The source of physician dissatisfaction with managed care may come from being an employed physician in a large medical group, a study in the current issue of the Journal of the American Board of Family Practice concludes.
Practice in offices with more physicians had the strongest association with physician job dissatisfaction, researchers from the University of Washington found. These larger groups may have greater bureaucratic restrictions that limit physician independence, they say.
"Salaried employment in large medical groups may be a risk factor for physician dissatisfaction," the study says. "In these settings, physicians dissatisfaction can be reduced by installing administrative arrangements that protect clinical autonomy and offer reasonable work schedules and compensation."
Funded by a grant from the Agency for Healthcare Research and Quality, the study is based on survey of 495 primary care physicians in the Seattle metropolitan area in 1997. There is a relatively balanced mix of HMO, point-of-service, PPO and fee-for-service health plans in the Seattle area, the study says.
The researchers, led by David Grembowski of the UW Center for Cost and Outcomes Research, cite previous studies that show physician satisfaction affects appropriate prescribing practices, patient adherence, patient satisfaction and turnover.
"Because of these associations, provider satisfaction is regarded as one of the four critical outcomes of healthcare, along with health status, patient satisfaction and cost," the study says.
Compensation, financial incentives and care management tools were not associated generally with doctors' job and referral satisfaction, the researchers found.
"After adjusting for physician, practice and office characteristics, only the association between salary payment and job satisfaction remained significant," the authors conclude. "Changes in physicians' practice arrangements may explain these findings."
The prevalence of group practice grew in the Seattle market in the 1990s along with the penetration of managed care. Many doctors moved from solo to group practice and from being owners to being salaried employees.
"Compared with solo practice, large medical groups are more likely to be bureaucratic and impose controls on the clinic and workload autonomy of their physician employees, mainly to reduce costs and improve quality of care," the study says. "The impact of these practice changes on physicians' job satisfaction are reflected in our results."