Original Articles

Journal of General Internal Medicine

, Volume 15, Issue 7, pp 441-450

First online:

Managed care, time pressure, and physician job satisfaction: Results from the physician worklife study

  • Mark LinzerAffiliated withDepartment of Medicine, University of Wisconsin Medical School
  • , Thomas R. KonradAffiliated withthe Program on Primary Care and Health Professionals, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
  • , Jeffrey DouglasAffiliated withthe Department of Biostatistics, University of Wisconsin
  • , Julia E. McMurrayAffiliated withDepartment of Medicine, University of Wisconsin Medical School
  • , Donald E. PathmanAffiliated withthe Program on Primary Care and Health Professionals, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
  • , Eric S. WilliamsAffiliated withDepartment of Marketing and Management, University of Alabama
  • , Mark D. SchwartzAffiliated withDepartment of Medicine, Primary Care Division, New York University
  • , Martha GerrityAffiliated withDepartment of Medicine, Oregon Health Sciences University
  • , William SchecklerAffiliated withthe Department of Family Medicine, University of Wisconsin
    • , JudyAnn BigbyAffiliated withDivision of General Internal Medicine, Brigham and Women’s Hospital, Harvard Medical School
    • , Elnora RhodesAffiliated withthe SGIM
    • , the Society of General Internal Medicine (SGIM) Career Satisfaction Study Group (CSSG)

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OBJECTIVE: To assess the association between HMO practice, time pressure, and physician job satisfaction.

DESIGN: National random stratified sample of 5,704 primary care and specialty physicians in the United States. Surveys contained 150 items reflecting 10 facets (components) of satisfaction in addition to global satisfaction with current job, one’s career and one’s specialty. Linear regression-modeled satisfaction (on 1–5 scale) as a function of specialty, practice setting (solo, small group, large group, academic, or HMO), gender, ethnicity, full-time versus part-time status, and time pressure during office visits. “HMO physicians” (9% of total) were those in group or staff model HMOs with >50% of patients capitated or in managed care.

RESULTS: Of the 2,326 respondents, 735 (32%) were female, 607 (26%) were minority (adjusted response rate 52%). HMO physicians reported significantly higher satisfaction with autonomy and administrative issues when compared with other practice types (moderate to large effect sizes). However, physicians in many other practice settings averaged higher satisfaction than HMO physicians with resources and relationships with staff and community (small to moderate effect sizes). Small and large group practice and academic physicians had higher global job satisfaction scores than HMO physicians (P<.05), and private practice physicians had quarter to half the odds of HMO physicians of intending to leave their current practice within 2 years (P<.05). Time pressure detracted from satisfaction in 7 of 10 satisfaction facets (P<.05) and from job, career, and specialty satisfaction (P<.01). Time allotted for new patients in HMOs (31 min) was less than that allotted in solo (39 min) and academic practices (44 min), while 83% of family physicians in HMOs felt they needed more time than allotted for new patients versus 54% of family physicians in small group practices (P<.05 after Bonferroni’s correction).

CONCLUSIONS: HMO physicians are generally less satisfied with their jobs and more likely to intend to leave their practices than physicians in many other practice settings. Our data suggest that HMO physicians’ satisfaction with staff, community, resources, and the duration of new patients visits should be assessed and optimized. Whether providing more time for patient encounters would improve job satisfaction in HMOs or other practice settings remains to be determined.

Key words

job satisfaction time pressure HMO, managed care