Today, we’re speaking to Dr Ben Walker, a post-doctoral associate based at the University of Calgary, who conducted this work while working at the University of Manchester.

Title of paper: Relationships of actual and expected levels of income with GP job satisfaction: repeated cross-sectional study

Available at: https://doi.org/10.3399/BJGP.2025.0683

Recruitment and retention of GPs remains an issue for general practice in England. This work examined the relationship between actual income and income expectations with job satisfaction and intentions to quit. Higher actual income was found to be associated with job satisfaction, but there was little evidence to show that it was associated with intentions to quit. A key and novel finding was that higher income expectations were associated with both lower job satisfaction and higher intentions to quit. The findings suggest that policies that help GPs build accurate income expectations, such as increased transparency for incomes for different GP job roles, may be a means of addressing job dissatisfaction caused by discrepancies between expected and actual income for GPs.

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:01.040 - 00:00:58.350

Hello and welcome to BJJP Interviews. I'm Nada Khan and I'm the Senior Research editor at the bjjp. Thanks for taking the time today to listen to this podcast.

In today's episode we're talking to Dr. Ben Walker.

Ben used to be based as a research fellow at the University of Manchester, but is now working as a postdoctoral associate at the University of Calgary in Canada.

We here to talk about the paper he's just published in the BJ GP that's titled Relationships of Actual and Expected Levels of Income with GP Job Satisfaction. A Repeated Cross Sectional Study.

So, hi Ben, it's really nice to meet you and to talk about this work and I guess to start us off, I just wanted to talk a little bit about the background to this paper and it's about GP income and job satisfaction, which is clearly a topic that people have plenty of opinions about. But what made you want to look at this question in a bit more detail?

Speaker B

00:00:58.590 - 00:02:08.930

So, yeah, it's something we had been discussing internally as a team for a while, obviously, I mean, working in a primary care group, a lot of the driving motivation for a lot of our work is the GP recruitment and retention crisis. And we've always had, we've had this data for a while on GP income from us via our surveys.

We've also had this data on GP income expectations and this has been in the survey forever and we've never, we hadn't used anything with it and basically because a lot of us are economists as well as this concept in economics of the Easterland Paradox or the idea that relative income matters more than actual income for happiness.

And so we decided that, well, it would be like, like because we are interested in the GP recruitment and retention crisis, it would be interesting to look at the extent to which relative income matters for GP recruitment and retention. So job satisfaction and intentions to quit being two components of recruitment and retention.

Speaker A

00:02:09.330 - 00:02:14.290

So you mentioned about a survey. So are you talking about the GP Work Life Survey that was done through Manchester?

Speaker B

00:02:14.370 - 00:02:17.130

We are indeed, yeah. So the GP Work Life Survey.

Speaker A

00:02:17.130 - 00:02:28.110

Yeah, yeah. So talk us through that just briefly. So what was that all about? I think, I mean there have been a few publications in the BJGP about it, but what.

Who are you surveying through that?

Speaker B

00:02:28.590 - 00:03:18.400

So the GP Work Life Survey has been going since I believe, 1998.

It's been run by Manchester for I believe, all of its history and it's a government funded survey and when we do it we are attempting to a sample of the general GP population to basically ask about various things to do with their work life, including more sort of like formal things like their income and how many hours they're working, but also just how satisfied they are with their jobs, different aspects of their jobs. Yeah, so we collect lots of data on the GP to respond, and, yeah, we aim to get as general a sample of a population as we can.

Speaker A

00:03:18.800 - 00:03:40.000

And I think one of the really interesting things about this study is that you're not just asking how much GPs actually earn, but how much they think they should earn.

And you mentioned about this paradox that you're interested in in terms of health economics, and I wonder why you think that distinction is important between actual earnings and sort of relative earnings or how much people think they should earn.

Speaker B

00:03:40.990 - 00:04:21.630

So I guess with a lot of things in life, and obviously from this economics paradox, a lot of things are not. It's not necessarily what you have. Absolutely.

A lot of it is driven by things like peer comparison, or if you're seeing that someone else is getting paid more for doing what you believe is like, similar amount of work or similar quality work to you.

So the idea of pure comparison's always just been like, important and there's lots of data out there and lots of studies looking at sort of the effect of absolute income. And this just felt like another relevant dimension to explore, basically.

Speaker A

00:04:22.190 - 00:04:33.710

So I guess if we just come on to sort of the big finding. And what did you find when you looked at actual income and GP job satisfaction? What was sort of the main headline here?

