What Primary Care Physicians in Germany Consider Meaningful and Meaningless Work: A Qualitative Interview Study Using Reflexive Thematic Analysis

Abstract

Background Germany faces a critical shortage of primary care physicians (PCPs). A protective factor against job turnover is the experience of meaningful work. While the presence of meaning fosters work engagement and well-being, its absence can lead to career exit. This qualitative study explores perceptions of meaningful and meaningless work among German PCPs to inform health policies and help minimize career exit.

Methods We implemented a qualitative study design, conducting online, one-on-one, semi-structured interviews with 24 PCPs practicing across Germany. Participants were recruited through purposive and snowball sampling to ensure a representative sample. We evaluated the data using reflexive thematic analysis.

Results We generated five central themes. Meaning is derived from realizing professional identity through autonomous medical expertise (theme 1) and cultivating trust-based, long-term patient relationships on an equal footing (theme 2). Conversely, meaninglessness arises through unrealistic patient expectations and physicians’ experiences of frustration (theme 3), and systemic devaluation through administrative burdens and inadequate compensation (theme 4). The resulting disillusionment (theme 5) increases the risk of career exit.

Conclusions Our findings show that the projected PCP shortage in Germany may stem in part from a “crisis of meaning”. Current billing structures prioritize high-volume transactional encounters, which obstruct the very tasks that PCPs find meaningful. To ensure workforce stability, policy reforms must move beyond individual resilience and address these systemic drivers of meaninglessness.