Specialty Selection and Relative Job Satisfaction of Family Physicians and Medical Specialists in Austria

A number of framework conditions for the work of family physicians in Austria and in other European health systems (1,2) are still not well defined. In Austria, it is not clear what services have to be provided in primary care and when patients should be referred to a specialist. Due to the non-remuneration for some services and procedures, the spectrum of care generally provided by family physicians is limited. Specialists can be consulted not only in hospital outpatient departments, but also in private offices under contract with the national health insurance board. Patients have a more or less free choice to consult a family physician, one or more self-employed specialists under contract with the national health insurance board, or specialists in hospital outpatient departments. There are many self-employed specialists, especially in larger cities like Vienna (3). As family physicians in Austria often fail to play the role of gatekeepers, private practice specialists frequently see patients with complaints that, in a well-defined primary care system, would be treated by family physicians. This situation creates a competitive relationship between family physicians and private practice specialists. Academic family medicine in Austria is still underdeveloped in comparison with other countries in Europe with more advanced health care systems (4). It is also not recognized as a medical specialty, which is reflected in the quality and duration of training and many other aspects. Even within the medical profession, there is sometimes little understanding for the competencies and skills of family physicians and the possible benefits of a well-defined primary care system (5,6). As has been widely discussed, the quality of vocational training for both family medicine and various specialties is often far from satisfactory (7-10). The European Academy of Teachers in General Practice considers it essential that the right career opportunities be given to right candidates (11). However, there is a question of whether the candidates who are particularly interested in and suitable for family medicine end up practicing that discipline. If residency programs were designed to impart the knowledge, skills, and attitudes needed to care for patients with chronic diseases, students and interns who were genuinely interested in providing high-quality ambulatory care would recognize the exciting opportunities offered within primary care (12). The graduates who are likely to acquire the competencies needed for family medicine (13) should be given a chance to become family physicians. The aim of this study was to determine if family physicians had originally desired to work as family physicians and if the relative job satisfaction of family physicians and other medical specialists depended on whether they obtained their training in desired medical specialty.