Speaker B

00:04:34.220 - 00:05:21.850

So, for job satisfaction, we, like, we find absolute income matters quite a lot and it has higher absolute income lead generally associated with higher job satisfaction across most, if not all domains.

And for job satisfaction, absolute income matters a lot, but we found that absolute income didn't seem to have any statistically significant association with intentions to quit. So we asked them whether or not they want to leave direct patient care within five years or leave medical work entirely in five years.

And we found that absolute income didn't have enough, didn't have a statistically significant association with that.

Speaker A

00:05:22.170 - 00:05:41.410

So that's quite interesting, I guess, and it's a bit surprising, really.

So higher actual income wasn't really associated with intentions to quit, but paying gps might make them more satisfied, but doesn't make them necessarily mean they'll stay. What do you make of that? It's kind of an interesting finding with.

Speaker B

00:05:41.410 - 00:06:00.300

Job satisfaction that's obviously kind of in line with what we would expect. Intentions to quit, maybe it's just. It's a surprising finding.

We would have expected it to have an effect on intention to quit, especially given that job satisfaction, intention to quit, go together. So it's a little contrary to what we might expect.

Speaker A

00:06:00.940 - 00:06:17.100

I think it's quite an interesting distinction, I guess, because I guess sometimes in workforce discussions, we sometimes think about pay as one answer to recruitment and retention problems. And I think what this work is showing that maybe the picture is a little bit more complicated than that, actually.

Speaker B

00:06:17.420 - 00:06:18.540

Yeah, I completely agree.

Speaker A

00:06:19.100 - 00:06:27.420

So I wanted just to move on to some of your other findings. So you found something interesting when you looked at expected income. So can you talk us through that as well?

Speaker B

00:06:27.920 - 00:07:00.990

So we find that higher expected income is associated with lower job satisfaction, and we actually find that has a small but positive effect on intentions to quit. So higher expected income has a small association with higher intentions to quit. I think there's obviously rationale for this.

Obviously it kind of goes along with the economic theory and what studies have found in other domains with things like worse mental health, with higher gaps between actual and expected income.

Speaker A

00:07:01.070 - 00:07:15.230

Yeah. So if I'm understanding that.

Right, it's not simply that earning less makes you unhappy, it's about the gap between what you earn and what you feel someone else with your experience and career stage ought to be earning. So do you think that's a fair way of thinking about it?

Speaker B

00:07:15.230 - 00:07:57.860

I think that's a very fair way of characterizing it, yeah.

Basically, if you feel that you should be earning more, even if you're on, like a salary that, say, is pretty good, or they do things like pay the bills, if you feel that you should be earning more for the stage of your career, you're at the training you've had. I mean, gps are, obviously, they have to go through a lot of training through med school, and GP training itself is quite intense.

And there's a lot of hours they have to work. So all of this builds into income expectations.

And if they feel that they're earning less than they feel they should be, that leads to feeling more likely like they want to quit or, and. Or just feel less satisfied with their job in general.

Speaker A

00:07:58.180 - 00:08:13.300

And you also looked at different groups of gps because you had this big database of these surveys. And were there any findings there that particularly stood out to you?

So differences between partner GP partners and other GPs, or between different age groups at all?

Speaker B

00:08:13.780 - 00:09:30.260

Yeah, I think the really interesting ones are probably the age groups is probably the most interesting one.

So we found that our relationship between expected income, intentions to quit was stronger in younger GPs, specifically with intentions to continue medical work abroad. For GPs aged under 40 the relationship was noticeably stronger than for the other age groups.

Yeah, younger GPs expected income seems to lead to sort of higher intentions to continue work abroad, which I guess makes sense, they're younger. But it also shows that maybe the gap between expected income and actual income might be more profound for younger GPs.

And we also found that the relationship between actual income and job satisfaction was sort of less consistent, less pronounced in younger GPs relative to GPs over 50. I thought that was quite interesting.

Maybe this is because actual income matters more to older GPs and for younger GPs, the sort of expected their expectations matter more. But it was. We thought this was interesting.

Speaker A

00:09:30.740 - 00:09:53.650

Sometimes I wonder with this idea of GP salaries, I wonder if it raises some interesting questions about transparency and salary and just.

Yeah, be interesting to get your thoughts on this and you might not have anything that you want to say about it, but do you think that GPs actually have a good sense of what other GPs earn, considering that, you know, everyone's working different roles and working patterns and hours and things like that?

