Grembowski D, Ulrich CM, Paschane D, Diehr P, Martin D, Patrick DL; AcademyHealth. Meeting (2003 : Nashville, Tenn.).

Abstr AcademyHealth Meet. 2003; 20: abstract no. 894.

University of Washington, Health Services, Box 357660, Seattle, WA 98195 Tel. (206) 616-2921 Fax (206) 543-3964

RESEARCH OBJECTIVE: Physician satisfaction is important because previous studies indicate that it contributes to the quality of health care. Many physicians believe that managed care and market competition have eroded their satisfaction with medical practice, although past studies report contradictory evidence about the relationship between managed care and physician satisfaction. Therefore, our aim is to examine whether physician compensation, financial incentives, and care management tools are associated with primary physician job satisfaction. Our study is guided by a conceptual model of physician satisfaction derived from published evidence. The model posits that in a single market, primary physician satisfaction is determined directly and indirectly by the characteristics of the primary physician, the characteristics of the physician's practice, and the organizational characteristics of the physician's primary care office and its compensation and care management tools STUDY DESIGN: Cross-sectional survey using a self-administered physician questionnaire. POPULATION STUDIED: A representative sample of 561 primary physicians (family practitioners, general practitioners, general internists) in the Seattle metropolitan area in 1997 were invited to complete a self-administered questionnaire. Completed questionnaires were received from 495 physicians (88% response rate). Physician satisfaction was measured through a job satisfaction scale which had evidence of predictive validity. Managed care variables included measures of physician compensation, financial incentives (productivity bonuses and financial withhold for referrals), and care management tools (the office's referral preauthorization requirements, and whether the office used referral guidelines or clinical guidelines for specific conditions). Bivariate analysis of variance (ANOVA) tests were computed to determine whether each physician, practice, office, compensation and care management variable was associated significantly with physician job satisfaction. Partial correlation analysis was performed to determine the associations between the managed care measures and physician satisfaction, controlling for other factors in the conceptual mod PRINCIPAL FINDINGS: Bivariate analyses revealed that salary compensation, productivity bonuses, and withholds for referrals were associated with job dissatisfaction. However, after controlling for physician, practice, and office characteristics, only the association between salary payment and job dissatisfaction remained significant. Practice in offices with more physicians had the strongest association with physician job dissatisfaction. CONCLUSIONS: Although managed care features are correlated with physician job dissatisfaction, the source of dissatisfaction may originate from being an employed physician in a large medical group with more physicians, which may be more likely to impose bureaucratic controls that limit physician autonomy. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Salaried employment in large medical groups may be a risk factor for physician dissatisfaction. In these settings, physician dissatisfaction may be reduced by installing administrative arrangements that protect clinical autonomy and offer reasonable work schedules and compensation. Funding from AHRQ Grant No. HS11712.

Publication Types:

• Meeting Abstracts

Keywords:

• Cross-Sectional Studies
• Income
• Job Satisfaction
• Managed Care Programs
• Physicians
• Physicians, Family
• Primary Health Care
• Questionnaires
• Referral and Consultation
• Salaries and Fringe Benefits
• Workload
• economics
• hsrmtgs

Other ID:

• GWHSR0004179

UI: 102275858

From Meeting Abstracts