WORKING CONDITIONS AND SATISFACTION WITH WORKING CONDITIONS AMONG 
SLOVENIAN FAMILY MEDICINE TRAINEES: A CROSS-SECTIONAL STUDY
Klemen PAŠIĆ1,2, Vojislav IVETIĆ1,3*
1University of Maribor, Faculty of Medicine, Department of Family Medicine, Taborska ulica 8, 2000 Maribor, Slovenia
2MEDIKUS d.o.o., Cesta k Dravi 8, 2241 Spodnji Duplek, Slovenia
3SAVA MED d.o.o., Cesta k Dravi 8, 2241 Spodnji Duplek, Slovenia
Received: Feb 20, 2021
Accepted: Jun 30, 2021
Original scientific article
*Corresponding author: Tel. + 386 2 620 2490; E-mail: vojislav.ivetic@um.si
10.2478/sjph-2021-0032 Zdr Varst. 2021;60(4):237-243
237
DELOVNE RAZMERE IN ZADOVOLJSTVO Z NJIMI MED SLOVENSKIMI 
SPECIALIZANTI DRUŽINSKE MEDICINE: PRESEČNA ŠTUDIJA
© National Institute of Public Health, Slovenia. 
Pašić K, Ivetić V. Working conditions and satisfaction with working conditions among Slovenian family medicine trainees: a cross-sectional study.  
Zdr Varst. 2021;60(4):237-243. doi: 10.2478/sjph-2021-0032.
ABSTRACT
Keywords: 
family medicine, 
primary healthcare, 
trainees, working 
conditions, satisfaction
IZVLEČEK
Ključne besede: 
družinska medicina, 
primarno zdravstveno 
varstvo, specializanti, 
delovne razmere, 
zadovoljstvo
Introduction: In order to achieve a high standard in training programmes for future family medicine specialists, 
it is essential to have good tutors with well-organised family medicine practices. Proper working conditions for 
young doctors are essential for their satisfaction and future professional development. The aim of our study 
was to check the current working conditions of family medicine trainees in the practical modular part of the 
training programme in Slovenia, and to determine their satisfaction with working conditions.
Methods: A cross-sectional study was conducted. The data was collected through a questionnaire distributed to 
105 family medicine trainees undergoing the practical modular part of their training programme.
Results: The study showed that the following 7 out of 25 organisational and labour law factors are significantly 
associated with a trainee’s general satisfaction with working conditions: the location where work with patients 
takes place, the privacy of the premises, the accessibility of the main tutor, a constant patient population, 
suitable places for rest, paid out-of-hours substitutions, and appropriate pay grade.
Conclusion: The results we obtained can be used to address certain aspects of trainees’ working conditions 
in Slovenia that need improvement. By determining which working conditions significantly affect a trainee’s 
satisfaction, we have the opportunity to modify these conditions and thereby improve the training programme. 
This could result in a less stressful and more efficient residency programme.
Namen dela: Družinska medicina predstavlja enega od ključnih dejavnikov organizacije vsakega modernega 
in kakovostnega zdravstvenega sistema. Ob tako pomembni nalogi, ki jo v zdravstvenemu sistemu skuša 
uresničevati družinska medicina, je smiselno pričakovati ustrezne delovne razmere, ki vključujejo tudi 
kakovostno izobraževanje bodočih specialistov družinske medicine. Pri tem so izjemnega pomena dobri mentorji 
in primerna organizacija ustanove, ki lahko mlademu zdravniku v svojih ambulantah zagotovi ustrezne pogoje 
dela. Namen naše raziskave je bil preveriti delovne razmere slovenskih specializantov družinske medicine v 
ambulantno-modularnem delu specializacije in izmeriti njihovo zadovoljstvo delovnimi razmerami.
Metode: Uporabili smo presečno obliko študije. Podatki so bili zbrani z tridelnim vprašalnikom, ki je bil 
razdeljen 105 slovenskim specializantom družinske medicine (v tem trenutku 29,75 % vseh specializantov 
družinske medicine v državi) v ambulantno-modularnem delu specializacije. Prvi del vprašalnika se je nanašal 
na sociodemografske značilnosti specializantov družinske medicine, drugi del pa na delovne razmere, v katerih 
opravljajo program specializacije. Poudarek je bil na mentorstvu, zagotavljanju ustreznih prostorov in opreme 
za diagnostiko ter redno delo, ureditvi ustrezne zasebnosti pri delu, srečanju z regionalnim koordinatorjem, 
uporabi računalnika, ustreznih izobraževanjih, uporabi poklicnih kartic, ustreznem plačnem razredu ipd. Tretji 
del ankete je vseboval vprašanja o zadovoljstvu zaposlenih (notranji odnosi, motivacija in zavzetost, občutek 
pripadnosti instituciji, struktura organizacije, strokovna usposobljenost in učenje, zavedanje poslanstva, vizije 
in ciljev, notranja komunikacija in informacije).
Rezultati: Raziskava je pokazala, da je naslednjih 7 od 25 organizacijskih in delovnopravnih dejavnikov 
