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Journal of General Internal Medicine

, Volume 20, Issue 3, pp 271–277 | Cite as

Managed care, physician job satisfaction, and the quality of primary care

  • David GrembowskiEmail author
  • David Paschane
  • Paula Diehr
  • Wayne Katon
  • Diane Martin
  • Donald L. Patrick
Original Articles

Abstract

OBJECTIVE: To determine the associations between managed care, physician job satisfaction, and the quality of primary care, and to determine whether physician job satisfaction is associated with health outcomes among primary care patients with pain and depressive symptoms.

DESIGN: Prospective cohort study.

SETTING: Offices of 261 primary physicians in private practice in Seattle.

PATIENTS: We screened 17,187 patients in waiting rooms, yielding a sample of 1,514 patients with pain only, 575 patients with depressive symptoms only, and 761 patients with pain and depressive symptoms; 2,004 patients completed a 6-month follow-up survey.

MEASUREMENTS AND RESULTS: For each patient, managed care was measured by the intensity of managed care controls in the patient’s primary care office, physician financial incentives, and whether the physician read or used back pain and depression guidelines. Physician job satisfaction at baseline was measured through a 6-item scale. Quality of primary care at follow-up was measured by patient rating of care provided by the primary physician, patient trust and confidence in primary physician, quality-of-care index, and continuity of primary physician. Outcomes were pain interference and bothersomeness, Symptom Checklist for Depression, and restricted activity days. Pain and depression patients of physicians with greater job satisfaction had greater trust and confidence in their primary physicians. Pain patients of more satisfied physicians also were less likely to change physicians in the follow-up period. Depression patients of more satisfied physicians had higher ratings of the care provided by their physicians. These associations remained after controlling statistically for managed care. Physician job satisfaction was not associated with health outcomes.

CONCLUSIONS: For primary care patients with pain or depressive symptoms, primary physician job satisfaction is associated with some measures of patient-rated quality of care but not health outcomes.

