Indian Journal of Public Health

: 2014  |  Volume : 58  |  Issue : 4  |  Page : 256--260

Relationship between job satisfaction and performance of primary care physicians after the family physician reform of east Azerbaijan province in Northwest Iran

Hossein Jabbari1, Mohamad Zakarria Pezeshki2, Mohammad Naghavi-Behzad3, Mohammad Asghari4, Fariba Bakhshian5,  
1 Department of Social Medicine and Medical Education Research Center, Tabriz University of Medical Sciences, Golgasht Street, Tabriz, Iran
2 Medical Education Research Center, Tabriz University of Medical Sciences, Golgasht Street, Tabriz, Iran
3 Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Golgasht Street, Tabriz, Iran
4 Department of Biostatics, Health & Nutrition Faculty, Tabriz University of Medical Sciences, Golgasht Street, Tabriz, Iran
5 Department of Chancellor, Tabriz University of Medical Sciences, Golgasht Street, Tabriz, Iran

Correspondence Address:
Fariba Bakhshian
Department of Chancellor, Tabriz University of Medical Sciences, Golgasht Street, Tabriz


Background: Following the implementation of family physician program in 2004 in Iranian healthcare system, the understanding in changes in physicians«SQ» practice has become important. Objective: The objective of this study was to determine the level of family physicians«SQ» job satisfaction and its relationship with their performance level. Materials and Methods: A cross-sectional study was conducted among all 367 family physicians of East Azerbaijan province in during December 2009 to May 2011 using a self-administered, anonymous questionnaire for job satisfaction. The performance scores of primary care physicians were obtained from health deputy of Tabriz Medical University. Results: In this study, overall response rate was 64.5%. The average score of job satisfaction was 42.10 (±18.46), and performance score was 87.52 (±5.74) out of 100. There was significant relationships between working history and job satisfaction (P = 0.014), marital status (P = 0.014), and sex (P = 0.018) with performance among different personal and organizational variables. However, there was no significant relationship between job satisfaction and performance, but satisfied people had about three times better performance than their counterparts (all P < 0.05). Conclusions: The low scores of family physicians in performance and job satisfaction are obvious indications for more extensive research in identifying causes and finding mechanisms to improve the situation, especially in payment methods and work condition, in existing health system.

How to cite this article:
Jabbari H, Pezeshki MZ, Naghavi-Behzad M, Asghari M, Bakhshian F. Relationship between job satisfaction and performance of primary care physicians after the family physician reform of east Azerbaijan province in Northwest Iran.Indian J Public Health 2014;58:256-260

How to cite this URL:
Jabbari H, Pezeshki MZ, Naghavi-Behzad M, Asghari M, Bakhshian F. Relationship between job satisfaction and performance of primary care physicians after the family physician reform of east Azerbaijan province in Northwest Iran. Indian J Public Health [serial online] 2014 [cited 2020 Oct 28 ];58:256-260
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Establishing a strong PHC network and constitution of Ministry of Health and Medical Education in 1985, [1] were significant steps toward an improved life expectancy, in Iran. However in response to new challenges, programs for family physicians and expansion of rural health insurance have started in 2004. [2],[3],[4] This reform trebled the number of physicians in rural areas and increased their incomes ten folds. [5],[6] Now-a-days the ministry is planning to expand the program to all cities. [7] However a number of challenges such as improper motivation initiatives, poor comprehensiveness in instructions and arrangements, lack of job security and delay in payment of salary [8] lead to burnout [9] in order to participate in residency entrance examination. [10]

In order to assess the impact of this reform in the health sector [11] understanding the change in physicians' behavior is important. Numerous studies indicate that job satisfaction is a major determinant of stated intentions to leave the workforce. [9],[12] Previous studies mainly focused on job satisfaction of physicians in different situations, while the relationship between physicians' performance and their job satisfaction was unknown [13] especially in Iranian health system. Therefore, it is important to investigate job satisfaction of family physicians [12] and its relationship with performance. Hence, the objectives of this study were determining the level of family physicians' job satisfaction and its relationship with their performance in Iran.

 Materials and Methods

A cross-sectional study was conducted among 367 family physicians of public sector in East Azerbaijan province of Iran, during December 2009 to May 2011; who had minimum 6 months of working history and was working at the time of the study.

Data were collected using a self-administered, anonymous questionnaire containing 35 questions about job satisfaction, personal and professional variables, and three open questions.

A 4-point Likert scale was used for section 2, with "very dissatisfied", "dissatisfied", "satisfied" and "very satisfied" options. The 35 items of job satisfaction questionnaire were categorized in eight domains. The total scores of participants in job satisfaction were transformed into percentage in order to quantitatively relate to physician's performance scores.