Speaker B

00:09:54.210 - 00:11:37.350

I don't have to preface any of this with by mentioning that I'm not a gp. So a lot of this is things I can just talk about, things I've learned through my research and talking to colleagues who are gps.

But it feels like gps, it's harder for them to get a sense of what the income of their peers is relative to sort of to other types of doctors. Because other types of doctors, my impression is there's a bit more transparency and like sort of published rates on what these doctors are earning.

Whereas, yeah, for gps we have.

There is the review body on doctors and dentist remuneration report that does have sort of like average GP earnings, but it doesn't account for sort of session, like sessions worked or hours worked, which obviously is like, that's going to drive a lot of what, how gps, like how much gps feel they should be earning. So, yeah, it kind of feels like there, there isn't as much transparency and I think this would.

This can lead to it being harder for gps to sort of get an accurate impression on what they should earn. Yeah.

So we actually feel that, like one of the big policy recommendations from our paper or policy implications from our paper is for anything to increase transparency on GP income would be great.

Specifically as regarding sort of sessional and hourly rates, there's obviously a lot of variation in what GPs earn as well, because general practices, there's obviously these are like private businesses, so there's a lot of variation and yeah, not a lot of transparency. And all of this could lead to sort of erroneous expectations.

Speaker A

00:11:38.070 - 00:11:48.710

Yeah.

And I guess I was going to ask about sort of the practical findings and I guess, is that sort of what you think the takeaway is for policymakers or employers in terms of how they could use the findings of this work?

Speaker B

00:11:49.030 - 00:11:50.830

Yep, I think that's one of the biggest ones.

Speaker A

00:11:50.830 - 00:12:08.690

Yeah, brilliant. And I think you also make the point in the paper that improving working conditions still matters. So.

So I guess it's a sort of balance between income and how it sits along other things like workload and the administrative burden and having control over how you work as well in terms of retention.

Speaker B

00:12:09.490 - 00:12:23.330

Yeah, absolutely. Income and income expectations are only one component of this.

There's a lot of other things that are driving GP dissatisfaction as well, and intentions to quit.

Speaker A

00:12:23.900 - 00:12:32.700

And I guess, finally, if you could leave gps listening to this with one main takeaway from the study, what would you like that to be? What would you like them to sort of take from this?

Speaker B

00:12:33.500 - 00:13:29.310

Yeah, I think I'd want to say that actual income matters a lot.

I don't want to suggest that job satisfaction is an important component of working life and the quality of care that patients get, and actual income is predictive of that. So I don't want to. Basically, I don't want to suggest that actual income doesn't matter and how much GPs are paid doesn't matter.

Regarding sort of a takeaway, I think basically it's worth acknowledging that there is limited resources out there to sort of get an accurate picture of what your peers earn. I'd sort of recommend that it's worth using whatever resources you can, like the Doctors and Dentists Review Body.

I realize it's hard to get accurate expectations on what your peers are earning, so hopefully that changes in future.

Speaker A

00:13:30.030 - 00:13:49.320

That's great.

But I think that's been a really interesting study to reflect on and some interesting findings, as you say, around sort of what GPs earn, what they expect to earn, and how that feeds into job satisfaction and intention to stay in the job. So I think that's a great place to wrap things up. But I just wanted to say thank you very much.

Speaker B

00:13:49.560 - 00:13:54.040

No, thank you. Nada. And yeah, thank you so much. It was. Yeah, it was really good to talk about this.

Speaker A

00:13:54.840 - 00:14:09.480

And thank you all very much for your time here and for listening to this BJGP podcast. Ben's original research article can be found on bjgp.org and the show notes and podcast audio are@bjgp life.com thanks again and bye.

Hello and welcome to BJJP Interviews.

I'm Nada Khan and I'm the Senior Research editor at the bjjp.

Thanks for taking the time today to listen to this podcast.

In today's episode we're talking to Dr. Ben Walker.

Ben used to be based as a research fellow at the University of Manchester, but is now working as a postdoctoral associate at the University of Calgary in Canada.

We here to talk about the paper he's just published in the BJ GP that's titled Relationships of Actual and Expected Levels of Income with GP Job Satisfaction.

A Repeated Cross Sectional Study.

So, hi Ben, it's really nice to meet you and to talk about this work and I guess to start us off, I just wanted to talk a little bit about the background to this paper and it's about GP income and job satisfaction, which is clearly a topic that people have plenty of opinions about.

But what made you want to look at this question in a bit more detail?

So, yeah, it's something we had been discussing internally as a team for a while, obviously, I mean, working in a primary care group, a lot of the driving motivation for a lot of our work is the GP recruitment and retention crisis.

