Do compensation models affect family physician job satisfaction? Scoping review

To explore how factors associated with various compensation models affect job satisfaction of family physicians.

Three databases were searched (Web of Science, Embase, and MEDLINE) with 3 keywords (MeSH headings) used: family physician, payment model, and job satisfaction.

To be included articles had to be peer reviewed, at least 50% of study participants had to be family physicians practising longitudinal or comprehensive care, and articles had to address career satisfaction in relation to compensation models. Twenty-seven studies were included.

An extraction form was used to synthesize key details from each study, followed by thematic analysis. Four predominant job satisfaction factors were identified: workload or administrative burden, autonomy, income security, and justice or fairness of compensation. Five distinct models, representing both direct and indirect compensation, were identified in the literature most frequently: salaried, fee-for-service, capitation, loan repayment programs or incentives, and pay-for-performance. Each payment model had merits and drawbacks in relation to job satisfaction. Salaried physicians tended to experience less stress associated with administrative and management responsibilities; capitation models appeared to be associated with less workload stress; and fee-for-service models tended to be associated with a greater sense of autonomy. Income security, as provided by capitation and salaried models, was generally positively associated with job satisfaction.

Use of blended models has the potential to address job satisfaction issues uncovered in this review and to maximize satisfaction among family physicians. Current changes and enhancements being made to compensation models in Canada present opportunities to further study their effects on family physician career satisfaction and attractiveness of the profession.