Authors' response

We would like to thank Dr Billington for his interest in our article on salaried GPs.¹ As he correctly notes, job satisfaction was not on our agenda — although we do briefly comment on the results of one such study on page 21 — but, in light of the concerns raised in his letter, it clearly deserves more attention.

We know of only two studies^2,3 which have compared job satisfaction between salaried and principal GPs: neither found a significant difference in overall job satisfaction. Gosden, et al,² which is the study alluded to above, did find that salaried GPs (n = 61) in PMS pilot practices were more satisfied with their remuneration and the recognition they received for good work, compared with ‘standard contract’ GPs, but were less satisfied with their colleagues and fellow workers and physical working conditions. This study was carried out on data collected in 1998–1999, and, as yet, there is no up-to-date evidence to support or oppose Dr Billington's statement.

Economic theory predicts that all types of GP should be equally happy if the market is sufficiently open to permit movement to their position of choice (for example, principal versus salaried). Only if the market constrains GPs to one type of position would we expect to find systematic differences in job satisfaction. It is unclear if such market constraints exist or are becoming apparent, for if they do, Dr Billington's concerns would be sustained.