Table 2.

Determinants of well-being—verbatim quotes

Quote	Themes Subthemes	Verbatim data (participant code)
a	Identity/self Well-being beliefs, intentions and behaviour	‘… I think it’s probably a case of the medical profession has lost control of wellbeing and it’s now the domain of Instagram influencers. … I think wellbeing as a principle is what we've been trying to do for years’. (GP9)
b	Identity/self Exercise, nutrition social connection, leisure, hobbies	‘So that’s probably exercise, and eating healthy, and being with friends and family is probably what keeps me well. … I suppose having your work/life in balance, and still being able to function at work at an optimal level, and still be able to maintain all your responsibilities outside of work, with family and recreation, I suppose. And being happy with both aspects of your life’. (GP18)
c	Identity/self Responsibility, expectations, sense of duty	‘You know, you’ve just got to be professional. Doesn’t matter how you’re feeling, doesn’t matter what’s happening. Work is work. And, if you don’t, bad things happen’. (GP5)
d	Identity/self Ability, high achiever, performance, resilience	‘I expect myself to be more resilient [than others]. And I expect myself to cope with hardships’. (GP8)
e	Identity/self Variation of work roles	‘If I work five, six, seven days [per week] in a general practice it really starts to affect you mentally. So, mixing it up is a fantastic way of keeping sane’. (GP5)
f	System Specialisation	‘The other things around the health system that I find very difficult and concerning, … is the proliferation of sub-, sub-, super-specialists. … That puts an incredible strain on you as a GP because now suddenly, like a GP is supposed to know everything. … You know, you’re a sub-doctor in everything, or you’re less of a doctor in everything because here these super-specialists telling you about the micro-details of how you should manage this one. But it also creates this huge gap. You’re the generalist, and the next step is to this super-specialist’. (GP14)
g	Organisation Team and peer support	‘I think that’s one of the most common causes of stress, depression, and mental illnesses in other practices, not having a good relationship with other GPs. … Belittling the other GP, and telling the patients that the other GP isn't good enough, or things like that. Or going against the medical advice of the other GP, even though that may have been correct, you know, trying to win over the patient, things like that’. (GP13)
h	Organisation Local differences team and peer support	‘And I feel quite strongly that general practice, particularly in [a metro area], is in a really bad state in relation to the lack of collegial relationships that most GPs have. And I really sense that moving from [a regional area], you know I came from—I worked in two separate practices as a registrar, with huge, big tearooms. We’d all sit down for like a one-and-a-half-hour lunch, just chat, connect, all that stuff. And then, I came back to [a metro area], and started going to interviews, and I said to everybody, like, ‘Where are your tearooms? Where do you guys have lunch?’ And they said, ‘Oh, I don’t know. Well, we were going to put a tearoom in, but we decided that, you know, we couldn’t really afford it. We just had to put another consulting room in’. Or others were like, ‘Well, I think the doctors just eat at their own table.’ And so, that I found really shocking. And I know that it’s, it’s just one thing. But I think that that really symbolizes just how much of a commodity that the general practitioner is seen as. You know, in most urban contexts… is you just come in, you sit at your table, you see the patients, and you go home. And I think that there’s a huge cost to that. You know that you’re, that you’re not having those, you know, informal chats over morning or lunch’. (GP12)
i	Profession Advocacy and representation	‘And I do find that the college is completely useless at sticking up for GPs. I refuse to join them. I find them very frustrating. They don’t, in my opinion, act as a good voice for us. So, mostly I work around them’. (GP6)
j	System Value, understanding, support	‘Maybe people who go into politics of general practice really have forgotten the basics. Yes, I think ‘naïve’ is the word. I don’t think they have a great idea of the day to day’. (GP10)
k	System Value, understanding, support	‘… With the vaccination programme … we weren’t regarded as frontline workers, and we did Covid testing. We treat people with respiratory illness. And so, that was kind of—I think that was a diminishing thing, really, apart from you know, not feeling protected’. (GP16)
l	System Audits, complaints, liability	‘This complaint, and all the other ones I've had, and other people I’ve seen … There should be some sort of triage system [within the HCCC, Health Care Complaints Commission] where the crap is weeded out, to reduce the stress on GPs, and other doctors, and save time. And at the same time not discouraging complainants, but perhaps it could be dealt with at a lower level’. (GP20)
m	System Audits, complaints, liability	‘The other thing that can affect you, is probably if you get a few patient complaints to HCCC and AHPRA, or to the board. That actually brings your morale down quite a lot. It’s one of the easiest things to complain against a doctor. You know, we’re all soft targets’. (GP13).
n	System Patient expectations	‘Patients think that they can come in, and see you, and have a great amount of things dealt with. And if you deal with three of the sixteen things, they walk away feeling unhappy, even though they’ve booked 15 minutes [consultation]’. (GP20)
o	Finances System	‘But the wellbeing that GPs achieve, is by their own measures, and they are to counteract the negative pressures that come from outside this [consult] room. So … the forces that are negative, are Medicare, and the way GPs are treated. Like the telehealth items are just going to be cut … ECGs [electro-cardiograms], that item was just cut. Joint injections, they were just cut’. (GP9)
p	Finances Organisation	So, [we are] private billing … with discretion, so that there will be some patients that, you know, we’ll bulk bill. But generally—And, I always have that mindset that I’m not going to undervalue myself. Otherwise, yeah, you know, yeah … And I think my patients have appreciated, that I do that extra bit for them and, you know, and they appreciate what they get. So, but I still will get occasional patients who will try [to get bulk billing]’. (GP15)
q	Finances Organisation	‘One of the things I like about a bulk billing practice, and it’s good, I think, for my wellbeing—I have worked at some practices that charge. I hated the stress at the end of every consult where someone would be saying, “Please, can you just bulk bill me”? or “I just can’t pay this week”. And honestly, it was a very stressful situation at the end of every consult …’ (GP2)
r	Finances Personal	‘Ahhm, I think GPs themselves hinder themselves. … I think doctors’ knowledge and understanding of Medicare, or GPs’, is often appalling. … They claim wrongly, they act poorly, they spend the public money poorly, and they’re scared of things they shouldn't be scared of, or conversely, they’re not scared of things they should be scared of. I think it’s GPs themselves, not Medicare. … It is ridiculous, because if you're a bulk billing GP your entire income is based on understanding that system, how can you possibly derive your income without understanding it? … There is tons of information, Medicare videos, tutorials, loads of stuff on there, regular webinars. GPs do not educate themselves, it’s their fault’. (GP4)
s	Finances Personal	‘And obviously, none of us get maternity leave from work. … So financially, it’s a huge source of stress, because—I’m lucky that my wife, who’s also a doctor, works in the hospital system. She’s put on and off about getting into general practice. Quite frankly, one of the things that puts her off is maternity leave and the thought of being completely unsupported by, you know, national government or any other organisation, if we were to take time off work’. (GP1)

This table contains further verbatim quotes (overflow table) in addition to those embedded in the text.

Bulk billing, Medicare rebates cover practitioner charges (no out of pocket fees for patients); HCCC, Healthcare Complaints Commission; PHNs, Primary Care Networks.