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. 2020 May 12;10(5):e029846.
doi: 10.1136/bmjopen-2019-029846.

Understanding why primary care doctors leave direct patient care: a systematic review of qualitative research

Linda Long  1 , Darren Moore  2 , Sophie Robinson  3 , Anna Sansom  4 , Alex Aylward  5 , Emily Fletcher  4 , Jo Welsman  6 , Sarah Gerard Dean  7 , John L Campbell  4 , Rob Anderson  3
Affiliations

Understanding why primary care doctors leave direct patient care: a systematic review of qualitative research

Linda Long et al. BMJ Open. .

Abstract

Background: UK general practitioners (GPs) are leaving direct patient care in significant numbers. We undertook a systematic review of qualitative research to identify factors affecting GPs' leaving behaviour in the workforce as part of a wider mixed methods study (ReGROUP).

Objective: To identify factors that affect GPs' decisions to leave direct patient care.

Methods: Qualitative interview-based studies were identified and their quality was assessed. A thematic analysis was performed and an explanatory model was constructed providing an overview of factors affecting UK GPs. Non-UK studies were considered separately.

Results: Six UK interview-based studies and one Australian interview-based study were identified. Three central dynamics that are key to understanding UK GP leaving behaviour were identified: factors associated with low job satisfaction, high job satisfaction and those linked to the doctor-patient relationship. The importance of contextual influence on job satisfaction emerged. GPs with high job satisfaction described feeling supported by good practice relationships, while GPs with poor job satisfaction described feeling overworked and unsupported with negatively impacted doctor-patient relationships.

Conclusions: Many GPs report that job satisfaction directly relates to the quality of the doctor-patient relationship. Combined with changing relationships with patients and interfaces with secondary care, and the gradual sense of loss of autonomy within the workplace, many GPs report a reduction in job satisfaction. Once job satisfaction has become negatively impacted, the combined pressure of increased patient demand and workload, together with other stress factors, has left many feeling unsupported and vulnerable to burn-out and ill health, and ultimately to the decision to leave general practice.

Keywords: burnout; flexible working; general practitioner; job satisfaction; leave; systematic review.

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Conflict of interest statement

Competing interests: None, except that two of the included studies were conducted by two of the coauthors of this systematic review (JLC and AS) and the principal investigator of the wider ReGROUP study of which this systematic review is a part (JLC). Neither AS or JLC had any involvement in the detailed data extraction or quality assessment of their studies or any of the other studies. Also, AA has received personal fees from the Northern, Eastern and Western Devon CCG, Devon Local Medical Committee, British Medical Association, University of Exeter, CLAHRC South West Peninsula, and NHS England Medical Directorate (South), outside of this work.

Figures

Figure 1
Figure 1
Medline search strategy.
Figure 2
Figure 2
PRISMA flow diagram showing the process of study selection. *Papers excluded at full-text stage are listed in online supplementary file 1online supplementary appendix 3. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 3
Figure 3
Explanatory model of key factors associated with general practitioners’ (GPs) leaving behaviour.
See this image and copyright information in PMC

References

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