pomembno povezanih s specializantovim splošnim zadovoljstvom delovnimi razmerami: lokacija dela s pacienti, 
zasebnost prostora, dostopnost glavnega mentorja, stalnost populacije bolnikov, ustrezen prostor za odmor, 
plačana nadomeščanja izven delovnega časa in ustreznost plačnega razreda.
Zaključek: V raziskavi smo predstavili delovne razmere slovenskih specializantov družinske medicine v 
ambulantno-modularnem delu specializacije. S pridobljenimi rezultati lahko opozorimo na določena slabša 
področja delovnih razmer specializantov in s tem vplivamo na njihovo izboljšanje. Ugotovili smo, katera 
področja delovnih razmer pomembno vplivajo na zadovoljstvo specializantov družinske medicine v Sloveniji 
ter s tem pridobili priložnost za predlaganje sprememb in s tem izboljšanje samega programa usposabljanja. 
Posledično bi lahko povečali učinkovitost poteka specializacije in predvsem zmanjšali stres pri specializantih.
1 INTRODUCTION
In their work, family medicine physicians (FMPs) use a 
comprehensive approach and specific problem-solving 
methods leading to person-centred healthcare and 
concurrent management of several problems (1, 2). The 
healthcare system in Slovenia, like in most European 
countries, considers the FMP to be a gatekeeper and 
coordinator, in line with the principles of the World 
Health Organization (3), thus imposing on them a great 
responsibility towards their patients. Since 1992, the 
FMP’s private practices have provided equivalent and 
equal services to those provided by public healthcare 
institutions (3).  
Employee satisfaction refers to a distinctly positive 
emotional state resulting from how an employee perceives 
work, how they understand and consider their working 
environment and their work experience, and the way they 
comprehend all the elements of their work and job (4). These 
perceptions are influenced by the work itself, co-workers, 
superiors, salary, etc. (5). Different authors provide various 
definitions of work satisfaction factors (5, 6). Good working 
conditions and appropriate high-quality work assets act as 
a motivating force for employees (7, 8). The studies also 
reveal many work-related motivational factors (9).
In the course of a young physicians’ education, tutorship 
is essential, since several studies have demonstrated the 
tutor’s impact on the future career of a student or physician 
(10, 11, 13). A better tutor-trainee relationship positively 
impacts the trainee’s subsequent career (12, 14, 15) and 
improves clinical abilities (16-21). On the other hand, a 
dysfunctional relationship with the tutor might negatively 
impact the trainee’s professional development (17). 
In Slovenia, completed specialist training in family 
medicine has been mandatory since 2000 for independent 
work at a family medicine practice (22). According to 
the current programme in force since 2015, the training 
lasts for 4 years, of which 2 years are for the clinical 
hospital rotation and 2 years for the practical modular 
part (practical work in family practice with 20 educational 
courses – two days per month) (3). For a family medicine 
trainee (FMT) in Slovenia, working with a main tutor is 
mandatory throughout the specialist training, both during 
the clinical part and during practical work in family 
practice (3). Competent performance by FMTs can only 
be realised in medical practice when many different 
conditions are met (3, 23).
Detailed studies outlining the working conditions for FMTs, 
either in Slovenia or other countries, were not available 
during our study while the literature was being reviewed. 
The purpose of our study was to determine working 
conditions for the FMTs during their work at family 
practices and establish the level of FMTs’ satisfaction with 
their working conditions.
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2 METHODS
2.1 Study design
This was a cross-sectional study. A three-part questionnaire 
was used for data collection. 
The first part of the questionnaire concerned the 
sociodemographic characteristics of the responding family 
medicine trainees. We inquired about gender, age, marital 
status, location of medical studies, employment and work 
at the community health centre or practice with the 
concession (individual contractors with National health 
insurance), employment of the main tutor, number of 
trainees at the institution or concessionaire, and number 
of trainees overseen by the main tutor.
The second part enquired about the trainee’s working 
conditions. The focus was on the tutorship, provision 
of suitable premises and equipment for diagnostics 
and regular work, level of appropriate privacy at work, 
meeting with the regional coordinator for specialization 
