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INTRODUCTION:There is concern in the US about the burden and potential ramifications of dissatisfaction among physicians. The purpose of this article is to systematically review the literature on US physician satisfaction.METHODS:A MEDLINE search with the medical subject headings (MeSH) phrases: (physicians OR physician's role OR physician's women) AND (job satisfaction OR career satisfaction OR burnout), limited to humans and abstracts, with 1157 abstracts reviewed. After exclusions by 2 independent reviewers, 97 articles were included. Physician type sampled, sample size/response rate, satisfaction type, and satisfaction results were extracted for each study. Satisfaction trends were extracted from those studies with longitudinal or repeated cross sectional design. Variables associated with satisfaction were extracted from those studies that included multivariate analyses.RESULTS:Physician satisfaction was relatively stable, with small decreases primarily among primary care physicians (PCPs). The major pertinent mediating factors of satisfaction for hospitalists include both physician factors (age and specialty), and job factors (job demands, job control, collegial support, income, and incentives).CONCLUSIONS:The majority of factors associated with satisfaction are modifiable. Tangible recommendations for measuring and diminishing dissatisfaction are given. Journal of Hospital Medicine 2009;4:560–570. © 2009 Society of Hospital Medicine.

BACKGROUND:Accreditation Council on Graduate Medical Education (ACGME) duty hour restrictions have led to the widespread implementation of non–house staff services in academic medical centers, yet little is known about the quality and efficiency of patient care on such services.OBJECTIVE:To evaluate the quality and efficiency of patient care on a physician assistant/hospitalist service compared with that of traditional house staff services.DESIGN:Retrospective cohort study.SETTING:Inpatient general medicine service of a 747‐bed academic medical center.PATIENTS:A total of 5194 consecutive patients admitted to the general medical service from July 2005 to June 2006, including 992 patients on the physician assistant/hospitalist service and 4202 patients on a traditional house staff service.INTERVENTION:A geographically localized service staffed with physician assistants and supervised by hospitalists.MEASUREMENTS:Length of stay (LOS), cost of care, inpatient mortality, intensive care unit (ICU) transfers, readmissions, and patient satisfaction.RESULTS:Patients admitted to the study service were younger, had lower comorbidity scores, and were more likely to be admitted at night. After adjustment for these and other factors, and for clustering by attending physician, total cost of care was marginally lower on the study service (adjusted costs 3.9% lower; 95% confidence interval [CI] −7.5% to −0.3%), but LOS was not significantly different (adjusted LOS 5.0% higher; 95% CI, −0.4% to +10%) as compared with house staff services. No difference was seen in inpatient mortality, ICU transfers, readmissions, or patient satisfaction.CONCLUSIONS:For general medicine inpatients admitted to an academic medical center, a service staffed by hospitalists and physician assistants can provide a safe alternative to house staff services, with comparable efficiency. Journal of Hospital Medicine 2008;3:361–368. © 2008 Society of Hospital Medicine.