, Volume 16, Issue 10, pp 675-684

Managed care, professional autonomy, and income

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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 be “very 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.

This work was supported by The Robert Wood Johnson Foundation. The authors express their appreciation to Jack Hadley, Paul Ginsburg, Ann Greiner, Peter Kemper, Joy Grossman, and James D. Reschovsky at the Center for Studying Health System Change for their helpful comments on earlier versions of this manuscript.