To our knowledge, this was the first study that uses the COPSOQ questionnaire for practice assistants in a general medical care setting in Germany, where to date there has been little published research in this field. Our study contributes early evidence to a field with increasing importance due to issues with general practice workforce shortages in Germany. It was found that practice assistants showed high level of sense of community, meaning of work, and role-clarity which are crucial aspects for intrinsic motivation at work. Previous studies have reported that clear responsibilities and also extension of roles of health care staff resulted in a higher job satisfaction and identification with their job [18–20]. Moreover, job satisfaction is an important predictor of intention to stay in the job but could be influenced by organizational attributes within the practice [21, 22].
It was found that practice assistants who worked part-time showed lower levels of quantitative and emotional demands, work-privacy conflict, workplace bullying, thinking about early retirement and burnout. Furthermore, for this group higher job satisfaction and higher level of satisfaction with life were observed. In addition, the results demonstrated that practice assistants who worked part-time rated their psychosocial factors at work and health-related outcomes more positive than full-time employees. The same result was found in a German-wide study about job satisfaction surveying practice assistants where the part-time workers were more satisfied with their job than full-time staff [18]. Furthermore, a study with employees from the service sector in five western European countries demonstrated that working part-time positively affect work-family balance [23]. In our study and general, nearly 100 % of practice assistants in general medical practices are female, for whom the opportunity to work in a part-time position to juggle family and work is often desirable. Therefore, a prospective study followed by a targeted intervention would be necessary to consider employment status and working condition for recruitment and retention of practice assistants.
Furthermore, it has been demonstrated that different psychosocial factors at work are associated with health-related outcomes. The two scales of health related outcomes ‘burnout’ and ‘job satisfaction’ showed strong associations between different psychosocial factors and socio-demographic variables with an explained variance of 67 % resp. 60 %. These results compared favorably to a study with service personnel, which also used the COPSOQ questionnaire and showed that psychosocial factors at work strongly related to the risk of burnout (24). In our study, a number of psychosocial factors were associated with burnout, such as higher cognitive stress symptoms, work-privacy conflict, emotional demands, and role-conflict, lower general health, satisfaction with life, demanding for hiding emotions, and younger practice assistants. A study with primary care providers in the United States showed that physician assistants and nurse practitioners reported a higher level of stress than physicians [25]. A review by van Laar et al. showed that medical staff across different practice settings from 17 countries were stressed and strained [26].
It should be noted that a strong predictor for job satisfaction was the quality of leadership. A systematic review conducted in the hospital sector showed that leadership practices influences health care staff retention [27]. Moreover, it was found that authentic leadership positively influences health and retention of nurses and increased job satisfaction [28, 29]. It is to be recommended that general practitioners actively develop their own leadership skills depending on the individual workplace conditions, with the intent of enhancing their staff satisfaction and thereby, positively impacting on staff retention.
Furthermore, burnout and job satisfaction are strong predictors for the outcome item ‘thinking about early retirement’. It was shown that the relationship between work environment, working conditions and health are essential for retention of health care staff. Moreover, it was found that job satisfaction is highly associated with organizational attributes in primary care [22]. The establishment of healthy workplaces to positively impact on the recruitment and retention of staff in the health care sector cannot be underestimated [30]. Moreover, the work environment including psychosocial factors at work is an indirect predictor of quality of care, which should be addressed in further studies [3].
Strengths and limitations
To our knowledge there is no published research for psychosocial factors at work of practice assistants in general medical practice in Germany. Our study provides an important contribution and provides early evidence in this field of research. The findings are tentative and it is not possible to determine cause-and-effect relationships. In addition, the use of an internationally validated instrument for the evaluation of psychosocial factors at work, the COPSOQ-instrument, enables international comparison and benchmarking of results [15–17]. Finally, our study had a good response rate from practice assistants in general medical practices (73.8 %). Data from non-responders were not evaluated. The non-response rate of 8.5 % was negligible. However, only limited conclusions can be drawn as we were unable to collect data on a broader range of socio-demographic characteristics including health risk behaviors of practice assistants. The participation of practice assistants in this study was voluntary. Therefore, a potential selection bias is indicated. In addition, as this was an exploratory study and the direction of the relationship cannot be determined, p values should be interpreted with caution. Significant results may be due to chance and will need to be confirmed in further targeted studies.