Key words

managed care programs pain depression quality physician job satisfaction 

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References

  1. 1.
    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.PubMedCrossRefGoogle Scholar
  2. 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.PubMedCrossRefGoogle Scholar
  3. 3.
    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.PubMedCrossRefGoogle Scholar
  4. 4.
    Kerr EA, Mittman BS, Hays RD, Zemencuk JK, Pitts J, Brook RH. Associations between primary care physician satisfaction and self-reported aspects of utilization management. Health Serv Res. 2000;35(pt 2):333–49.PubMedGoogle Scholar
  5. 5.
    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(pt 2):307–21.PubMedGoogle Scholar
  6. 6.
    Collins KS, Schoen C, Sandman DR. The Commonwealth Fund Survey of Physician Experiences with Managed Care. The Commonwealth Fund; 1997. Available at: http://www.cmwf.org/publications/publicationsshow.htm? doc-id=221402. Accessed February 2, 2005.Google Scholar
  7. 7.
    Donelan K, Blendon RJ, Lundberg GD, et al. The new medical market-place: physicians’ views. Health Aff (Millwood). 1997;16:139–48.CrossRefGoogle Scholar
  8. 8.
    Hadley J, Mitchell JM. Effects of HMO market penetration on physicians’ work effort and satisfaction. Health Aff (Millwood). 1997;16:99–111.CrossRefGoogle Scholar
  9. 9.
    Deckard GJ. Physician responses to a managed environment: A perceptual paradox. Health Care Manage Rev. 1995;20:40–6.PubMedGoogle Scholar
  10. 10.
    Reschovsky J, Reed M, Blumenthal D, Landon B. Physicians’ assessments of their ability to provide high-quality care in a changing health care system. Med Care. 2001;39:254–69.PubMedCrossRefGoogle Scholar
  11. 11.
    Blumenthal D. Effects of market reforms on doctors and their patients. Health Aff (Millwood). 1996;15:170–84.CrossRefGoogle Scholar
  12. 12.
    Koehler WF, Fottler MD, Swan JE. Physician-patient satisfaction: equity in the health services encounter. Med Care Rev. 1992;49:455–84.PubMedCrossRefGoogle Scholar
  13. 13.
    Haas JS, Cook EF, Puopolo AL, Burstin HR, Cleary PD, Brennan TA. Is the professional satisfaction of general internists associated with patient satisfaction? J Gen Intern Med. 2000;15:122–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Linn LS, Brook RH, Clark VA, Davies AR, Fink A, Kosecoff J. Physician and patient satisfaction as factors related to the organization of internal medicine group practices. Med Care. 1985;23:1171–8.PubMedCrossRefGoogle Scholar
  15. 15.
    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
  16. 16.
    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
  17. 17.
    Mechanic D. Changing medical organization and the erosion of trust. Milbank Q. 1996;74:171–89.PubMedCrossRefGoogle Scholar
  18. 18.
    Mechanic D, Schlesinger M. The impact of managed care on patients’ trust in medical care and their physicians. JAMA. 1996;275:1693–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Dugdale DC, Epstein R, Pantilat SZ. Time and the patient-physician relationship. J Gen Intern Med. 1999;14(suppl 1):S34-S40.PubMedCrossRefGoogle Scholar
  20. 20.
    Bates AS, Harris LE, Tierney WM, Wolinsky FD. Dimensions and correlates of physician work satisfaction in a midwestern city. Med Care. 1998;36:610–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Freeborn DK. Satisfaction, commitment, and psychological well-being among HMO physicians. West J Med. 2001;174:13–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Grembowski DE, Patrick DL, Williams B, Diehr P, Martin DP. Managed care and the quality of care from primary physicians. Med Care Res Rev. 2005;62:31–55.PubMedCrossRefGoogle Scholar
  23. 23.
    Miller RH, Luft HS. HMO plan performance update: an analysis of the literature, 1997–2001. Health Aff (Millwood). 2002;21:63–86.CrossRefGoogle Scholar
  24. 24.
    Forrest CB, Shi L, von Schrader S, Ng J. Managed care, primary care, and the patient-practitioner relationship. J Gen Intern Med. 2002;17:270–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Safran DG, Rogers WH, Tarlov AR, et al. Organizational and financial characteristics of health plans: are they related to primary care performance? Arch Intern Med. 2000;160:69–76.PubMedCrossRefGoogle Scholar
  26. 26.
    Dudley RA, Miller RH, Korenbrot TY, Luft HS. The impact of financial incentives on quality of health care. Milbank Q. 1998;76:649–86, 511.PubMedCrossRefGoogle Scholar
  27. 27.
    Woolhandler S, Himmelstein DU. Annotation: patients on the auction block. Am J Public Health. 1996;86:1699–700.PubMedCrossRefGoogle Scholar
  28. 28.
    Davies HT, Rundall TG. Managing patient trust in managed care. Milbank Q. 2000;78:609–24, iv–v.PubMedCrossRefGoogle Scholar
  29. 29.
    Waitzkin H, Cook MA. Managed care and the geriatric patient-physician relationship. Clin Geriatr Med. 2000;16:133–51, x–xi.PubMedCrossRefGoogle Scholar
  30. 30.
    Covinsky KE, Rosenthal GE, Chern MM, et al. The relation between health status changes and patient satisfaction in older hospitalized medical patients. J Gen Intern Med. 1998;13:223–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Kane RL, Maciejewski M, Finch M. The relationship of patient satisfaction with care and clinical outcomes. Med Care. 1997;35:714–30.PubMedCrossRefGoogle Scholar
  32. 32.
    Kaplan SH, Greenfield S, Ware JE Jr. Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care. 1989;27(suppl):S110-S127.PubMedCrossRefGoogle Scholar
  33. 33.
    Patrick DL, Scrivens E, Charlton JR. Disability and patient satisfaction with medical care. Med Care. 1983;21:1062–75.PubMedCrossRefGoogle Scholar
  34. 34.
