This cross-sectional study offers valuable insights into patient satisfaction with outpatient services at a peripheral public medical college hospital in Bangladesh. Male gender, suburban residence, business occupation, positive prior healthcare experiences, and favorable perceptions of management quality and administrative efficiency independently increase outpatient care utilization satisfaction. Conversely, upper-middle-class socioeconomic status significantly decreases satisfaction. Therefore, patient satisfaction in Bangladesh’s resource-limited public hospital settings is affected by various factors, including demographic, experiential, and institutional aspects.

Our finding that male patients reported 79% higher satisfaction than females (AOR = 1.79) resonates with gendered care gaps across South Asia, where systemic biases limit consultation time and privacy for women [14,15]. This underscores the imperative for gender-transformative training—not merely ‘sensitive’ approaches—to dismantle entrenched inequities. Notably, upper-middle-class patients expressed significantly lower satisfaction than lower-income counterparts, aligning with recent regional analyses [17]. This may reflect heightened expectations arising from greater health system familiarity and prior exposure to private healthcare services, despite socioeconomic advantages. Similarly, suburban residents reported higher satisfaction than rural patients, corroborating studies from Nepal and Sri Lanka [12,14,18] that identify perceived inefficiency and disrespect in rural public healthcare delivery.

The study also found that business professionals and employed individuals had higher odds of satisfaction than students. This may reflect different expectations and thresholds of acceptability among various employment groups, as students may be more sensitive to delays or less empowered to demand respectful treatment. Comparable results from a Sri Lankan cross-sectional study suggested that occupational status influences health literacy and perceived entitlement, thereby shaping satisfaction [19].

Our findings indicated that although clinical care, particularly physician competence and respectful communication, was positively rated, notable dissatisfaction stemmed from managerial shortcomings such as poor information flow, inadequate medicine supply, staff shortages, and inefficient time management. This paradox is further exacerbated by the fact that, while physician competence and empathy were praised, systemic failures in sanitation, resource allocation, and gender-sensitive care undermined patient satisfaction. This misalignment mirrors trends across South Asia, where underfunded public systems struggle to meet non-clinical expectations [2–4,20].

Key administrative factors, including adequate staffing, staff behavior, protection of patient privacy, timely service delivery, and effective communication, were identified as strong predictors of patient satisfaction [1, 5, 21]. This aligns with WHO recommendations on people-centered care, which emphasize the importance of dignity and responsiveness in enhancing patient experiences and promoting greater utilization of health services [22]. There is a positive correlation between the quality of management and administration and overall patient satisfaction. Previous studies conducted in Bangladesh and India have shown that factors such as cleanliness of facilities, effective queue management, and courteous staff behavior play a crucial role in establishing patient trust. This is particularly important in outpatient departments, where patient interactions are often brief and infrequent [3–5].

Interestingly, patients who previously had positive experiences with the hospital’s OPD services were significantly more likely to report satisfaction again, illustrating the importance of perceived consistency in care. These prior positive experiences have been previously observed in LMICs, where even minor negative experiences can discourage future use of services and lead patients to opt for more expensive private alternatives [5, 23]. Given these results and patient involvement in service improvement, healthcare institutions should incorporate satisfaction monitoring as a core component of their quality assurance frameworks [24].

These findings indicate important implications for policy and practice. First, interventions should focus on reforming managerial and administrative processes. Key areas to address include the availability and timeliness of services, the supply of medications, monitoring procedures, patient privacy, waiting times, the allocation of time per patient, and staff responsiveness. Secondly, gender-sensitive training for healthcare workers should be arranged to minimize the disparity in satisfaction experienced by female patients. Thirdly, rural outreach and equity-focused quality improvements are necessary to bridge the suburban-rural-perception gap. Finally, feedback from patient satisfaction tools should be institutionalized to guide adaptive service delivery and resource allocation.

Despite methodological strengths, including a large sample, validated instruments, and advanced statistical analyses, this study has three principal limitations. The cross-sectional design precludes causal inference, while single-center sampling restricts generalizability to similar resource-constrained tertiary settings. Interviewer-administered Likert scales can introduce response biases, particularly central tendency and social desirability effects, where participants may adjust their responses to align with perceived norms. Although anonymity mitigated social desirability bias, residual inflation of satisfaction metrics remains possible.