Journal of General Internal Medicine

, Volume 15, Issue 7, pp 441–450 | Cite as

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

  • Mark Linzer
  • Thomas R. Konrad
  • Jeffrey Douglas
  • Julia E. McMurray
  • Donald E. Pathman
  • Eric S. Williams
  • Mark D. Schwartz
  • Martha Gerrity
  • William Scheckler
  • JudyAnn Bigby
  • Elnora Rhodes
  • the Society of General Internal Medicine (SGIM) Career Satisfaction Study Group (CSSG)
Original Articles


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 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Schultz R, Scheckler WE, Moberg P, Johnson P. Changing physician satisfaction with health maintenance organization and fee for service practices. J Fam Pract. 1997;45:321–30.Google Scholar
  2. 2.
    Kerr EA, Hays RD, Mittman BS, et al. Primary care physicians satisfaction with quality of care in California capitated medical groups. JAMA. 1997;278:308–12.PubMedCrossRefGoogle Scholar
  3. 3.
    Schmoldt RA, Freeborn DK, Klevit HD. Physician burnout: recommendations for HMO managers. HMO Pract. 1994;8:58–63.PubMedGoogle Scholar
  4. 4.
    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
  5. 5.
    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
  6. 6.
    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
  7. 7.
    Madison DL, Konrad TR. Large medical group practice organizations and employed physicians: a relationship in transition. Milbank Q. 1988;66:240–82.PubMedCrossRefGoogle Scholar
  8. 8.
    Stamps PL, Cruz NTB. Issues in Physician Satisfaction. Ann Arbor, Mich: New Perspectives in Health Administration Press; 1994.Google Scholar
  9. 9.
    Lichtenstein R. Measuring the job satisfaction of physicians in organized settings. Med Care. 1984;22:56–68.PubMedCrossRefGoogle Scholar
  10. 10.
    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
  11. 11.
    Lessler JT, Kalsbeek WD. Nonsampling error in surveys. New York, NY: Wiley and Sons; 1992.Google Scholar
  12. 12.
    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
  13. 13.
    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
  14. 14.
    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
  15. 15.
    Barr D. The effects of organizational structure on primary care outcomes under managed care. Ann Intern Med. 1995;122:353–9.PubMedGoogle Scholar
  16. 16.
    Kassirer JP. Doctor discontent. N Engl J Med. 1998;339:1543–5.PubMedCrossRefGoogle Scholar
  17. 17.
    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
  18. 18.
    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
  19. 19.
    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
  20. 20.
    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
  21. 21.
    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
  22. 22.
    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
  23. 23.
    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
  24. 24.
    Davidoff F. Time. Ann Intern Med. 1997;127:483–5.PubMedGoogle Scholar
  25. 25.
    Steel RP, Ovalle NK. A review and meta-analysis of research on the relationship between behavioral intentions and employee turnover. J Appl Psychol. 1984;69:673–86.CrossRefGoogle Scholar
  26. 26.
    Mobley WH, Horner SO, Hollingsworth AT. An evaluation of precurssors of hospital employee turnover. J Appl Psychol. 1978;63:408–14.PubMedCrossRefGoogle Scholar
  27. 27.
    Asch D, Jedrziewski K, Christakis NA. Response rates to mail surveys published in medical journals. J Clin Epidemiol. 1997;50:1129–36.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2000

Authors and Affiliations

  • Mark Linzer
    • 1
  • Thomas R. Konrad
    • 4
  • Jeffrey Douglas
    • 3
  • Julia E. McMurray
    • 1
  • Donald E. Pathman
    • 4
  • Eric S. Williams
    • 5
  • Mark D. Schwartz
    • 6
  • Martha Gerrity
    • 7
  • William Scheckler
    • 2
  • JudyAnn Bigby
    • 8
  • Elnora Rhodes
    • 9
  • the Society of General Internal Medicine (SGIM) Career Satisfaction Study Group (CSSG)
  1. 1.Department of MedicineUniversity of Wisconsin Medical SchoolMadison
  2. 2.the Department of Family MedicineUniversity of WisconsinMadison
  3. 3.the Department of BiostatisticsUniversity of WisconsinMadison
  4. 4.the Program on Primary Care and Health Professionals, Cecil G. Sheps Center for Health Services ResearchUniversity of North Carolina at Chapel Hill
  5. 5.Department of Marketing and ManagementUniversity of AlabamaTuscaloosa
  6. 6.Department of Medicine, Primary Care DivisionNew York UniversityNY
  7. 7.Department of MedicineOregon Health Sciences UniversityPortland
  8. 8.Division of General Internal MedicineBrigham and Women’s Hospital, Harvard Medical SchoolBoston
  9. 9.the SGIMWashington, DC

Personalised recommendations