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Electronic letters published:
![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
Physician Quality of Work Life Matters
Differing Views on What Contributes to Physician Satisfaction
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Sharon B. Buchbinder, Towson, MD, USA Professor & Chair, Department of Health Science, Towson University
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Less than two decades ago, only a handful of scholars believed that physician quality of work life was an important area of research. Now, there is a growing body of literature that informs practitioners, policymakers, patients, and health care managers about the importance of this topic. The article by Beasley et al, in this issue of Annals of Family Medicine is a major contribution to a growing body of literature on physician quality of work life and sheds some much needed light into perceptions of independent physicians and physicians employed by health care organizations (HCOs) with respect to work satisfaction, practice issues, and outcomes. In all of these aspects, independent physicians were more satisfied, felt they had greater control over their practice, and perceived a greater ability to provide a higher quality of care. The authors note: “Whether these physicians’ subjective measures translate into an actual lower quality of care or greater likelihood of leaving the practice cannot be determined from this study, but the literature cited above certainly suggests a relationship between the physicians’ reports and reality.” I would submit to readers that perceptions are reality, and that the management of perceptions is dependent upon one’s ability to control one’s work environment. If physicians cannot be trusted to assess quality of care provided, then who can? Nurses and health care managers are team members in providing care, but in the final analysis, it is the physician who is held accountable, in most cases, for the provision of quality of care. One need only glance at the headlines about rising malpractice insurance costs to see who is being sued. This article is a cautionary tale that deserves follow-up research to see how many physicians do leave the HCOs and why. Additionally, it should be considered required reading for all health care managers and students of health care management. It will be added to my required reading list this spring. Competing interests: None declared |
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Jennifer E DeVoe, Portland, OR Research Fellow, Department of Family Medicine, Oregon Health & Science University
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It is crucial to learn more about factors impacting physician satisfaction as discussed in the Nov/Dec 2005 article by Beasley, et al. Physician dissatisfaction directly impacts upon patient satisfaction and adherence to recommended medical regimens (1-2). Other studies have come to similar conclusions about trends in physician dissatisfaction yet found slightly different associations with some of the factors that may influence a physician’s quality of work life. In a study of national data from the Community Tracking Study Physician Survey (CTS) done a few years earlier, a similar percentage of family physicians/general practitioners (FP/GPs) reported career satisfaction (81.9% compared with 83.5% reported in the Beasley article) (3). This national study, however, showed that FP/GPs who fully owned their practice were more likely to express dissatisfaction with their careers than were FP/GPs who either shared ownership or did not own their practice (OR 1.57; 95% CI, 1.11-2.21) (3). The Beasley, et al. article suggests otherwise. Perhaps, Beasley’s grouping of managed care organizations, large multi-specialty groups and hospital-based practices into a single group–the health care organization (HCO) employed group—impacted their results. Data from FP/GPs in the CTS suggests that satisfaction among physicians in HMOs varies from those who practice in hospital-based or medical school clinics. The CTS also reveals a pattern of dissatisfaction related to a higher percentage of gatekeeping (i.e., providing permission for their patients to seek specialty care) (3). Another analysis of the CTS showed that physicians with low managed care revenues are significantly more likely to be “very satisfied” than are physicians with high managed care revenues (4). Further study of the WReN data would benefit from separating the HCO group into three or four separate categories for analysis. Another potential explanation for differences in regional and national data may be geographic variation in levels of physician satisfaction (5). On a completely different note, one might wonder if physicians believe that choosing to work for a health care organization (HCO) with a poorer quality of work life but fewer hours will improve their quality of life at home. This trade-off may not hold true. The Beasley et al. study showed that physicians working for independent practices had a better quality work life and were also more satisfied with their amount of family time. Perhaps, there is more of a connection between these two “lives” than some physicians realize. (1) 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. (2) 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. (3) DeVoe J, Fryer GE Jr, Hargraves JL, Phillips RL, Green LA. Does career dissatisfaction affect the ability of family physicians to deliver high-quality patient care? J Fam Pract. 2002;51:223–228. (4) Stoddard, JJ, Hargraves, JJ, Reed M, Vratil A. Managed Care, Professional Autonomy, and Income. J Gen Int Med 2001; 16 (10), 675-684. (5) DeVoe J, Fryer GE, Straub A, McCann J, Fairbrother G. Congruent Satisfaction: Is There Geographic Correlation Between Patient and Physician Satisfaction? Presented at the Society of Teachers of Family Medicine Annual Meeting. New Orleans, LA: May 2005. Competing interests: None declared |
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