    Grembowski DE, Martin D, Patrick DL, et al. Managed care, access to mental health specialists, and outcomes among primary care patients with depressive symptoms. J Gen Intern Med. 2002;17:258–69.PubMedCrossRefGoogle Scholar
  35. 35.
    Grembowski DE, Martin D, Diehr P, et al. Managed care, access to specialists, and outcomes among primary care patients with pain. Health Serv Res. 2003;38(pt 1):1–19.PubMedCrossRefGoogle Scholar
  36. 36.
    National Centers for Health Statistics. National Ambulatory Medical Care Survey: 1989 Summary. Vital and Health Statistics. Hyattsville, MD: U.S. Department of Health and Human Services; 1992;13(110):1–80.Google Scholar
  37. 37.
    Derogatis LRK, Rickels EH, Uhlenhuth L, Covi. The Hopkins Symptom Checklist: a measure of primary symptom dimensions. In: Pichot P, ed Psychological Measurements in Psychopharmacology: Problems in Pharmacopsychiatry. Basel, Switzerland: Kargerman; 1974:79–110.Google Scholar
  38. 38.
    Greenfield S, Sullivan S, Kaplan S, Stillman R. Diabetes II—Patient Outcomes Research Team, Physician Questionnaire, Section 3: Job and Practice Satisfaction. Boston, MA: New England Medical Center, The Health Institute; 1992.Google Scholar
  39. 39.
    Grembowski DE, Ulrich C, Paschane D, et al. Managed care and primary physician satisfaction. J Am Board Fam Pract. 2003;16:383–93.PubMedGoogle Scholar
  40. 40.
    Hays RD, Shaul JA, Williams VS, et al. Psychometric properties of the CAHPS 1.0 survey measures. Consumer Assessment of Health Plans Study. Med Care. 1999;37(suppl):MS22-MS31.PubMedCrossRefGoogle Scholar
  41. 41.
    Gerteis M, Edgman-Levitan S, Daley J, Delbanco TL. Through the Patient’s Eyes: Understanding and Promoting Patient-centered Care. San Francisco, CA: Jossey-Bass Publishers; 1993:Picker Institue survey instruments are available at: http://www.pickerinstitute.org.Google Scholar
  42. 42.
    Meredith LS, Orlando M, Humphrey N, Camp P, Sherbouren CD. Are better ratings of the patient-provider relationship associated with higher quality care for depression? Med Care. 2001;39:349–60.PubMedCrossRefGoogle Scholar
  43. 43.
    Mulrow CD, Williams JW Jr, Gerety MB, Ramirez G, Montiel OM, Kerber C. Case-finding instruments for depression in primary care settings. Ann Intern Med. 1995;122:913–21.PubMedGoogle Scholar
  44. 44.
    Hough R, Landsverk J, Stone J, et al. Comparison of Psychiatric Screening Questionnaires for Primary Care Patients. Final report for NIMH contract 278-81-0036 (DB); 1983.Google Scholar
  45. 45.
    Ware J Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34:220–33.PubMedCrossRefGoogle Scholar
  46. 46.
    Patrick DL, Deyo RA, Atlas SJ, Singer DE, Chapin A, Keller RB. Assessing health-related quality of life in patients with sciatica.. Spine. 1995;20:1899–908; discussion 1909.PubMedCrossRefGoogle Scholar
  47. 47.
    Von Korff M, Ormel J, Keefe FJ, Dworkin SF. Grading the severity of chronic pain. Pain. 1992;50:133–49.CrossRefGoogle Scholar
  48. 48.
    Grembowski DE, Cook K, Patrick DL, Roussel AE. Managed care and physician referral. Med Care Res Rev. 1998;55:3–31.PubMedCrossRefGoogle Scholar
  49. 49.
    Bigos S, Bowyer O, Braen G, et al. Acute Low Back Pain Problems in Adults. Clinical Practice Guideline Number 14. AHCPR Publication No. 95-0642. Rockville, MD: U.S. Department of Health and Human Services; 1994.Google Scholar
  50. 50.
    Rush AJ, Golden WE, Hall GW, et al. Depression in Primary Care, Vols. 1 and 2: Clinical Practice Guideline Number 5. AHCPR Publication No. 93-0551. Agency for Health Care. Rockville, MD: Agency for Health Care Policy and Research; 1993.Google Scholar
  51. 51.
    Wells KB, Rogers W, Burnam A, Greenfield S, Ware JE Jr. How the medical comorbidity of depressed patients differs across health care settings: results from the Medical Outcomes Study. Am J Psychiatry. 1991;148:1688–96.PubMedGoogle Scholar
  52. 52.
    Gerrity MS, DeVellis RF, Earp JA. Physicians’ reactions to uncertainty in patient care. A new measure and new insights. Med Care. 1990;28:724–36.PubMedCrossRefGoogle Scholar
  53. 53.
    Stata Corporation. STATA: Statistics/Stata Analysis. College Station, TX: Stata Corporation; 1999.Google Scholar
  54. 54.
    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.PubMedCrossRefGoogle Scholar
  55. 55.
    Thom DH. Physician behaviors that predict patient trust. J Fam Pract. 2001;50:323–8.PubMedGoogle Scholar
  56. 56.
    Hall MA, Dugan E, Zheng B, et al. Trust in physicians and medical institutions: what is it, can it be measured, and doet it matter? Milbank Q. 2001;79:613–39.PubMedCrossRefGoogle Scholar
  57. 57.
    Marshall GN, Hays RD, Mazel R. Health status and satisfaction with health care: results from the Medical Outcomes Study. J Consult Clin Psychol. 1996;64:380–90.PubMedCrossRefGoogle Scholar
  58. 58.
    Gandhi TK, Francis EC, Puopolo AL, et al. Inconsistent report cards: assessing the comparability of various measures of the quality of ambulatory care. Med Care. 2002;40:155–65.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2005

Authors and Affiliations

  • David Grembowski
    • 1
    • 2
    Email author
  • David Paschane
    • 5
  • Paula Diehr
    • 1
    • 2
    • 3
  • Wayne Katon
    • 4
  • Diane Martin
    • 1
    • 2
  • Donald L. Patrick
    • 1
    • 2
  1. 1.Center for Cost and Outcomes ResearchUSA
  2. 2.Department of Health ServicesUniversity of WashingtonSeattle
  3. 3.Department of BiostatisticsUniversity of WashingtonSeattleUSA
  4. 4.Department of Psychiatry and Behavioral SciencesUniversity of WashingtonSeattleUSA
  5. 5.Department of GeographyUniversity of WashingtonSeattleUSA

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