Payment method as a predictor of daily distress experienced by physicians

Abstract

Background: Physicians face intrinsic tensions when practicing medicine; therefore, extrinsic factors that could affect distress, such as payment methods, need to be assessed. The study objectives were to: compare levels of distress by payment method, identify factors predicting distress in a two-level regression model, and explore interactions between predictors of distress and payment method. Methods:A cross-sectional study was conducted among physicians in the Saskatoon Health Region, Saskatchewan.Physicians completed a pre-tested questionnaire about their distress. Analysis of variance was used to compare distress levels of physicians paid by fee-for-service (FFS), alternative payment plans (APPs), and blended methods. A mixed linear regression model was built to predict distress with geographical area of practice as the random component. Demographics, workload, complexity of patients, payment method, career satisfaction, and practice profile were the independent variables. The interactions between payment method and predictors of daily distress were evaluated.Results: A total of 382 physicians participated (response rate = 48.1%). Response bias was tested and found to be negligible. In the multivariable analysis, payment method was a predictor of distress which interacted with the proportion of complex cases. Lower levels of distress were found among physicians who had more than 75% of patients with complex conditions and were paid by APPs, compared to those paid by FFS and blended methods. Career satisfaction was found to be an important predictor. Nine percent of the outcome variation was explained by geographic area of practice.Conclusions: Payment method is a predictor of distress when adjusting by confounders, interacting with proportion of complex cases. APPs may promote provision of care for patients with complex conditions. Career satisfaction can be considered a protective indicator of distress. Practice environment influences distress experienced by physicians.

Modeling factors explaining physicians’ satisfaction with competence

“…Implementing effective incentives for physicians to take on administrative duties are challenging since financial payments tend to be viewed as insufficient, respect and prestige conferred by colleagues often being more persuasive. 12 Blended systems have been tried in recent years because no one-payment system can meet all the objectives of complex health systems. 65 …”

“…9 Physicians who have considerable academic or administrative responsibilities in addition to clinical responsibilities for patients often choose alternative payment plans. 12 The profile of duties for most physicians is about 75% patient care; 15% academic duties, split between teaching and research; and 10% administrative duties, which includes medical practice management duties and serving on professional and health facility committees.…”

The Experience of Risk-Adjusted Capitation Payment for Family Physicians in Iran: A Qualitative Study

“…The results of the present study indicate that capitation created assurance in income and reduced physician uncertainty in financial matters, and along with the increased income it created, physicians’ satisfaction was improved. The results obtained by Pena-Sanchez et al also revealed lower levels of distress in physicians who were paid according to the Alternative Payment Plan consisting of both salary and capitation compared to physicians receiving FFC when more than 75% of their patients suffered from complicated conditions ( 29 ).…”