The questionnaire, developed by World Health Organization in 1993, we confirmed and retained its validity and reliability after translation to Persian in a recent survey. A translation-back translation process was used to translate the measures. The content validity of the questionnaire was evaluated based on opinions of an expert panel consisting of eight specialists in the fields of health system research and after some modifications and corrections the questionnaire was approved. Cronbach's alpha values were calculated for all 35 items (0.92.), and it showed reasonable reliability (internal consistency). Questionnaires were distributed via post to all of the 367 doctors with a letter explaining the objectives of the study followed by a phone call. Furthermore, a code number was added to every questionnaire by the main researcher. Anonymity and confidentiality of respondents were ensured.

The performance scores, which are measured every three by skilled expert physicians months, as the main criterion for payment system, were added to the respective questionnaire of each respondent. Physician's performance was measured on a scale is measured by about 40 indicators with maximum possible score of 1000, which was transformed to a scale of 100 for this research. It was found that 30% of family physician income is at risk under the scheme. [14]

All analyses were performed using SPSS version 16.0 (SPSS Inc. Chicago) with t-tests, analysis of variances, logistic regression and odds ratios.

Ethical consideration for this study and the study protocol were approved by the Ethics Committee of Tabriz University of Medical Sciences (TUMS), which was in compliance with Helsinki declaration.


In this detailed study, 238 questionnaires were received as completed from 367 (64.5%) cases. Half of the participants were males, 71.1% were married, the average age was 32.98 (±5.49) years and the average length of service was 5.23 (±4.53) years. Furthermore, 80.5% of the respondents were temporary employees and the median distance of their work place to the capital of the province was 100 (range = 2-250) km. Each physician had covered 4131.85 (±1298.51) people.

[Table 1] shows the average score of job satisfaction to be 42.10 and that for performance to be 87.52. [Table 2] represents the mean scores computed for total job satisfaction and each subscale. The overall satisfaction was 32.4%. The respondents' were less satisfied in domains of survival or personal maintenance, security, and recognition but more satisfied in domains of status, companionship, and quality or style of supervision. Initial analyses of physician job satisfaction among single items of questionnaire showed, physicians were more satisfied with their "having colleagues' respect (73.67 ± 28.52)" and "patients' recovery (71.83 ± 25.29)" but were more unsatisfied with "career prospects (15.57 ± 26.94)" and "job security (20.21 ± 28.64)".{Table 1}

Evaluation of the relationship between satisfaction and performance with background variables showed, a significant relationship between working history and satisfaction only [Table 3]. In addition, the results showed significant relationships between marital status, and gender only. Other such relationships were nonsignificant. However, for relationship between satisfaction and performance, though not significant, but satisfied persons had about 3 times better performance than the unsatisfied persons had [Table 4].{Table 2}{Table 3}{Table 4}

A content analysis of three open questions about main value aspects of the job were: provision of services, relationship (companionship), and health promotion while the job security and insufficient salary were major aspects disliked. Financial obligation and interest in the provision of health services were indicated as main reasons to work in health system. Evaluation of relationship between satisfaction and performance with main value of job showed significant relationship between relationship (companionship) and health promotion with satisfaction, so that persons in relationship category had about three times more satisfaction level than persons in health promotion category had, but there was no such relationship between other background variables and satisfaction [Table 3]. The results showed no significant relationships between provision of services, and health promotion with Performance (P > 0.05).


In this study, the participation rate was higher than a similar study in England (53%), Norway (43%), and lower than a study in Lithuania (78.6%). Generally, the average score of job satisfaction in comparison with the GP job satisfactions in England (62%) and Mexico (54%), [12],[15] was lower and closer to a recently conducted research in Iran. [16] Security and personal maintenance were main factors for dissatisfaction where British GP doctors were dissatisfied with the working hours, recognition and rewards. [12] Furthermore, Lithuanian doctors were dissatisfied from low income, social status and heavy workload. [17] Other findings on physician job satisfaction in Iran are similar with our findings. [16] One study in European countries [18] showed the strongest correlation of job security with job satisfaction; which was similar to our findings. Furthermore, unequivocal relations between the level of job satisfaction and employment, gender, age and marital status of respondents did not emerge either in our study or those in Europe.

On the other hand, family physicians of our study were young and their income at this level was comparatively lower; and their lower job satisfaction and lookout for specialty education for additional revenues is reasonable. Physicians usually work permanently in Iran, but family physicians work as a contract or mandatory employees, therefore, their employment is uncertain. [1],[5] These differences and the lack of job security [8] could create more job dissatisfaction. Quality of control procedures, lack of insurance support by health system, and other items has raised family physicians' dissatisfaction. [8],[16] The low level of performance scores is similar with Jabbari's findings [19] in Iran, but lower than the performance of GP physicians in UK. [20] The small differences between job satisfaction and performance scores could be attributed to project life in Iran and performance-based payment schemes.

