Open Access Open Badges Research article

Physicians’ perceptions of quality of care, professional autonomy, and job satisfaction in Canada, Norway, and the United States

Reidar Tyssen1*, Karen S Palmer2, Ingunn B Solberg1, Edgar Voltmer3 and Erica Frank4

Author Affiliations

1 Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, PO Box 1111, Blindern, Oslo NO-0317, Norway

2 Faculty of Health Sciences and Faculty of Science, Simon Fraser University, Burnaby, BC, Canada

3 Department of Health and Behavioural Sciences, Friedensau Adventist University, Möckern-Fridensau, Germany

4 School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada

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BMC Health Services Research 2013, 13:516  doi:10.1186/1472-6963-13-516

Published: 15 December 2013



We lack national and cross-national studies of physicians’ perceptions of quality of patient care, professional autonomy, and job satisfaction to inform clinicians and policymakers. This study aims to compare such perceptions in Canada, the United States (U.S.), and Norway.


We analyzed data from large, nationwide, representative samples of physicians in Canada (n = 3,213), the U.S. (n = 6,628), and Norway (n = 657), examining demographics, job satisfaction, and professional autonomy.


Among U.S. physicians, 79% strongly agreed/agreed they could provide high quality patient care vs. only 46% of Canadian and 59% of Norwegian physicians. U.S. physicians also perceived more clinical autonomy and time with their patients, with differences remaining significant even after controlling for age, gender, and clinical hours. Women reported less adequate time, clinical freedom, and ability to provide high-quality care. Country differences were the strongest predictors for the professional autonomy variables. In all three countries, physicians’ perceptions of quality of care, clinical freedom, and time with patients influenced their overall job satisfaction. Fewer U.S. physicians reported their overall job satisfaction to be at-least-somewhat satisfied than did Norwegian and Canadian physicians.


U.S. physicians perceived higher quality of patient care and greater professional autonomy, but somewhat lower job satisfaction than their colleagues in Norway and Canada. Differences in health care system financing and delivery might help explain this difference; Canada and Norway have more publicly-financed, not-for-profit health care delivery systems, vs. a more-privately-financed and profit-driven system in the U.S. None of these three highly-resourced countries, however, seem to have achieved an ideal health care system from the perspective of their physicians.