Physicians’ perceptions of quality of care, professional autonomy, and job satisfaction in Canada, Norway, and the United States

Reidar Tyssen,Ingunn B Solberg,Erica Frank,Edgar Voltmer,Karen S Palmer

doi:10.1186/1472-6963-13-516

Abstract

BackgroundWe lack national and cross-national studies of physicians’ perceptions of quality of patient care, professional autonomy, and job satisfaction to inform clinicians and policymakers. This study aims to compare such perceptions in Canada, the United States (U.S.), and Norway.MethodsWe analyzed data from large, nationwide, representative samples of physicians in Canada (n = 3,083), the U.S. (n = 6,628), and Norway (n = 638), examining demographics, job satisfaction, and professional autonomy.ResultsAmong U.S. physicians, 79% strongly agreed/agreed they could provide high quality patient care vs. only 46% of Canadian and 59% of Norwegian physicians. U.S. physicians also perceived more clinical autonomy and time with their patients, with differences remaining significant even after controlling for age, gender, and clinical hours. Women reported less adequate time, clinical freedom, and ability to provide high-quality care. Country differences were the strongest predictors for the professional autonomy variables. In all three countries, physicians’ perceptions of quality of care, clinical freedom, and time with patients influenced their overall job satisfaction. Fewer U.S. physicians reported their overall job satisfaction to be at-least-somewhat satisfied than did Norwegian and Canadian physicians.ConclusionsU.S. physicians perceived higher quality of patient care and greater professional autonomy, but somewhat lower job satisfaction than their colleagues in Norway and Canada. Differences in health care system financing and delivery might help explain this difference; Canada and Norway have more publicly-financed, not-for-profit health care delivery systems, vs. a more-privately-financed and profit-driven system in the U.S. None of these three highly-resourced countries, however, seem to have achieved an ideal health care system from the perspective of their physicians.

Highlights

We lack national and cross-national studies of physicians’ perceptions of quality of patient care, professional autonomy, and job satisfaction to inform clinicians and policymakers
In our comparison between the countries we controlled for age, because age has been associated with job satisfaction [11] and autonomy [12]
Include this variable in our analysis, nor did we include practice size because it was impossible to obtain these data for individual physicians in our samples, and because practice size was not a significant predictor of job satisfaction in another study that controlled for autonomy and other physician and practice characteristics [20]

Summary

Introduction

We lack national and cross-national studies of physicians’ perceptions of quality of patient care, professional autonomy, and job satisfaction to inform clinicians and policymakers. Our study compares physicians’ perception of quality of care, professional autonomy and job satisfaction between the health systems of Canada, Norway, and the U.S This comparison is of interest for three reasons. Country differences between the United States (U.S.), Germany and Britain regarding time with each patient and differences in job satisfaction between medical specialties have been shown [16,17], we control for this in our analysis. Include this variable in our analysis, nor did we include practice size because it was impossible to obtain these data for individual physicians in our samples, and because practice size was not a significant predictor of job satisfaction in another study that controlled for autonomy and other physician and practice characteristics (such as perceived time pressure) [20]

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