Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, PO Box 1111, Blindern, Oslo NO-0317, Norway.
BMC Health Serv Res. 2013 Dec 15;13:516. doi: 10.1186/1472-6963-13-516.
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. This study aims to compare such perceptions in Canada, the United States (U.S.), and Norway.
We analyzed data from large, nationwide, representative samples of physicians in Canada (n = 3,213), the U.S. (n = 6,628), and Norway (n = 657), examining demographics, job satisfaction, and professional autonomy.
Among 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.
U.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.
我们缺乏关于医生对患者护理质量、专业自主性和工作满意度的看法的国家和跨国研究，无法为临床医生和政策制定者提供信息。本研究旨在比较加拿大、美国和挪威的这些看法。
我们分析了来自加拿大（n=3213）、美国（n=6628）和挪威（n=657）的大型全国代表性医生样本的数据，考察了人口统计学、工作满意度和专业自主性。
在美国医生中，79%强烈同意/同意他们可以提供高质量的患者护理，而只有 46%的加拿大医生和 59%的挪威医生这样认为。美国医生还认为他们有更多的临床自主权和与患者相处的时间，即使在控制了年龄、性别和临床工作时间后，这些差异仍然显著。女性报告说时间不够、临床自由度和提供高质量护理的能力不足。国家差异是专业自主性变量的最强预测因素。在所有三个国家，医生对护理质量、临床自由和与患者相处时间的看法影响了他们的整体工作满意度。报告至少有些满意的美国医生比例低于挪威和加拿大医生。
与加拿大和挪威的同行相比，美国医生认为患者护理质量更高，专业自主性更大，但工作满意度略低。医疗保健系统融资和提供方式的差异可能有助于解释这种差异；加拿大和挪威的医疗保健提供系统更多地由公共资金资助、非营利性，而美国的系统则更多地由私人资金资助、以营利为导向。然而，这三个资源丰富的国家似乎都没有从医生的角度实现理想的医疗保健系统。