of family medicine, computer use, appropriate training, 
professional card (national ID card for healthcare 
professionals) use, appropriate pay grade, etc.
The third part of the employee satisfaction survey 
contained a part of the questionnaire on employee 
satisfaction in the model practice (MP) (24), prepared by 
the MP project council (24). A model practice is a family 
medicine practice additionally employing a registered nurse 
providing more effective management and monitoring of 
chronic patients and provision of preventive check-ups 
for patients aged over 30 (24).  27 statements were used 
concerning the organisational atmosphere to investigate 
its various dimensions (internal relations, motivation 
and commitment, sense of belonging to the institution, 
structure of organisation, professional competence and 
learning, being aware of the mission, vision and goals, 
internal communication, and information). 
A direct question regarding the satisfaction with working 
conditions was also asked. Opinions regarding the 
statements in this part were specified using the level of 
agreement, such as the five-point Likert scale (ranging 
from 1 = strongly disagree to 5 = strongly agree).
Following the example of another studies (29, 31), the 
adequacy of working conditions was defined according 
to spatial requirements, the availability of necessary 
equipment, and the requirements of the specialist 
training. Further on, the differences in the trainee’s 
general satisfaction with working conditions in relation to 
specified working conditions were analysed based on the 
pre-specified adequacy values.
A family medicine trainee should have properly equipped 
premises available and providing a suitable degree of 
privacy. The following issues are important: access to 
their own computer, protective clothing, a constant 
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patient population, their own location for work, 
appropriate consultation, and the internet, as well as 
completing appropriate training modules before starting 
work (occupational safety, fire safety, hospital infections, 
etc.), time to rest (annual leave, lunch breaks, etc.), and 
whether they work during their entire specialist training 
as a substitute, on behalf of someone else. In the latter 
case, the option of following up on work quality is lost, 
which prevents the advancements in knowledge and the 
mastery of competencies set out by the specialist training 
programme (4, 9).
2.2 Selection of study subjects
During data collection (between September 2016 and 
December 2016), 353 family medicine trainees were 
working in Slovenia. The analysis included 105 trainees 
who had been randomly chosen among all 353 (29.75%) 
Slovenian family medicine trainees. 93 of them were 
invited to participate while they were undergoing the 
practical modular part of their specialist training – 
members of modular groups 17, 18, 22, 23 (trainees from 
all Slovenian regions). An additional 12 trainees were 
included from the Maribor region at the time their regional 
meeting took place (which is also a mandatory part of 
the practical specialist training module). The trainees 
completed anonymous paper-based questionnaires. We 
also obtained participants’ verbal informed consent for 
their participation in our study. Everyone participated 
who had been invited to participate or received the 
questionnaire.
2.3 Statistical analysis
Statistical data analysis was performed using the IBM SPSS 
20.0 statistical package.  In accordance with the standards 
of statistical analysis, critical examination of the raw data 
and a logical control procedure was performed. During our 
critical examination, there was no replacement of missing 
values. The statistical significance level was set at 5% 
(p<0.05). Basic descriptive statistics were used to analyse 
the basic profile of family medicine trainees. In order to 
check the study questions, depending on the specified type 
of variables and on the (non-)normality of distribution, 
corresponding parametric and non-parametric tests were 
used, such as the t-test, x2 test, Mann-Whitney test and 
Kruskal-Wallis test. The Shapiro-Wilk and Kolmogorov-
Smirnov tests were used to verify the normality of data 
distribution. Adjusted standardised residuals were used to 
determine categories that considerably contribute to the 
significance of differences.
3 RESULTS
3.1 Sociodemographic characteristics of trainees
The average age of the responding trainees was 29.8 years 
(min. 25, max. 45). 22.1% (n=17) were 29 years old. The 
proportion of women among the trainees was high, 84 
out of 105 (80%). Sociodemographic characteristics are 
provided in Table 1. 
 
