[The opinions of Belgian physicians about their practice].

Questions: Considering the numerous changes in the health system, do medical doctors (MDs) feel difficulties in practising their profession? Are there complaints regarding the fact that the "medical chart" is in danger? Is Herzberg's theory about factors of satisfaction confirmed?

Method: Qualitative analysis of MDs' spontaneous comments, stated at the end of a postal survey (MDs of the French speaking universities of Belgium, settled since 5 to 10 years or 15 to 20 years): 5 546 were contacted in 1999 and 2040 answered; 862 provided comments about their career and/or about their feelings regarding their profession (the latter theme had not been specifically addressed by the main survey). Most comments were issued by practitioners providing care: 296 general practitioners and 396 specialists; the remaining physicians perform other types of activities in the health system (prevention, teaching, research, management, ...): they number 170.

Results: A large diversity of careers; a few typical patterns are noticeable. Several satisfactions, which are largely outnumbered by the amount of complaints: onerousness, lack of collaboration, patients' requirements, bureaucracy, political interference, insufficient fees, lack of family- and private life and, mainly for specialists, shortcomings of training and problems with the hospital administration. Complaints about the medical chart are absent. Herzberg's theory holds true partially: among positive comments, "hygiene factors" are as frequent as aspects related to the content of work.

Interpretation: 1) The evolution of relations with the patients is probably not only due to the changes within the health sector; other factors are also to be scented, e.g the difficulty of a) bearing uncomfortable working conditions within an hedonistic culture and b) meeting the various challenges proposed by diverse paradigms regarding the norms of good practice. 2) The previous importance of the medical chart enters in conflict with worries more down to earth. 3) All the positive comments do not reflect a large satisfaction: some are rather relative, regarding an improvement compared with a worse situation in the past or with difficulties endured by colleagues.