Kim Patrick, Premkumar Devyani, Philpott Jane, Chan-Nguyen Sophy, Grady Colleen
Medical student in the School of Medicine at Queen's University in Kingston, Ont.
Professor of Family Medicine at Queen's University.
Can Fam Physician. 2025 Jun;71(6):e140-e147. doi: 10.46747/cfp.7106e140.
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: , and .
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.
探讨与各种薪酬模式相关的因素如何影响家庭医生的工作满意度。
检索了三个数据库（科学网、Embase和MEDLINE），使用了三个关键词（医学主题词）： 、 和 。
纳入的文章必须经过同行评审，至少50%的研究参与者必须是从事纵向或综合医疗的家庭医生，并且文章必须涉及与薪酬模式相关的职业满意度。共纳入27项研究。
使用提取表从每项研究中综合关键细节，随后进行主题分析。确定了四个主要的工作满意度因素：工作量或行政负担、自主权、收入保障以及薪酬的公平性或公正性。在文献中最常出现的代表直接和间接薪酬的五种不同模式：薪水制、按服务收费、按人头收费、贷款偿还计划或激励措施以及绩效薪酬。每种支付模式在工作满意度方面都有优缺点。薪水制医生往往在行政和管理职责方面承受较小的压力；按人头收费模式似乎与较少的工作量压力相关；而按服务收费模式往往与更强的自主感相关。按人头收费和薪水制模式提供的收入保障通常与工作满意度呈正相关。
采用混合模式有可能解决本综述中发现的工作满意度问题，并使家庭医生的满意度最大化。加拿大目前对薪酬模式所做的改变和改进为进一步研究其对家庭医生职业满意度和该职业吸引力的影响提供了机会。
