Work-time arrangements, career progression, and job satisfaction among physicians in Germany: a cross-sectional survey

Abstract Background Demographic change and evolving expectations regarding work–life balance are increasingly challenging the medical workforce in Germany. Work-time arrangements play a key role in physician job satisfaction, well-being, and career development. However, part-time and alternative working models remain unevenly implemented and are frequently perceived as limiting career opportunities. This study characterized current work-time arrangements among physicians in Germany and examined satisfaction, employer support, colleague acceptance, perceived career opportunities, barriers to reducing working hours, and work–family balance. Methods This cross-sectional study is based on an anonymous digital survey conducted by the German Medical Women’s Association between September 2022 and July 2023. Physicians across medical specialties and career stages were invited to participate. The questionnaire assessed sociodemographic and professional characteristics, work-time arrangements (full-time, part-time, and alternative models), satisfaction with current arrangements, employer support, and perceived career opportunities. Results Of the 898 respondents, 90.9% were women and 46.2% were resident physicians. Full-time employment was the most common arrangement (56.8%). Physicians working in non-full-time arrangements were more frequently satisfied with their work-time arrangement than those working full-time (52.8% vs. 45.3%; p = 0.020). Hospital-based physicians were less likely to be satisfied with their work-time arrangement (aOR 0.33) or to receive support from their employer in implementing alternative work-time arrangements (aOR 0.24). They were also less likely to report acceptance of alternative work-time arrangements among colleagues (aOR 0.21) and equal career opportunities under such arrangements (aOR 0.31), while being more likely to report difficulties balancing work and family responsibilities (aOR 2.44; all p < 0.001). Compared with physicians in leadership positions, resident physicians and board-certified physicians without leadership responsibility reported lower satisfaction and lower perceived equal career opportunities, while reporting greater difficulty balancing work and family responsibilities (all p < 0.001). Fear of negative career consequences was the most frequently reported reason for not reducing working hours (58.2%), and approximately two thirds of respondents perceived unequal career opportunities for colleagues using alternative work-time arrangements. Conclusions Although full-time employment remained the most common arrangement, respondents not working full-time reported greater satisfaction. Part-time and alternative work-time-arrangements are widely perceived as career-limiting. Addressing structural barriers and ensuring equal career opportunities for physicians who require or prefer family-friendly working conditions are essential for physician well-being, workforce retention, and the long-term resilience of healthcare systems.