Managed Care, Professional Autonomy, and Income. Effects on Physician Career Satisfaction

Abstract

CONTEXT: Career satisfaction among physicians is a topic of importance to physicians in practice, physicians in training, health system administrators, physician organization executives, and consumers. The level of career satisfaction derived by physicians from their work is a basic yet essential element in the functioning of the health care system. OBJECTIVE: To examine the degree to which professional autonomy, compensation, and managed care are determinants of career satisfaction among physicians. DESIGN:Cross-sectional analysis using data from 1996±97 Community Tracking Study physician telephone survey. SETTING AND PARTICIPANTS:A nationally representative sample of 12,385 direct patient care physicians. The survey response rate was 65%.MAIN OUTCOME MEASURE: Overall career satisfaction among U.S. physicians. RESULTS:Bivariate results show that physicians with low managed care revenues are significantly more likely to bè`v ery satisfied'' than are physicians with high managed care revenue (P < .05), and that physicians with low managed care revenues are significantly more likely to report higher levels of clinical freedom than are physicians with high managed care revenue (P < .05). Multivariate analyses demonstrate that, among our measures, traditional core professional values and autonomy are the most important determinants of career satisfaction after controlling for all other factors. Relative income is also an important independent predictor. Multiple dimensions of professional autonomy hold up as strong, independent predictors of career satisfaction, while the effect of managed care does not. Managed care appears to exert its effect on satisfaction through its impact on professional autonomy, not through income reduction. CONCLUSIONS:Our results suggest that when managed care (or other influences) erode professional autonomy, the result is a highly negative impact on physician career satisfaction.KEY WORDS: physician career satisfaction; professional autonomy; managed care; income. J GEN INTERN MED 2001;16:675±684.

Association of Intrinsic Motivating Factors and Markers of Physician Well-Being: A National Physician Survey

“…6,7 Two recent literature reviews concluded that the factors most strongly associated with physician well-being include work environment (e.g., work hours, income), [19][20][21] physician autonomy (e.g., control over work, ability to provide needed service), 7,19,22 and changes in the local market (e.g., managed care). 22,23 Intrinsic motivating factors have received relatively scant attention because medical educators and practitioners have thought it too difficult to design institutional strategies and interventions that address stable physician characteristics. [24][25][26] Instead policymakers have tended to focus on extrinsic factors that are more readily manipulated.…”

A Longitudinal Study of Determinants of Career Satisfaction in Medical Students

“…10 Findings from this study have shown that physician satisfaction and dissatisfaction vary across region, specialty, age, and income, 11 and that being in a small or solo practice is associated with dissatisfaction. 12,13 Further, Stoddard and his colleagues 14 found that the most important determinants of satisfaction with a career in medicine were autonomy and professional values such as altruism, the maintenance of high ethical standards, a commitment to the needs of society, and humanistic values such as empathy, integrity, and trustworthiness. Landon and his colleagues 15 studied changes in physician satisfaction between 1997 and 2001.…”

Latent gender inequalities in the well-being of physicians according to payment method for practicing medicine: a cross-sectional study

“…In fact, since a lack of professional and clinical autonomy is associated with career dissatisfaction [29] and poor professional rewards [30] , the findings indicate that alternative payment schemes, both blended forms and pure APP, do not threaten physicians' clinical autonomy. Moreover, the intrinsic and unalterable tensions of practicing medicine are not affected by alternative payment methods.…”