Article Figures & Data
Tables
Characteristics Percent Male 62.5 Female 37.5 Full-time employed as family physician 54.2 Mean years in family practice (range) 18.8 (10–30) Mean years in health maintenance organization (range) 15.7 (4–30) - Table 2.
Factors Contributing to Sense of Dissatisfaction and Powerlessness of Family Physicians in this Organization
Category Identified From Interviews Text Example Isolation I come into my cubby-hole at 7 am. I work all day, and when I finally get out, everyone else here is gone, so meeting docs who work in the same building is sometimes awkward. It’s a little embarrassing. I don’t know them by sight. (FP 8) Limited role in decision making I get the team moving in a certain direction and get the support. I present it before higher ups, and they just veto everything …. (FP 22) Undervalued [The manager doesn’t] look for feedback or advice … she’s a teamster. She’s going to drive those horses, you don’t ask the horse for advice. (FP 8) Long working hours I put in 12- to 14-hour days sometimes—but I do have Sundays as my day off. Saturdays … I come back in to do paperwork … the main thing is just the ongoing long hours—it’s tiring. (FP 5) Increasing accessibility This is the latest craze … . Same-day access. Only certain groups are having to do it. Ask a psychiatrist if they’re going to have same-day access. (FP 1) Loss of effective functioning team Before they decentralized appointments … the doctor felt like he had a little more control of what he was doing … the receptionist could identify em’ and you know if they needed longer appointments or if they needed an appointment at all … not this anonymous person putting a name on your schedule … . (FP 16) Excessive paperwork 2–4 hours each day just following up on things… (FP 5) Difficulty accessing specialist support I called them up one time … I said you gotta see this patient, this patient’s sick, I can’t figure out what to do, and he said we don’t have appointments left… .(FP 6) Conflicting demands The priority is the acute problem … the diabetic who walks in with a blue leg or chest pain or a stroke, that takes precedence obviously over going to my desk and working on the registries and from my perspective as a provider there’s a bit of a disconnect … it’s the important but not urgent that’s [also] the issue. (FP 6) No time to think, talk, reflect I don’t have time to run off and start phoning people, you know, for discussing patients, ‘cause the next patient’s in the room, angry, ”where is he? What’s going on here?“ (FP 1)
Additional Files
The Article in Brief
More than half of the family physicians in a group model health maintenance organization feel they lack power to change or control their working environment, although some physicians have developed coping skills to help retain a sense of control. The physicians value the variety and complexity of family practice. The authors call for physicians and health care organizations to work together to restore family physicians� professional independence and involvement, and to incorporate these efforts in programs to improve quality of medical care and reduce costs.