And we've always had, we've had this data for a while on GP income from us via our surveys.

We've also had this data on GP income expectations and this has been in the survey forever and we've never, we hadn't used anything with it and basically because a lot of us are economists as well as this concept in economics of the Easterland Paradox or the idea that relative income matters more than actual income for happiness.

And so we decided that, well, it would be like, like because we are interested in the GP recruitment and retention crisis, it would be interesting to look at the extent to which relative income matters for GP recruitment and retention.

So job satisfaction and intentions to quit being two components of recruitment and retention.

So you mentioned about a survey.

So are you talking about the GP Work Life Survey that was done through Manchester?

We are indeed, yeah.

So the GP Work Life Survey.

Yeah, yeah.

So talk us through that just briefly.

So what was that all about?

I think, I mean there have been a few publications in the BJGP about it, but what.

Who are you surveying through that?

It's been run by Manchester for I believe, all of its history and it's a government funded survey and when we do it we are attempting to a sample of the general GP population to basically ask about various things to do with their work life, including more sort of like formal things like their income and how many hours they're working, but also just how satisfied they are with their jobs, different aspects of their jobs.

Yeah, so we collect lots of data on the GP to respond, and, yeah, we aim to get as general a sample of a population as we can.

And I think one of the really interesting things about this study is that you're not just asking how much GPs actually earn, but how much they think they should earn.

And you mentioned about this paradox that you're interested in in terms of health economics, and I wonder why you think that distinction is important between actual earnings and sort of relative earnings or how much people think they should earn.

So I guess with a lot of things in life, and obviously from this economics paradox, a lot of things are not.

It's not necessarily what you have.

Absolutely.

A lot of it is driven by things like peer comparison, or if you're seeing that someone else is getting paid more for doing what you believe is like, similar amount of work or similar quality work to you.

So the idea of pure comparison's always just been like, important and there's lots of data out there and lots of studies looking at sort of the effect of absolute income.

And this just felt like another relevant dimension to explore, basically.

So I guess if we just come on to sort of the big finding.

And what did you find when you looked at actual income and GP job satisfaction?

What was sort of the main headline here?

So, for job satisfaction, we, like, we find absolute income matters quite a lot and it has higher absolute income lead generally associated with higher job satisfaction across most, if not all domains.

And for job satisfaction, absolute income matters a lot, but we found that absolute income didn't seem to have any statistically significant association with intentions to quit.

So we asked them whether or not they want to leave direct patient care within five years or leave medical work entirely in five years.

And we found that absolute income didn't have enough, didn't have a statistically significant association with that.

So that's quite interesting, I guess, and it's a bit surprising, really.

So higher actual income wasn't really associated with intentions to quit, but paying gps might make them more satisfied, but doesn't make them necessarily mean they'll stay.

What do you make of that?

It's kind of an interesting finding with.

Job satisfaction that's obviously kind of in line with what we would expect.

Intentions to quit, maybe it's just.

It's a surprising finding.

We would have expected it to have an effect on intention to quit, especially given that job satisfaction, intention to quit, go together.

So it's a little contrary to what we might expect.

I think it's quite an interesting distinction, I guess, because I guess sometimes in workforce discussions, we sometimes think about pay as one answer to recruitment and retention problems.

And I think what this work is showing that maybe the picture is a little bit more complicated than that, actually.

Yeah, I completely agree.

So I wanted just to move on to some of your other findings.

So you found something interesting when you looked at expected income.

So can you talk us through that as well?

So we find that higher expected income is associated with lower job satisfaction, and we actually find that has a small but positive effect on intentions to quit.

So higher expected income has a small association with higher intentions to quit.

I think there's obviously rationale for this.

Obviously it kind of goes along with the economic theory and what studies have found in other domains with things like worse mental health, with higher gaps between actual and expected income.

Yeah.

So if I'm understanding that.

Right, it's not simply that earning less makes you unhappy, it's about the gap between what you earn and what you feel someone else with your experience and career stage ought to be earning.

So do you think that's a fair way of thinking about it?

I think that's a very fair way of characterizing it, yeah.

Basically, if you feel that you should be earning more, even if you're on, like a salary that, say, is pretty good, or they do things like pay the bills, if you feel that you should be earning more for the stage of your career, you're at the training you've had.

I mean, gps are, obviously, they have to go through a lot of training through med school, and GP training itself is quite intense.

And there's a lot of hours they have to work.

So all of this builds into income expectations.

