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. 2025 Jun;71(6):e140-e147.
doi: 10.46747/cfp.7106e140.

Do compensation models affect family physician job satisfaction? Scoping review

Patrick Kim  1 , Devyani Premkumar  1 , Jane Philpott  2 , Sophy Chan-Nguyen  3 , Colleen Grady  4
Affiliations

Do compensation models affect family physician job satisfaction? Scoping review

Patrick Kim et al. Can Fam Physician. 2025 Jun.

Abstract
in English, French

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

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

Study selection: 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.

Synthesis: 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.

Conclusion: 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.

Objectif: Explorer la façon dont les facteurs associés à divers modes de rémunération influent sur la satisfaction professionnelle des médecins de famille.

Sources de l’information: Trois bases de données ont fait l’objet d’une recension (Web of Science, Embase et MEDLINE) à l’aide de 3 expressions en anglais (mots-clés MeSH) : family physician, payment model et job satisfaction.

Sélection des études: Pour être inclus, les articles devaient être révisés par des pairs, 50 % des participants à l’étude devaient être des médecins de famille pratiquant des soins longitudinaux ou complets, et les articles devaient porter sur la satisfaction professionnelle relative au mode de rémunération. Vingt-sept études ont été retenues.

Synthèse: Un formulaire d’extraction a été utilisé pour faire la synthèse des principaux détails tirés dans chaque étude, résumé qui a ensuite fait l’objet d’une analyse thématique. Quatre facteurs prédominants de satisfaction professionnelle ont été cernés : fardeau de la charge de travail ou administratif, autonomie, sécurité du revenu, et justice ou équité dans la rémunération. Cinq modèles distincts, représentant à la fois une rémunération directe et indirecte, ont été identifiés le plus souvent dans la littérature scientifique : salariés, rémunérés à l’acte, par capitation, programmes ou incitatifs de remboursement de prêts, et rémunération au rendement. Chaque modèle avait ses avantages et ses inconvénients quant à la satisfaction professionnelle. Les médecins salariés semblaient vivre moins de stress associé aux responsabilités administratives et de gestion; les modèles par capitation semblaient associés à un moindre stress sur le plan de la charge de travail; et les modèles de rémunération à l’acte avaient tendance à être reliés à un plus grand sentiment d’autonomie. La sécurité du revenu, que procurent la capitation et les modèles salariés, était généralement associée positivement à la satisfaction professionnelle.

Conclusion: Le recours à des modèles mixtes a le potentiel de répondre aux enjeux liés à la satisfaction professionnelle cernés dans cette revue et de maximiser la satisfaction chez les médecins de famille. Les changements et les améliorations actuellement apportés aux modes de rémunération au Canada présentent des possibilités d’étudier plus en profondeur leurs effets sur la satisfaction professionnelle des médecins de famille et sur l’attractivité de la profession.

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Figures

Figure 1.
Figure 1.
Flowchart for literature search and study selection
See this image and copyright information in PMC

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