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How Strategies for Managing Patient Visit Time Affect Physician Job Satisfaction: A Qualitative Analysis

Abstract

BACKGROUND

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.

OBJECTIVE

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.

DESIGN

In-depth interviews with primary care providers in various clinical settings (academic medical centers, community-based centers, solo practices, nonacademic group practices) were audiorecorded.

PARTICIPANTS

Primary care physicians (n = 25).

APPROACH

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.

RESULTS

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.

CONCLUSION

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.

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References

  1. 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.

    PubMed  Google Scholar 

  2. 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.

    PubMed  Article  CAS  Google Scholar 

  3. 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.

    PubMed  Article  CAS  Google Scholar 

  4. 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.

    PubMed  CAS  Google Scholar 

  5. 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.

    PubMed  Article  CAS  Google Scholar 

  6. 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.

    PubMed  Article  Google Scholar 

  7. Tai-Seale M, McGuire TG, Zhang W. Time allocation in primary care office visits. Health Serv Res. 2006;42:1871–94.

    Article  Google Scholar 

  8. Landon BE, Reschovsky J, Blumenthal D. Changes in career satisfaction among primary care and specialist physicians, 1997–2001. JAMA. 2003;289:442–9.

    PubMed  Article  Google Scholar 

  9. 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.

    PubMed  Article  CAS  Google Scholar 

  10. Wetterneck TB, Linzer M, McMurray JE, et al. Worklife and satisfaction of general internists. Arch Intern Med. 2002;162:649–56.

    PubMed  Article  Google Scholar 

  11. Landon BE, Reschovsky JD, Pham HH, Blumenthal D. Leaving medicine: the consequences of physician dissatisfaction. Med Care. 2006;44:234–42.

    PubMed  Article  Google Scholar 

  12. 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.

    Article  Google Scholar 

  13. Anonymous. Primary care in the USA. Lancet. 2007;369:1055.

  14. 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.

  15. Moore G, Showstack J. Primary care medicine in crisis: toward reconstruction and renewal. Ann Intern Med. 2003;138:244–7.

    PubMed  Google Scholar 

  16. Larson EB, Grumbach K, Roberts KB. The future of generalism in medicine. Ann Intern Med. 2005;142:689–90.

    PubMed  Google Scholar 

  17. Bodenheimer T. Primary care—will it survive? N Engl J Med. 2006;355:861–4.

    PubMed  Article  CAS  Google Scholar 

  18. Woo B. Primary care—the best job in medicine? N Engl J Med. 2006;355:864–6.

    PubMed  Article  CAS  Google Scholar 

  19. Grumbach K. Primary care in the United States—the best of times, the worst of times. N Engl J Med. 1999;341:2008–10.

    PubMed  Article  CAS  Google Scholar 

  20. Zuger A. Dissatisfaction with medical practice. N Engl J Med. 2004;350:69–75.

    PubMed  Article  CAS  Google Scholar 

  21. Kassirer JP. Managing care—should we adopt a new ethic? N Engl J Med. 1998;339:397–8.

    PubMed  Article  CAS  Google Scholar 

  22. Campion EW. A symptom of discontent. N Engl J Med. 2001;344:223–5.

    PubMed  Article  CAS  Google Scholar 

  23. Schroeder SA. Primary care at a crossroads. Acad Med. 2002;77:767–3.

    PubMed  Article  Google Scholar 

  24. Mechanic D. Physician discontent: challenges and opportunities. JAMA. 2003;290:941–66.

    PubMed  Article  Google Scholar 

  25. Mechanic D. Managed care and the imperative for a new professional ethic. Health Aff (Millwood). 2000;19:100–11.

    Article  CAS  Google Scholar 

  26. 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.

    PubMed  Article  CAS  Google Scholar 

  27. 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.

    PubMed  Article  Google Scholar 

  28. Epstein RM. Time, autonomy, and satisfaction. J Gen Intern Med. 2000;15:517–8.

    PubMed  Article  CAS  Google Scholar 

  29. Davidoff F. Time. Ann Intern Med. 1997;127:483–5.

    PubMed  CAS  Google Scholar 

  30. Dugdale DC, Epstein R, Pantilat SZ. Time and the patient–physician relationship. J Gen Intern Med. 1999;14(Suppl 1)S34–40.

    PubMed  Article  Google Scholar 

  31. Warde C. Time is of the essence. J Gen Intern Med. 2001;16:712–3.

    PubMed  Article  CAS  Google Scholar 

  32. Levine JS. Trust: can we create the time? Arch Intern Med. 2004;164:930–2.

    PubMed  Article  Google Scholar 

  33. 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.

    PubMed  Article  CAS  Google Scholar 

  34. 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.

    PubMed  Article  CAS  Google Scholar 

  35. 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.

    PubMed  Article  CAS  Google Scholar 

  36. 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.

    PubMed  Article  Google Scholar 

  37. Charmaz K. Constructing Grounded Theory. Thousand Oaks: Sage; 2006.

    Google Scholar 

  38. Corbin J, Strauss A. Grounded theory research: procedures, canons, and evaluative criteria. Qual Sociol. 1990;13:3–21.

    Article  Google Scholar 

  39. Horowitz CR, Suchman AL, Branch WT, Jr., Frankel RM. What do doctors find meaningful about their work? Ann Intern Med. 2003;138:772–5.

    PubMed  Google Scholar 

  40. Csikszentmihalyi M. Flow: The Psychology of Optimal Experience. New York: HarperPerrenial; 1991.

    Google Scholar 

  41. Csikszentmihalyi M. The Evolving Self: A Psychology for the Third Millenium. New York: HarperCollins; 1993.

    Google Scholar 

  42. 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.

    PubMed  Article  CAS  Google Scholar 

  43. Hurst SA, Hull SC, DuVal G, Danis M. How physicians face ethical difficulties: a qualitative analysis. J Med Ethics. 2005;31:7–14.

    PubMed  Article  CAS  Google Scholar 

  44. Sandy LG, Schroeder SA. Primary care in a new era: disillusion and dissolution? Ann Intern Med. 2003;138:262–7.

    PubMed  Google Scholar 

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Acknowledgments

The research upon which this study is based was supported by a grant from the Jeffrey Epstein Fund. The views expressed in this article are those of the author and do not necessarily represent the views of the Department of Veterans Affairs. I would like to thank Barbara Bokhour and Paul Haidet for their comments on earlier drafts of this paper. I also would like to thank Howard Gardner, principal investigator of the Good Work Project, for his permission to use data from the study for the analysis in this paper. I would like to acknowledge the other researchers who conducted interviews for the study: Carrie James, Seth Wax, and Laura Horn. And finally, many thanks to Carrie James for her help in compiling the demographic information relevant to the study.

Conflicts of Interest

None disclosed.

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Correspondence to Jeffrey Solomon PhD.

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Solomon, J. How Strategies for Managing Patient Visit Time Affect Physician Job Satisfaction: A Qualitative Analysis. J GEN INTERN MED 23, 775–780 (2008). https://doi.org/10.1007/s11606-008-0596-y

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  • DOI: https://doi.org/10.1007/s11606-008-0596-y

Key words

  • physicians
  • job satisfaction
  • time constraints
  • professionalism
  • physician–patient relationships