And if they feel that they're earning less than they feel they should be, that leads to feeling more likely like they want to quit or, and.

Or just feel less satisfied with their job in general.

And you also looked at different groups of gps because you had this big database of these surveys.

And were there any findings there that particularly stood out to you?

So differences between partner GP partners and other GPs, or between different age groups at all?

Yeah, I think the really interesting ones are probably the age groups is probably the most interesting one.

So we found that our relationship between expected income, intentions to quit was stronger in younger GPs, specifically with intentions to continue medical work abroad.

For GPs aged under 40 the relationship was noticeably stronger than for the other age groups.

Yeah, younger GPs expected income seems to lead to sort of higher intentions to continue work abroad, which I guess makes sense, they're younger.

But it also shows that maybe the gap between expected income and actual income might be more profound for younger GPs.

And we also found that the relationship between actual income and job satisfaction was sort of less consistent, less pronounced in younger GPs relative to GPs over 50.

I thought that was quite interesting.

Maybe this is because actual income matters more to older GPs and for younger GPs, the sort of expected their expectations matter more.

But it was.

We thought this was interesting.

Sometimes I wonder with this idea of GP salaries, I wonder if it raises some interesting questions about transparency and salary and just.

Yeah, be interesting to get your thoughts on this and you might not have anything that you want to say about it, but do you think that GPs actually have a good sense of what other GPs earn, considering that, you know, everyone's working different roles and working patterns and hours and things like that?

I don't have to preface any of this with by mentioning that I'm not a gp.

So a lot of this is things I can just talk about, things I've learned through my research and talking to colleagues who are gps.

But it feels like gps, it's harder for them to get a sense of what the income of their peers is relative to sort of to other types of doctors.

Because other types of doctors, my impression is there's a bit more transparency and like sort of published rates on what these doctors are earning.

Whereas, yeah, for gps we have.

There is the review body on doctors and dentist remuneration report that does have sort of like average GP earnings, but it doesn't account for sort of session, like sessions worked or hours worked, which obviously is like, that's going to drive a lot of what, how gps, like how much gps feel they should be earning.

So, yeah, it kind of feels like there, there isn't as much transparency and I think this would.

This can lead to it being harder for gps to sort of get an accurate impression on what they should earn.

Yeah.

So we actually feel that, like one of the big policy recommendations from our paper or policy implications from our paper is for anything to increase transparency on GP income would be great.

Specifically as regarding sort of sessional and hourly rates, there's obviously a lot of variation in what GPs earn as well, because general practices, there's obviously these are like private businesses, so there's a lot of variation and yeah, not a lot of transparency.

And all of this could lead to sort of erroneous expectations.

Yeah.

And I guess I was going to ask about sort of the practical findings and I guess, is that sort of what you think the takeaway is for policymakers or employers in terms of how they could use the findings of this work?

Yep, I think that's one of the biggest ones.

Yeah, brilliant.

And I think you also make the point in the paper that improving working conditions still matters.

So.

So I guess it's a sort of balance between income and how it sits along other things like workload and the administrative burden and having control over how you work as well in terms of retention.

Yeah, absolutely.

Income and income expectations are only one component of this.

There's a lot of other things that are driving GP dissatisfaction as well, and intentions to quit.

And I guess, finally, if you could leave gps listening to this with one main takeaway from the study, what would you like that to be?

What would you like them to sort of take from this?

Yeah, I think I'd want to say that actual income matters a lot.

I don't want to suggest that job satisfaction is an important component of working life and the quality of care that patients get, and actual income is predictive of that.

So I don't want to.

Basically, I don't want to suggest that actual income doesn't matter and how much GPs are paid doesn't matter.

Regarding sort of a takeaway, I think basically it's worth acknowledging that there is limited resources out there to sort of get an accurate picture of what your peers earn.

I'd sort of recommend that it's worth using whatever resources you can, like the Doctors and Dentists Review Body.

I realize it's hard to get accurate expectations on what your peers are earning, so hopefully that changes in future.

That's great.

But I think that's been a really interesting study to reflect on and some interesting findings, as you say, around sort of what GPs earn, what they expect to earn, and how that feeds into job satisfaction and intention to stay in the job.

So I think that's a great place to wrap things up.

But I just wanted to say thank you very much.

No, thank you.

Nada.

And yeah, thank you so much.

It was.

Yeah, it was really good to talk about this.

And thank you all very much for your time here and for listening to this BJGP podcast.

Ben's original research article can be found on bjgp.org and the show notes and podcast audio are@bjgp life.com thanks again and bye.