Doctor Discontent. A Comparison of Physician Satisfaction in Different Delivery System Settings, 1986 and 1997

Abstract

OBJECTIVE:To examine the differences in physician satisfaction associated with open-versus closed-model practice settings and to evaluate changes in physician satisfaction between 1986 and 1997. Open-model practices refer to those in which physicians accept patients from multiple health plans and insurers (i.e., do not have an exclusive arrangement with any single health plan). Closedmodel practices refer to those wherein physicians have an exclusive relationship with a single health plan (i.e., staff-or group-model HMO). DESIGN:Two cross-sectional surveys of physicians; one conducted in 1986 (Medical Outcomes Study) and one conducted in 1997 (Study of Primary Care Performance in Massachusetts).SETTING: Primary care practices in Massachusetts. PARTICIPANTS: General internists and family practitioners in Massachusetts.MEASUREMENTS: Seven measures of physician satisfaction, including satisfaction with quality of care, the potential to achieve professional goals, time spent with individual patients, total earnings from practice, degree of personal autonomy, leisure time, and incentives for high quality. RESULTS:Physicians in open-versus closed-model practices differed significantly in several aspects of their professional satisfaction. In 1997, open-model physicians were less satisfied than closed-model physicians with their total earnings, leisure time, and incentives for high quality. Openmodel physicians reported significantly more difficulty with authorization procedures and reported more denials for care. Overall, physicians in 1997 were less satisfied in every aspect of their professional life than 1986 physicians. Differences were significant in three areas: time spent with individual patients, autonomy, and leisure time (P .05). Among openmodel physicians, satisfaction with autonomy and time with individual patients were significantly lower in 1997 than 1986 (P .01). Among closed-model physicians, satisfaction with total earnings and with potential to achieve professional goals were significantly lower in 1997 than in 1986 (P .01).CONCLUSIONS: This study finds that the state of physician satisfaction in Massachusetts is extremely low, with the majority of physicians dissatisfied with the amount of time they have with individual patients, their leisure time, and their incentives for high quality. Satisfaction with most areas of practice declined significantly between 1986 and 1997. Openmodel physicians were less satisfied than closed-model physicians in most aspects of practices.

Meeting the Imperative to Improve Physician Well-being: Assessment of an Innovative Program

“…1,2,33 Thus, programs such as the one presented in this study might be an important mitigator, at least partially, of the continuous slide in physician well-being and job satisfaction. The organization will also benefit.…”

“…Stressors include timeconstrained patient care, lack of resources, decline in compensation, malpractice litigation, and erosion of professional autonomy. They contribute to decreased physician satisfaction 1 and problems such as fatigue, anxiety, depression, suicide, substance abuse, cardiovascular disease, disability, and broken relationships. [2][3][4][5][6][7][8][9][10][11][12][13] Many experience burnout as a deterioration of values, dignity, spirit, and will.…”

Job satisfaction among Norwegian general practitioners

“…Shearer & Toedt found unhappiness with the current healthcare system among American family physicians and a decline in career satisfaction from 1996 to 1999 [7]. General practitioners in Massachusetts showed a decline in satisfaction with most areas of practice between 1986 and 1997, and so-called open-model physicians (accepting patients from multiple health plans and insurers) were less satisfied than the others [8].…”

«Comment se portent les médecins de premier recours?» / «Wie geht es den HausärztInnen?»

“…Un échantillon national représentatif de 5704 médecins de premier recours et autres spécialistes a révélé que les médecins travaillant dans un modèle type HMO (Health Maintenance Organization) étaient moins satisfaits que leurs confrères [5]. Une autre étude conduite au Massachusetts [6] a montré une diminution importante de la satisfaction des médecins de premier recours, en particulier en ce qui concerne le temps passé avec les patients, l'autonomie, et le temps à disposition pour la vie privée. Ces résultats sont importants dans la mesure où ils comparent une période encore exempte de restrictions (1986) à une situation (1997) comprenant plus de restrictions dans la manière de pratiquer, secondaire à la forte proportion de patients affiliés auprès de HMO.…”