The influence of organizational structure on physician satisfaction: findings from a national survey.
(33/1262)
BACKGROUND: The term managed care encompasses a variety of organizational arrangements between physicians and health plans. At one extreme, physicians are plan employees; at the other, physicians have contracts with multiple plans. How these arrangements affect physicians' satisfaction with managed care is not well known. OBJECTIVE: To explore the effect of organizational structure on physician satisfaction. DESIGN: Telephone survey of 751 practicing internists. The response rate for the 15-minute survey was 64%. SAMPLING STRATEGY: The random sample was taken from the membership of the American College of Physicians-American Society of Internal Medicine. Federal employees, retirees, physicians, and students who spent less than half of their time in patient care were excluded. RESULTS: 689 Physicians indicated that they were affiliated with a managed care plan: 9% were salaried employees, 6% had an exclusive contract with one plan, and 85% had a variety of nonexclusive arrangements with multiple plans. Among plan employees, 32% reported they were very satisfied with the managed care organization in which they worked. The corresponding figure was 19% among physicians with an exclusive contract and 5% among those with multiple contracts. A similar pattern of responses was seen when physicians were asked about their perception of the commitment of managed care to quality. Although 64% of plan employees responded that there was a great deal of commitment, the corresponding figure was 35% among physicians with an exclusive contract and only 7% among those with multiple contracts. CONCLUSIONS: Physicians who are salaried employees of a staff- or group-model HMO report the highest satisfaction with managed care. (+info)
Queen's University alternative funding plan. Effect on patients, staff, and faculty in the Department of Family Medicine.
(34/1262)
OBJECTIVE: To determine the effect of the Queen's University alternative funding plan (AFP) on the Department of Family Medicine in terms of patient, staff, and faculty satisfaction; patient encounter logistics; clinical volume; and academic activity. DESIGN: Before-after study. SETTING: Department of Family Medicine at Queen's University of Kingston, Ont. PARTICIPANTS: Patients, faculty, and staff of the Department of Family Medicine's Family Medicine Centre. INTERVENTIONS: The AFP of Queen's University. MAIN OUTCOME MEASURES: Patient satisfaction, staff and faculty job satisfaction, patient waiting time, time spent with patients, patient volume, number of publications, and amount of research funding obtained by faculty members. These outcomes were measured before the AFP began (time 0), 1 year post-AFP (time 1), and 2.5 years post-AFP (time 2). RESULTS: In some categories patients' satisfaction decreased at time 1, but in all cases it was either unchanged or improved at time 2. Staff and faculty job satisfaction did not change over time. Patients spent less time in the waiting room at time 2 than at time 0. Patient volume dropped about 10% between time 0 and time 2. Publication rate did not change, but external research funding increased significantly during the study period. CONCLUSION: The AFP has improved academic productivity, decreased patient volume by 10%, and improved patient flow during clinics. No negative effects on patient satisfaction or on job satisfaction of staff or faculty are apparent. (+info)
Family physician job satisfaction in different medical care organization models.
(35/1262)
OBJECTIVES: The aim of the present study was to estimate physician job satisfaction at the Mexican Institute of Social Security (IMSS), the Ministry of Health (SSA) and in the private sector, and to measure the association between these different family medical care organization models. METHODS: A comparative cross-sectional design was used to investigate the job satisfaction of family physicians in private and institutional family medicine clinics. Satisfaction was measured with a previously constructed and validated instrument. The instrument measures the satisfaction in four areas: 'global satisfaction', 'institution where the physician works', 'the patients' and 'themselves as physicians'. RESULTS: One hundred and seven IMSS physicians, 106 SSA physicians and 97 private physicians were selected randomly from a census according to the sample size. The sample was weighted. Fifty-one percent of IMSS and SSA physicians were dissatisfied, against 25% in the private sector, in the first three areas. Comparing the private model and the IMSS, differences were found (P < 0.0001) in the area of 'global satisfaction' [odds ratio (OR) = 2.47, 95% confidence interval (CI) 1.69-3.67], 'institution where the physician works' (OR = 2.12, CI 1. 45-3.13) and 'themselves as physicians' (OR = 1.84, CI 1.28-2.65). When the private/SSA groups were compared, the differences were similar (P < 0.0001). No differences were found in terms of 'the patients'. When stratifying, the risks increased in females, in the group aged 31-40 years and in specialists in family medicine. CONCLUSIONS: The organization model is associated with dissatisfaction in all areas, except in 'the patients'. (+info)
Cancer care workers in Ontario: prevalence of burnout, job stress and job satisfaction.