Gender 
Male 
Female
Year of specialist training 
First 
Second 
Third 
Fourth
Environment of the practice 
Urban 
Suburban 
Rural
I am employed
at the community health 
centre and I work at the 
community health centre
at the community health 
centre and I work at 
the concessionaire
at the concessionaire and 
I work at the community 
health centre
at the concessionaire and I 
work at the concessionaire
Main tutor location
at the community 
health centre
at the concessionaire
 
21 
84
 
45 
17 
37 
6
 
50 
27 
27
88 
 
2 
 
1 
 
14 
81 
24
 
20.0 
80.0
 
42.9 
16.2 
35.2 
5.7
 
48.1 
26.0 
26.0
83.8 
 
1.9 
 
0.9 
 
13.3 
77.1 
22.9
Table 1. Sociodemographic characteristics of FMTs.
Number (n) Proportion (%)
3.2 Basic characteristics of family medicine trainees 
according to working conditions
The overview of the basic characteristics of FMTs according 
to working conditions showed that on average there 
were 3–4 trainees per institution (30.5%), and 2 per main 
tutor (44.8%). A considerable majority of trainees work 
at a family medicine practice (87.6) and have more than 
2,000 registered patients (50.5%); on average, they see 
between 40 and 50 patients per day (32.4%). 92.3% have 
access to their main tutor for consultation, of which 75.2% 
work in parallel with their main tutor. Almost a quarter 
of trainees had not met their regional coordinator. Forty-
three percent still rotate between different practices, but 
they are, on average, well-equipped and have a computer 
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(94.3%) and telephone (94.3%) available, and are provided 
adequate privacy (82.9%). As a result, only 54.8% of the 
trainees work with a constant patient population. Apart 
from their regular work, 68.3% of the trainees also provide 
paid substitutions for other colleagues. Only slightly more 
than a half (55.8%) are categorised at an appropriate pay 
grade and 73.3% receive a correctly calculated monthly 
salary.
3.3 General satisfaction with working conditions in 
the practice
On a scale of one to five, 18.1% (n=19) of FMTs rated their 
satisfaction with the highest rating of five and no trainees 
appeared to be extremely unsatisfied, as no one rated 
it a one. The average rate of satisfaction with working 
conditions in the practice was 3.8. In relative terms, most 
FMTs, 47.6% (n=50), rated the working conditions in the 
practice with a rating of four.
3.4 Analysis of satisfaction with working conditions in 
the practice 
The following working conditions (18 to 25) were not 
significantly associated with the general satisfaction of 
FMTs (Table 2).
Out of 25 working conditions, 7 are significantly associated 
with the trainee’s general satisfaction with working 
conditions (Table 3).
Work location
Number of patients registered
Average daily number of patients seen
Selected patients
Meetings with the regional coordinator
Access to a useful computer
Access to a useful telephone
(Non)use of computer in the practice 
 
Mandatory trainings passed
 
 
 
 
 
Professional card use
Stamp use
Use of an appropriate uniform
Availability of equipment at the institution
Availability of equipment at the practice
Internal training courses
Additional funds for education
Travel expenses allocated for modules
Correct calculation of monthly salary
χ2=3.707; df=3; p=0.295
χ2=0.407; df=2; p=0.816
χ2=6.525; df=4; p=0.163
χ2=3.786; df=3; p=0.285
 
