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.
job satisfaction time pressure HMO, managed care
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Perkins RJ, Alley PG, Petrie KJ, Macfie AE, Morrah DD. Sources of stress and satisfaction in crown health enterprise senior medical staff. NZ Med J. 1995;108:75–8.Google Scholar
Tamblyn R, Berkson L, Dauphinee WD, et al. Unnecessary prescribing of NSAIDs and the management of NSAID-related gastropathy in medical practice. Ann Intern Med. 1997;127:429–38.PubMedGoogle Scholar
McMurray JE, Williams E, Schwartz MD, et al. for the SGIM Career Satisfaction Study Group. Physician job satisfaction: developing a model using qualitative data. J Gen Intern Med. 1997;12:711–14.PubMedCrossRefGoogle Scholar
Madison DL, Konrad TR. Large medical group practice organizations and employed physicians: a relationship in transition. Milbank Q. 1988;66:240–82.PubMedCrossRefGoogle Scholar
Stamps PL, Cruz NTB. Issues in Physician Satisfaction. Ann Arbor, Mich: New Perspectives in Health Administration Press; 1994.Google Scholar
Williams E, Konrad TR, Linzer M, et al. Refining the measurement of physician job satisfaction: results from the Physician Worklife Study. Med Care. 1999;37:1140–54.PubMedCrossRefGoogle Scholar
Lessler JT, Kalsbeek WD. Nonsampling error in surveys. New York, NY: Wiley and Sons; 1992.Google Scholar
Grol R, Mokkink H, Smits A, et al. Work satisfaction of general practitioners and the quality of patient care. Fam Pract. 1985;2:128–35.PubMedCrossRefGoogle Scholar
DiMatteo MR, Sherbourne CD, Hays RD, et al. Physicians’ characteristics influence patients’ adherence to medical treatment: results from the Medical Outcomes Study. Health Psychol. 1993;12:93–102.PubMedCrossRefGoogle Scholar
Grumbach K, Osmond D, Vranizan K, Jaffe D, Bindman A. Primary care physicians’ experience of financial incentives in managed-care systems. N Engl J Med. 1998;339:1516–21.PubMedCrossRefGoogle Scholar
Barr D. The effects of organizational structure on primary care outcomes under managed care. Ann Intern Med. 1995;122:353–9.PubMedGoogle Scholar
McMurray JE, Schwartz MD, Genero NP, Linzer M, for the SGIM Task Force on Career Choice in Internal Medicine. The attractiveness of internal medicine: a qualitative analysis of the experiences of female and male medical students. Ann Intern Med. 1993;119:812–8.PubMedGoogle Scholar
Levinson W, Roter D, Mullooly JP, Dull VT, Frankel RM, Physician-patient communication: the relationship with malpractice claims among primary care physicians and surgeons. JAMA. 1997;277:553–9.PubMedCrossRefGoogle Scholar
Gross D, Zyzanski S, Borawski E, Cebul R, Stange K. Patient satisfaction with time spent with their physician. J Fam Pract. 1998;47:133–7.PubMedGoogle Scholar
Hutten JBF. Workload and Provision of Care in General Practice. Netherlands Institute for Health Care and Interuniversity Center for Social Science Theory and Methodology; 1998.Google Scholar
Hall JA, Roter DL, Milburn MA, Daltroy LH. Why are sicker patients less satisfied with their medical care? Tests of two explanatory models. Health Psychol. 1998;17:70–5.PubMedCrossRefGoogle Scholar
Callahan EJ, Jaen CR, Crabtree BF, Zyzanski SJ, Goodwin MA, Stange KC. The impact of recent emotional distress and diagnosis of depression or anxiety on the physician-patient encounter in family practice. J Fam Pract. 1998;46:410–8.PubMedGoogle Scholar
Zyzanski SJ, Stange KC, Langa D, Flocke S. Trade-offs in high-volume primary care practice. J Fam Pract. 1998;46:397–402.PubMedGoogle Scholar