Evaluating general practitioners’ job satisfaction, a comparison between private and public practice

Abstract

General practitioners (GPs) play a vital role in the effective functioning of primary healthcare systems, yet their job satisfaction is influenced by a complex interplay of personal, professional, and systemic factors. This thesis investigates job satisfaction among GPs in Malta using a triangulated mixed-methods approach, integrating both quantitative and qualitative data to capture a comprehensive picture of the local context. The study is underpinned by the Social Production Function (SPF) theory, which considers how individuals seek to optimise physical well-being and social approval through goal-oriented activities. A national survey was distributed to 70 GPs working across public and private sectors, examining factors such as workload, autonomy, administrative burden, patient continuity, remuneration, peer support, and opportunities for professional development. These results were further explored through focus group discussions with both public and private GPs, allowing for deeper insight into the lived experiences behind the quantitative patterns. Findings revealed significant disparities between public and private sector GPs. Public GPs frequently cited issues related to lack of continuity of care, walk-in systems resembling ‘shopping counter’ dynamics, inadequate administrative support, and limited career progression. Conversely, private GPs reported higher satisfaction correlated to autonomy, long-term patient relationships, and more control over work schedules. Across both sectors, stress and burnout were common themes, compounded by structural and policy-related constraints. Notably, appointment-based clinics and improved patient registration systems emerged as promising areas for reform, with participants highlighting their potential to enhance patient care, reduce GP stress, and improve professional satisfaction. The study also points to a broader systemic challenge: the limited responsiveness of primary care policy in Malta to the evolving needs of GPs and patients alike. This research contributes to the limited literature on GP job satisfaction in Malta and offers practical recommendations for health system leaders. It calls for policy changes that support continuity of care, investment in workforce planning, better recognition of GP roles, and the implementation of more sustainable practice models. Addressing these concerns is essential for retaining a motivated GP workforce and strengthening primary care as the cornerstone of the Maltese health system.