Only a few studies conducted on the relationship between performances of physicians and their job satisfaction. [21] The finding of Godard indicates that a moderate use of high performance increases workers' job satisfaction, esteem, commitment, and citizenship behavior [13]

Finally our findings indicate, there is no strong evidence for relationship between job satisfaction and performance, while some reported the positive association between job satisfaction and high quality of interpersonal care; [22] while others concluded the relationship to be weak. [23] However, a large scale study shows that a higher involvement in high performance is associated with higher job satisfaction. [18] This inconsistency could be related to organizational determinants.


The low scores of family physicians in performance and job satisfaction indicate an obvious need for further research to identify the root causes of low levels of scores. By and large, revision in current policies especially in payment methods and working condition is recommended.


The authors wish to thank from Medical Education Research Center (for supporting grant), health deputy, and authorities of health networks in the TUMS.


1Majdzadeh R. Family physician implementation and preventive medicine; opportunities and challenges. Int J Prev Med 2012;3:665-9.
2Gressani D, Saba J, Fetini H, Rutkowski M, Maeda A, Langenbrunner J. Islamic Republic of Iran health sector review, volume I: main report. The World Bank Group. Human Development Sector, Middle East and North Africa. 2007;1575-81.
3Karimi S, Moghadam SA. Designing a health equity audit model for Iran in 2010. J Res Med Sci 2011;16:541-52.
4The 4 th national development program of Iran; 2007. Available from: [Last accessed on 2014 Jun 5].
5Lebaron SW, Schultz SH. Family medicine in Iran: The birth of a new specialty. Fam Med 2005;37:502-5.
6Takian A, Rashidian A, Kabir MJ. Expediency and coincidence in re-engineering a health system: An interpretive approach to formation of family medicine in Iran. Health Policy Plan 2011;26:163-73.
7The 5 th national development program of Iran; 2007. Available from: [Last accessed on 2014 Jun 5].
8Jannati A, Maleki MR, Gholizade M, Narimani MR, Vakeli S. Assessing the strengths & weaknesses of family physician program. J Knowl Health 2010;4:39-44.
9Keshvari M, Mohammadi E, Boroujeni AZ, Farajzadegan Z. Burnout: Interpreting the perception of Iranian primary rural health care providers from working and organizational conditions. Int J Prev Med 2012;3:S79-88.
10Mehrdad R. Health system in Iran. Japan Med Assoc J 2009;52:69-73.
11Hojat M, Gonnella JS, Erdmann JB, Veloski JJ, Louis DZ, Nasca TJ, et al. Physicians' perceptions of the changing health care system: Comparisons by gender and specialties. J Community Health 2000;25:455-71.
12Sibbald B, Enzer I, Cooper C, Rout U, Sutherland V. GP job satisfaction in 1987, 1990 and 1998: Lessons for the future? Fam Pract 2000;17:364-71.
13Bauer TK. High Performance Workplace Practices and Job Satisfaction: Evidence from Europe. Discussion Paper No. 1265. Bonn, Jermany: IZA; 2004.
14Training Manual on Management of Human Resources for Health. Section 1. Geneva: World Health Organization; 1993.
15Nylenna M, Gulbrandsen P, Førde R, Aasland OG. Unhappy doctors? A longitudinal study of life and job satisfaction among Norwegian doctors 1994-2002. BMC Health Serv Res 2005;5:44.
16Motlagh ME, Shirvani N, Ashrafiana H, Kabir M, Shabestani Monfared A, Nahvijoy A. Satisfaction of family physicians (FPs) about effective factors on activation of FP program in medical universities. J Guilan Univ Med Sci 2010;19:48-55.
17Buciuniene I, Blazeviciene A, Bliudziute E. Health care reform and job satisfaction of primary health care physicians in Lithuania. BMC Fam Pract 2005;6:10.
18Measuring job satisfaction in surveys - Comparative analytical report; © European Foundation for the Improvement of Living and Working Conditions; 2007.
19Jabbari A, Sharifirad GH, Shokri A, Bahmanziari N, Kordi A. Overview of the performance of rural family physician in Iran. Health Inf Manage 2013;9:1145.
20Whalley D, Bojke C, Gravelle H, Sibbald B. GP job satisfaction in view of contract reform: A national survey. Br J Gen Pract 2006;56:87-92.
21Mache S, Vitzthum K, Nienhaus A, Klapp BF, Groneberg DA. Physicians' working conditions and job satisfaction: Does hospital ownership in Germany make a difference? BMC Health Serv Res 2009;9:148.
22Utsugi-Ozaki M, Bito S, Matsumura S, Hayashino Y, Fukuhara S, MEMO-J Study Group. Physician job satisfaction and quality of care among hospital employed physicians in Japan. J Gen Intern Med 2009;24:387-92.
23Jones MD. Which is a better predictor of job performance: Job satisfaction or life satisfaction? Inst Behav Appl Manag 2006:8:20-44.