How Strategies for Managing Patient Visit Time Affect Physician Job Satisfaction: A Qualitative Analysis
- Jeffrey Solomon PhD
- … show all 1 hide
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
There is much physician discontent regarding policies that limit time for patient visits and contribute to physician dissatisfaction with the medical profession as a whole. Yet little is known about how physician strategies for managing time limits correspond to job satisfaction.
The goal of this study was to identify strategies physicians use for managing time with patients and the effects these strategies have on job satisfaction.
In-depth interviews with primary care providers in various clinical settings (academic medical centers, community-based centers, solo practices, nonacademic group practices) were audiorecorded.
Primary care physicians (n = 25).
Transcribed audiorecordings of physician interviews were coded using a modified grounded theory approach. An open coding process was used to identify major themes, subthemes, and the interrelationships among them.
Three main themes emerged. (1) Study physicians disregarded time limits despite the known financial consequences of doing so and justified their actions according to various ethical- and values-based frameworks. (2) Disregarding time limits had a positive impact on job satisfaction in the realm of direct patient care. (3) The existence of time limits had a negative impact on overall job satisfaction.
For the study physicians, disregarding time limits on patient visits is an adaptive short-term strategy that enhances satisfaction with direct patient care. It is unlikely that such a strategy alone will help physicians cope with their broader—and growing—dissatisfaction with the profession.
- Williams ES, Konrad TR, Linzer M, et al. Physician, practice, and patient characteristics related to primary care physician physical and mental health: results from the Physician Worklife Study. Health Serv Res. 2002;37:121–43.
- Murray A, Montgomery JE, Chang H, Rogers WH, Inui T, Safran DG. Doctor discontent. A comparison of physician satisfaction in different delivery system settings, 1986 and 1997. J Gen Intern Med. 2001;16:452–9. CrossRef
- Cykert S, Hansen C, Layson R, Joines J. Primary care physicians and capitated reimbursement. Experience, attitudes, and predictors. J Gen Intern Med. 1997;12:192–4. CrossRef
- Hadley J, Mitchell JM, Sulmasy DP, Bloche MG. Perceived financial incentives, HMO market penetration, and physicians’ practice styles and satisfaction. Health Serv Res. 1999;34:307–21.
- Stoddard JJ, Hargraves JL, Reed M, Vratil A. Managed care, professional autonomy, and income: effects on physician career satisfaction. J Gen Intern Med. 2001;16:675–84. CrossRef
- Keating NL, Landon BE, Ayanian JZ, Borbas C, Guadagnoli E. Practice, clinical management, and financial arrangements of practicing generalists. J Gen Intern Med. 2004;19:410–8. CrossRef
- Tai-Seale M, McGuire TG, Zhang W. Time allocation in primary care office visits. Health Serv Res. 2006;42:1871–94. CrossRef
- Landon BE, Reschovsky J, Blumenthal D. Changes in career satisfaction among primary care and specialist physicians, 1997–2001. JAMA. 2003;289:442–9. CrossRef
- Shortell SM, Waters TM, Clarke KW, Budetti PP. Physicians as double agents: maintaining trust in an era of multiple accountabilities. JAMA. 1998;280:1102–8. CrossRef
- Wetterneck TB, Linzer M, McMurray JE, et al. Worklife and satisfaction of general internists. Arch Intern Med. 2002;162:649–56. CrossRef
- Landon BE, Reschovsky JD, Pham HH, Blumenthal D. Leaving medicine: the consequences of physician dissatisfaction. Med Care. 2006;44:234–42. CrossRef
- Blue Ribbon Panel of the Society of General Internal Medicine. Redesigning the practice model for general internal medicine. A proposal for coordinated care: a policy monograph of the society of general internal medicine. J Gen Intern Med. 2007;22:400–9. CrossRef
- Anonymous. Primary care in the USA. Lancet. 2007;369:1055.
- American College of Physicians. The impending collapse of primary care medicine and its implications for the state of the nation’s health care: a report from the American College of Physicians. 2006. http://www.acponline.org/hpp/statehc061.pdf.
- Moore G, Showstack J. Primary care medicine in crisis: toward reconstruction and renewal. Ann Intern Med. 2003;138:244–7.
- Larson EB, Grumbach K, Roberts KB. The future of generalism in medicine. Ann Intern Med. 2005;142:689–90.