 
 
 
 
 
 
χ2=2.061; df=2; p=0.357 
χ2=0.204; df=1; p=0.652
χ2=2.688; df=3; p=0.442
χ2=2.815; df=3; p=0.421 
χ2=3.030; df=2; p=0.220
χ2=3.052; df=2; p=0.217; 
U=444.500; p=0.107
U=1309.500; p=0.907
U=1225.000; p=0.447
U=1009.500; p=0.453
U=1128.000; p=0.091
U=225.000; p=0.283
U=184.000; p=0.092
p=0.807  
(the latter is significantly associated with using 
computer for email consultations, p=0.040)
a. occupational safety: Mann-Whitney test 
of differences: U=760.500; p=0.293 
b. fire safety: Mann-Whitney test of 
differences: U=910.500; p=0.082 
c. training course on hospital 
infections: Mann-Whitney test of 
differences: U=1142.000; p=0.284 
d. pre-employment physical exam: Mann-
Whitney test of differences: U=289.000; p=0.976
U=608.500; p=0.319
U=516.500; p=0.652
U=868.500; p=0.101
U=477.500; p=0.655
U=252.500; p=0.507
U=551.000; p=0.939
U=942.500; p=0.256
U=705.000; p=0.230
U=199.000; p=0.144
Table 2. Working conditions not significantly associated with the general satisfaction of FMTs.
KRUSKAL-WALLIS TEST OF DIFFERENCES MANN-WHITNEY TEST OF DIFFERENCESWORKING CONDITIONS
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Location where work with 
patients takes place
Privacy of premises
Main tutor accessibility
Constant patient population
Suitable place for rest
Paid out-of-hours substitutions
Appropriate pay grade
χ2=9.224; df=3; p=0.026 
χ2=10.487; df=3; p=0.015
χ2=14.259; df=5; p=0.014
U=523.000; p=0.017 
U=485.000; p=0.006
U=380.000; p=0.001
U=444.000; p=0.011
U=713.500; p=0.002
U=355.000; p=0.011
Table 3. Working conditions significantly associated with the general satisfaction of FMTs.
KRUSKAL-WALLIS TEST OF DIFFERENCES MANN-WHITNEY TEST OF DIFFERENCESWORKING CONDITIONS
Of note, concerning the working condition “additional 
funds for education”, the highest level of satisfaction (avg. 
3.89) with working conditions was expressed by those 
FMTs who were not aware that there are additional funds 
for education available (!), while the lowest (avg. 3.33) by 
those whose additional funds were spent by the employers 
themselves.
Further contextual data to support interpretation for 
readers outside Slovenia is available from the authors.
4 DISCUSSION
The purpose of the study was to check the current working 
conditions of FMTs in the practical modular part of the 
specialist training, and to correlate working conditions 
with the general satisfaction of FMTs. Given the important 
role of family medicine in the healthcare system (32), 
appropriate working conditions are to be expected, 
including working environments in which future family 
medicine specialists further their education. Seven out of 
25 organisational and labour law factors (location where 
work with patients takes place, privacy of the premises, 
main tutor accessibility, constant patient population, 
suitable place for rest, paid out-of-hours substitutions and 
appropriate pay grade) are significantly associated with 
a trainee’s general satisfaction with working conditions 
(Table 3). The data obtained constitute a solid basis for 
improving the organisation and training within specialist 
training programmes in the future.
One of the main findings of our study is that seven out 
of 25 working conditions are significantly associated 
with the general satisfaction of FMTs with their working 
environment. Regarding the “location where work with 
patients takes place” and “privacy of premises”, our 
results show that appropriate premises are significantly 
associated with the trainee’s general satisfaction with 
working conditions. Similar studies indicate that patient 
privacy is also essential (3). The studies show that patient 
satisfaction is higher when consultations are private (25). 
As a result, physicians themselves are more satisfied. 
Our results also indicate the significance of “main tutor 
accessibility”. It is interesting to note that trainee 
physicians working in person with their direct tutor 
achieve comparatively higher levels of satisfaction with 
working conditions compared to those whose main tutor is 
only available by phone. Similar associations regarding the 
improved satisfaction of medical students were likewise 
demonstrated in a study on a curricular reform that also 
entailed better access to tutors (33). “Working with a 
constant population” is one of the important features 
of a family physician’s work, which is also supported by 
our results. Previous studies also show improved patient 
satisfaction when patients are always managed by the 
same physician (26). The consistency of care leads to 
a better doctor-patient relationship, which results in 
greater patient satisfaction (26). Some parallels are also 
evident with respect to a study that compared experience 
with specialist training between full-time and part-time 
employees. Satisfaction of part-time employees was lower 
(27). A “suitable place for rest” also proved to be an 
important factor for higher FMT satisfaction with working 
conditions. Based on the literature, which theoretically 
underlines the importance of a place for rest, the above 
result was expected (6). Regarding “paid out-of-hours 
substitutions”, the result was also expected, since similar 
studies indicated increased employee satisfaction levels 
when overtime work or substitutions were properly 
paid (28). Furthermore, in our study, paid out-of-hours 
substitutions proved to be significantly associated with 
the FMTs’ general satisfaction with working conditions. 
Like the preceding observation, the “appropriate pay 
grade” result can be compared to similar studies, 
which also indicate that the appropriate pay grade is 
significantly associated with satisfaction (29). Our results 
show that increasing levels of irregularity in calculating 
monthly salaries lead to decreasing trainee satisfaction 
with general working conditions, which is comparable to 
similar studies (30).
A strength of our study is its relatively large sample size, 
i.e. 105 out of 353 (29.75%) of all Slovenian FMTs took 
part in the study. Another positive aspect is that the 
FMTs were highly motivated to participate in our study, 
i.e. 105 out of 105 (100%) participated. Some weaknesses 
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of our study might be relative subjectivity regarding 
the criteria for suitable working conditions in terms of 
spatial requirements, necessary equipment, and the 
requirements of the specialist training course (Table 1), 
although the studies conducted so far were taken into 
account (3, 31, 34). Another possible disadvantage of our 
study is the method of sample selection (randomly chosen 
modular groups and regional meetings, consequently only 
trainees from them) and time lag from data collection 
to publication. We are also aware of the challenges 
associated with multiple statistical testing in our data set. 
 
5 CONCLUSION
In our study, we investigated the current working 
conditions of family medicine trainees in the practical 
modular part of their specialist training. The study shows 
that even an exceptionally well-devised specialist training 
programme does not necessarily lead to good practical 
implementation. The opinions expressed by the trainees, 
their satisfaction with working conditions, and the 
implementation of the programme constitute a starting 
point for all stakeholders involved in the educational 
process of family medicine specialist training to improve 
the key factors for successful FMT training. The results 
of our study, which is the first of its kind in Slovenia, are 
useful for improving the existing programmes of clinical 
practice and family medicine specialist training, both in 
terms of organisation and content, in Slovenia and beyond. 
Our results also can be a good basis for the development 
of quality criteria for the accreditation of training sites. 
Our results are valuable in terms of investigating the 
family medicine trainee programmes in Slovenia, thus 
opening new avenues of study on this subject.
ACKNOWLEDGMENTS
The authors want to thank Ms. Smerkolj and Ms. Hadler for 
reviewing the English language of the manuscript, and to 
Prof. Zalika Klemenc Ketiš for the useful advice during the 
preparation of this article.
DECLARATION OF INTEREST
The authors declare that there are no conflicts of interest. 
The authors alone are responsible for the content and the 
writing of the paper.
FUNDING
This research received no specific grant from any funding 
agency in the public, commercial, or non-profit sectors.
ETHICAL APPROVAL
The study was approved by the National Medical Ethics 
Committee of the Republic of Slovenia, Decision No. 0120-
493/2016-2 dated 16 Feb 2017.
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