysis includes some distinct strengths and weaknesses. A major strength is our response rate of 70%, which is higher than the rates of 50%–60% in other physician surveys reported in the literature (Asch et al. 1997
; Bovier and Perneger 2003
; Linzer et al. 2000
; Pathman et al. 2002
). Our survey was a census of all family physicians in southwestern Ontario, and there were no statistically significant differences between the responders and non-responders. In addition, we used a conceptual model that has been validated and widely used in the literature, and we controlled for most of the variables identified in the literature.
The caveats that should be borne in mind include the fact that our analysis was cross-sectional in nature, thus precluding any assertions about causality. Because the data were based on physician self-report, there is the possibility that physicians could have erred in reporting on variables such as the number of patients seen per week and patient case mix. Finally, the data are limited in that some variables of interest were not available. For example, physician income and balance between personal and professional commitments have been shown to be significant predictors of physician satisfaction but are unavailable in our data set (Keeton et al. 2007
; Landon et al. 2003
; Pathman et al. 1996
; Rivet et al. 2007
In conclusion, our research demonstrates that a majority of family physicians practising in southwestern Ontario are “very satisfied” with their current practice, and that marital status, teaching involvement, practice volume, difficulty in specialist referrals and lack of timely specialist response are significant determinants of their satisfaction level. However, further research is needed to elucidate the causal mechanisms and to generalize these results beyond southwestern Ontario.