- Bodenheimer T. Primary care—will it survive? N Engl J Med. 2006;355:861–4. CrossRef
- Woo B. Primary care—the best job in medicine? N Engl J Med. 2006;355:864–6. CrossRef
- Grumbach K. Primary care in the United States—the best of times, the worst of times. N Engl J Med. 1999;341:2008–10. CrossRef
- Zuger A. Dissatisfaction with medical practice. N Engl J Med. 2004;350:69–75. CrossRef
- Kassirer JP. Managing care—should we adopt a new ethic? N Engl J Med. 1998;339:397–8. CrossRef
- Campion EW. A symptom of discontent. N Engl J Med. 2001;344:223–5. CrossRef
- Schroeder SA. Primary care at a crossroads. Acad Med. 2002;77:767–3. CrossRef
- Mechanic D. Physician discontent: challenges and opportunities. JAMA. 2003;290:941–66. CrossRef
- Mechanic D. Managed care and the imperative for a new professional ethic. Health Aff (Millwood). 2000;19:100–11. CrossRef
- Grumbach K, Osmond D, Vranizan K, Jaffe D, Bindman AB. Primary care physicians’ experience of financial incentives in managed-care systems. N Engl J Med. 1998;339:1516–21. CrossRef
- Braddock CH 3rd, Snyder L. The doctor will see you shortly. The ethical significance of time for the patient–physician relationship. J Gen Intern Med. 2005;20:1057–62. CrossRef
- Epstein RM. Time, autonomy, and satisfaction. J Gen Intern Med. 2000;15:517–8. CrossRef
- Davidoff F. Time. Ann Intern Med. 1997;127:483–5.
- Dugdale DC, Epstein R, Pantilat SZ. Time and the patient–physician relationship. J Gen Intern Med. 1999;14(Suppl 1)S34–40. CrossRef
- Warde C. Time is of the essence. J Gen Intern Med. 2001;16:712–3. CrossRef
- Levine JS. Trust: can we create the time? Arch Intern Med. 2004;164:930–2. CrossRef
- Linzer M, Konrad TR, Douglas J, et al. Managed care, time pressure, and physician job satisfaction: results from the physician worklife study. J Gen Intern Med. 2000;15:441–50. CrossRef
- Federman AD, Cook EF, Phillips RS, et al.. Intention to discontinue care among primary care patients: influence of physician behavior and process of care. J Gen Intern Med. 2001;16:668–74. CrossRef
- Feldman DS, Novack DH, Gracely E. Effects of managed care on physician–patient relationships, quality of care, and the ethical practice of medicine: a physician survey. Arch Intern Med. 1998;158:1626–32. CrossRef
- Klitzman R. “Patient-time”, “doctor-time”, and “institution-time”: perceptions and definitions of time among doctors who become patients. Patient Educ Couns. 2007;66:147–55. CrossRef
- Charmaz K. Constructing Grounded Theory. Thousand Oaks: Sage; 2006.
- Corbin J, Strauss A. Grounded theory research: procedures, canons, and evaluative criteria. Qual Sociol. 1990;13:3–21. CrossRef
- Horowitz CR, Suchman AL, Branch WT, Jr., Frankel RM. What do doctors find meaningful about their work? Ann Intern Med. 2003;138:772–5.
- Csikszentmihalyi M. Flow: The Psychology of Optimal Experience. New York: HarperPerrenial; 1991.
- Csikszentmihalyi M. The Evolving Self: A Psychology for the Third Millenium. New York: HarperCollins; 1993.
- Wynia MK, Cummins DS, VanGeest JB, Wilson IB. Physician manipulation of reimbursement rules for patients: between a rock and a hard place. JAMA. 2000;283:1858–65. CrossRef
- Hurst SA, Hull SC, DuVal G, Danis M. How physicians face ethical difficulties: a qualitative analysis. J Med Ethics. 2005;31:7–14. CrossRef
- Sandy LG, Schroeder SA. Primary care in a new era: disillusion and dissolution? Ann Intern Med. 2003;138:262–7.
- How Strategies for Managing Patient Visit Time Affect Physician Job Satisfaction: A Qualitative Analysis
Journal of General Internal Medicine
Volume 23, Issue 6 , pp 775-780
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- job satisfaction
- time constraints
- physician–patient relationships
- Industry Sectors
- Author Affiliations
- 1. Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA