Article Figures & Data
Tables
Variable Independent HCO-Employed P Value HCO = health care organization. Note: A χ2 2-sided significance was used for sex and age. An independent samples t test (equal variance not assumed) was used for hours worked per week, number in work group, years in practice, and years in present practice, The N varies from 70 to 75 for the independent group and from 470 to 496 for the HCO-employed group because respondents left some items blank. Sex, female, % 24 34 .09 Age <45 years, % 49 58 .17 Hours worked per week, mean ± SD 54.2 ± 13.8 50.5 ± 12.6 .04 Number in work group, mean ± SD 9.4 ± 7.8 14.9 ± 35.8 .004 Years in practice, mean ± SD 14.4 ± 7.8 12.2 ± 8.1 .03 Years in present practice, mean ± SD 12.3 ± 8.7 8.2 ± 8.7 .001 - Table 2.
Comparison of Independent and HCO-Employed Respondents: Means, Standard Deviations, and Correlations for Dependent QOWL Variables
Independent HCO-Employed Correlations* Variable† Mean SD Mean SD d 1 2 3 4 5 6 7 8 9 10 11 12 13 HCO = health care organization; QOWL = quality of work life. Note: See the “Methods” section for a description of the scales on which variables were rated. * All correlations >|0.09| have P ≤.05. † The mean (SD) values shown are expressed in points. See “Methods” for a description of the rating scale for each variable. Work satisfaction issues Satisfaction with income 2.81 0.93 2.83 1.03 0.02 1.00 – – – – – – – – – – – – Amount of family time 2.33 0.96 2.19 1.16 0.12 .33 1.00 – – – – – – – – – – – Quality of relationships within the work group 3.30 0.83 2.80 1.01 0.51 .11 .18 1.00 – – – – – – – – – – Continuity of care 3.44 0.87 3.32 0.79 0.15 .16 .18 .21 1.00 – – – – – – – – – Practice issues Often work under time pressure 3.04 0.75 3.06 0.77 0.03 –.08 –.34 .00 –.16 1.00 – – – – – – – – Amount of paperwork is reasonable 1.10 0.95 1.30 1.06 0.19 .17 .35 .08 .21 –.31 1.00 – – – – – – – Influence over management decisions 3.25 1.07 1.90 1.12 1.21 .22 .15 .26 .32 –.11 .09 1.00 – – – – – – Ability to match time to complexity of patient 2.62 0.69 2.44 0.81 0.23 .20 .27 .10 .31 –.31 .21 .32 1.00 – – – – – Opportunity to fully use skills 3.36 0.92 3.16 0.88 0.23 .32 .24 .26 .39 –.10 .15 .34 .30 1.00 – – – – Outcomes Satisfaction with being a physician 3.48 0.85 3.26 0.95 0.24 .23 .28 .22 .23 –.16 .14 .29 .29 .28 1.00 – – – Perceived quality of care 3.35 0.62 3.02 0.63 0.53 .17 .13 .29 .32 –.05 .06 .32 .33 .29 .33 1.00 – – Ability to achieve professional goals 2.99 0.96 2.44 1.01 0.55 .43 .31 .35 .39 –.16 .15 .46 .38 .48 .44 .41 1.00 – Intention to leave the practice 1.68 1.35 2.31 1.85 0.35 –.15 –.16 –.36 –.17 .07 –.04 –.36 –.16 –.22 –.26 –.25 –.39 1.00 Independent Physician Comments HCO-Employed Physician Comments HCO = health care organization; EMR = electronic medical record; HMO = health maintenance organization. “I started my own practice 10 years ago because I was unhappy with the parent organization … to which I belonged … they were making bad business decisions which were detrimental to both doctors and patients … I’m happier, in control of my practice and I love all my patients. I’d never go back to corporate practice.” “You are a small unimportant cog in a giant wheel and realistically have no say in administrative overhead decisions or in business contract reimbursement, all of which affect your personal reimbursement. There is also no say in formulary and budgetary decisions.” “I’m happy in my practice because we are an independent, family practice only clinic. We completely control our own work schedules and clinic protocols. All 10 doctors in our group meet every 2 weeks … to discuss problems and work divisions. Our patients love us and vice versa.” “I and the rest of my work group have resigned from our HMO effective. ... We will be returning to independent practice in order to reestablish control of our practices… . I plan to spend the remaining 5–6 years of my career doing the right things rather than the organizationally determined things.” “Independent practice = freedom to cooperatively make decisions, determine income allocations, set ground rules—in exchange for less security. … Since we are independent, nobody except ourselves sets the rules.” “…management who increases responsibilities of practice, not help reduce them. Makes me wonder why I work for them at all—except their remuneration right now is pretty good. … I will no doubt leave because of their attitude, hassles with scheduling, medical records, requests for time off.” “I am in an independent all family practice group. This independence I believe allows me to be positive about my work environment. If I don’t like any aspect of it, I can change it.” “Much of my practice satisfaction comes from being a self-owned corporation and this ability to determine our own rules and destiny.” “Although we now have EMR and a few other ‘luxuries’ I now have very little control over much of my practice. The administrative managers control our department/practice setting. I was in a large multispecialty group prior to becoming ABC clinic. Even though we were large, there still was the ability to control or affect things that were important to me.” “My partner and I started our practice 10 years ago. I work hard, but I am able to choose when and what I do. I am in control—life is good.” “Being a physician in an independent clinic, I and my colleagues and staff are forced to deal with an increasing % of our time negotiating with HMO administrators, insurance companies, and ancillary care services (pharmacies and home health care). This takes from patient care time and my personal time and family time.” “I am privileged to be a member of a physician run and owned organization. This comes with the responsibility of involvement. I sit on the board of directors and several other large committees. This is a lot of work, but it empowers me. I truly feel the only way physicians can maintain autonomy and some input into the practice of medicine is to be involved from Mission Statements to creation, implementation of practice guidelines and community health programs.”
Additional Files
The Article in Brief
Quality of Work Life of Independent vs Employed Family Physicians in Wisconsin? A WRen Study
John W. Beasley, MD , and colleagues
Background Increasing numbers of doctors are employed by large health care organizations, such as hospitals, HMOs, and multispecialty clinics. This study compares the quality of work life of family doctors who are employed by health care organizations with that of doctors in independent practices.
What This Study Found Doctors in independent practice report higher quality of work life than doctors employed by health care organizations. In particular, they report better work relationships, more influence over management decisions, more satisfaction with family time, more satisfaction with being a doctor, and better perception of the quality of care they provide. Independent doctors in this study have been in practice longer than employed doctors and report working longer hours.
Implications
- The growing number of doctors employed by health care organizations face important quality-of-work-life issues, including lack of control and lack of social support.
- By addressing these issues, health care organizations might encourage a more satisfied, effective, and stable workforce.
