Physician Conceptions of Responsibility to Individual Patients and Distributive Justice in Health Care

Article Figures & Data

Table 1.

Distribution of Percentage of Physician Responses to Professional Values Items

Item	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
Note: Percentages may not add to 100% because of rounding.
Sense of responsibility to individual patients
The physician’s main responsibility is to each individual patient rather than to society	28	42	13	13	4
Egalitarian beliefs about distributive justice
It is the responsibility of society to provide everyone with the best available health care	18	35	13	25	9
Society should allow patients who are willing to pay more to purchase more expensive treatments	25	38	20	8	8
It is unfair, in principle, for some people to have different health care than others for the same problems	18	29	20	23	9

Table 2.

Unadjusted Associations Between Physician Characteristics and Professional Values

Physician Characteristic	No.	Percent Reporting Strong Sense of Responsibility to Individual Patients	PValue*	Mean Egalitarian Score	PValue^†
MCO = managed care organization.
* Obtained with χ² tests, comparing percentage of physicians with individual-patient ethic.
† Obtained with t tests and analysis of variance, comparing mean egalitarian scores.
Type of MCO
Staff model	184	24		8.89
Network model	188	33	.077	8.86	.932
Age, years
<35	76	21		8.89
35–50	224	26		8.84
>50	72	43	.010	8.97	.950
Sex
Male	246	29		8.55
Female	121	26	.491	9.61	.001
Race
White	235	28		8.70
Nonwhite	105	29	.804	9.32	.031
Type of provider
Family medicine	138	31		8.83
Internal medicine	172	30		9.01
Housestaff	48	18	.215	8.88	.858
Geographic region
West	237	26		8.93
Non-West	135	33	.154	8.79	.651
Hours per week direct patient care
<28	74	25		8.53
28–40	181	27		8.96
>40	56	40	.144	8.82	.541

Table 3.

Adjusted Odds of Physician Reporting Strong Sense of Responsibility to Individual Patients

Factor	AOR*	95% CI
AOR = adjusted odds ratio; CI = confidence interval; MCO = managed care organization.
* Logistic regression model included MCO type, physician age, number of hours in direct patient care, and geographic region.
Type of MCO
Network model	1.00
Staff model	0.67	0.51–0.88
Age, years
<35	1.00
35–50	1.48	0.73–2.97
>50	3.30	1.38–7.93
Number of hours direct patient care	1.02	1.00–1.03
Geographic region
Non-West	1.00
West	0.77	0.60–0.98

Table 4.

Associations Between Professional Values and Career Satisfaction

Specific Satisfaction Measure	Physician Response	No.	Percent Reporting Strong Sense of Responsibility to Individual Patients	Mean Egalitarian Score
* P <.001 obtained with χ² tests.
† P <.05 obtained with t tests.
Quality of care provided	Very satisfied	82	44	9.28
	Not very satisfied	254	23*	8.79
Ability to serve enrollee needs	Very satisfied	54	48	9.23
	Not very satisfied	280	24*	8.85
Professional autonomy	Very satisfied	52	31	9.15
	Not very satisfied	281	28	8.83
Compensation	Very satisfied	34	24	9.76
	Not very satisfied	301	29	8.81^†
Overall practice	Very satisfied	52	37	9.67
	Not very satisfied	281	27	8.73^†

Table 5.

Adjusted Odds of Physician Very Satisfied With Overall Practice

Factor	AOR*	95% CI
AOR = adjusted odds ratio; CI = confidence interval.
* Logistic regression model included strong sense of responsibility to individual patients, egalitarian score, MCO type, physician age, physician sex, physician race, noumber of direct hours in patient care, and geographic region.
Strong sense of responsibility to individual patients
No	1.00
Yes	2.23	1.11–4.49
Egalitarian score	1.19	1.09–1.29
Type of MCO
Network model	1.00
Staff model	0.28	0.11–0.75
Age, years
<35	1.00
35–50	0.97	0.34–2.80
>50	1.02	0.40–2.62
Sex
Male	1.00
Female	0.70	0.37–1.34
Race
White	1.00
Nonwhite	0.83	0.36–1.95
Noumber of hours in direct patient care	0.99	0.97–1.01
Geographic region
Non-West	1.00
West	1.89	0.75–4.78

The Article in Brief

Doctors� values may be shifting as a younger generation of doctors comes to the fore, according to a survey of 372 doctors from 11 managed care organizations. The researchers found that a strong sense of responsibility to individual patients is less common among younger doctors and those who practice in staff-model managed care organizations (compared with those who practice in network-model managed care organizations). They also found that doctors with a strong sense of responsibility to individual patients were significantly more likely to report being satisfied with the quality of care they provide and with their ability to serve the needs of their patients.