The relationship between effort-reward imbalance and job satisfaction among primary care general practitioners in Gansu of China: the mediating role of public service motivation.

backgroundWith the development of society and the economy, along with the aging population, the demand for primary health care services is growing. As the core providers of primary healthcare services, the job satisfaction of general practitioners (GPs) directly affects the quality of healthcare services and patient satisfaction, and it is one of the key indicators for assessing the effectiveness of relevant policy implementations. However, the heavy workload of Chinese primary care physicians, their low income levels, and their weak sense of professional identity may lead to an effort-reward imbalance (ERI). Therefore, analyzing the mechanisms behind ERI in relation to GPs' job satisfaction is crucial for advancing their professional growth. This is particularly relevant in less developed regions, as it can significantly boost the performance of healthcare services, elevate the standard of primary healthcare, and ultimately contribute to the realization of universal health coverage.

methodsThis study, conducted from December 2023 to March 2024, employed a cross-sectional analysis of primary care GPs in Gansu Province, China, based on social exchange theory, to investigate whether and how ERI affects job satisfaction among primary care GPs. An electronic questionnaire survey was distributed to resident doctors who had completed their training through standardized residency training bases to test the theoretical hypotheses.

findingsThis study found that the ERI among primary care GPs in China was relatively significant (3.57/5.00). The ERI negatively affected primary care GPs' job satisfaction (B = - 0.381, p < 0.01), explaining 23.6% of the variance in job satisfaction. Additionally, public service motivation (PSM) fully mediated the relationship between ERI and primary care GPs' job satisfaction (mediation effect of - 0.500, 95% bootstrap confidence interval [- 0.818 to - 0.156]). The study also revealed that GPs in primary hospitals had higher job satisfaction, while rural order-oriented GPs experienced lower job satisfaction.

conclusionThis study examines the detrimental effects and underlying mechanisms of ERI on the job satisfaction of primary care GPs, thereby contributing to the body of research on the factors influencing their job satisfaction. The findings underscore the importance of considering PSM as a critical intermediary when addressing ERI among primary care GPs. The conclusions offer practical insights for enhancing the job satisfaction of GPs, which, in turn, may lead to improved medical service performance in underdeveloped regions of China.