(36/1262)
BACKGROUND: Cancer Care Ontario's Systemic Therapy Task Force recently reviewed the medical oncology system in the province. There has been growing concern about anecdotal reports of burnout, high levels of stress and staff leaving or decreasing their work hours. However, no research has systematically determined whether there is evidence to support or refute these reports. To this end, a confidential survey was undertaken. METHODS: A questionnaire was mailed to all 1016 personnel of the major providers of medical oncology services in Ontario. The questionnaire consisted of the Maslach Burnout Inventory, the 12-item General Health Questionnaire, a questionnaire to determine job satisfaction and stress, and questions to obtain demographic characteristics and to measure the staff's consideration of alternative work situations. RESULTS: The overall response rate was 70.9% (681 of 961 eligible subjects): by group it was 63.3% (131/207) for physicians, 80.9% (314/388) for allied health professionals and 64.5% (236/366) for support staff. The prevalence of emotional exhaustion were significantly higher among the physicians (53.3%) than among the allied health professionals (37.1%) and the support staff (30.5%) (p < or = 0.003); the same was true for feelings of depersonalization (22.1% v. 4.3% and 5.5% respectively) (p < or = 0.003). Feelings of low personal accomplishment were significantly higher among physicians (48.4%) and allied health professionals (54.0%) than among support staff (31.4%) (p < or = 0.002). About one-third of the respondents in each group reported that they have considered leaving for a job outside the cancer care system. Significantly more physicians (42.6%) than allied health professionals (7.6%) or support staff (4.5%) stated that they have considered leaving for a job outside the province. INTERPRETATION: The findings support the concern that medical oncology personnel are experiencing burnout and high levels of stress and that large numbers are considering leaving or decreasing their work hours. This is an important finding for the cancer care system, where highly trained and experienced health care workers are already in short supply. (+info)
Managed care, time pressure, and physician job satisfaction: results from the physician worklife study.
(37/1262)
OBJECTIVE: To assess the association between HMO practice, time pressure, and physician job satisfaction. DESIGN: National random stratified sample of 5,704 primary care and specialty physicians in the United States. Surveys contained 150 items reflecting 10 facets (components) of satisfaction in addition to global satisfaction with current job, one's career and one's specialty. Linear regression-modeled satisfaction (on 1-5 scale) as a function of specialty, practice setting (solo, small group, large group, academic, or HMO), gender, ethnicity, full-time versus part-time status, and time pressure during office visits. "HMO physicians" (9% of total) were those in group or staff model HMOs with > 50% of patients capitated or in managed care. RESULTS: Of the 2,326 respondents, 735 (32%) were female, 607 (26%) were minority (adjusted response rate 52%). HMO physicians reported significantly higher satisfaction with autonomy and administrative issues when compared with other practice types (moderate to large effect sizes). However, physicians in many other practice settings averaged higher satisfaction than HMO physicians with resources and relationships with staff and community (small to moderate effect sizes). Small and large group practice and academic physicians had higher global job satisfaction scores than HMO physicians (P <.05), and private practice physicians had quarter to half the odds of HMO physicians of intending to leave their current practice within 2 years (P <.05). Time pressure detracted from satisfaction in 7 of 10 satisfaction facets (P <.05) and from job, career, and specialty satisfaction (P <.01). Time allotted for new patients in HMOs (31 min) was less than that allotted in solo (39 min) and academic practices (44 min), while 83% of family physicians in HMOs felt they needed more time than allotted for new patients versus 54% of family physicians in small group practices (P <.05 after Bonferroni's correction). CONCLUSIONS: HMO physicians are generally less satisfied with their jobs and more likely to intend to leave their practices than physicians in many other practice settings. Our data suggest that HMO physicians' satisfaction with staff, community, resources, and the duration of new patient visits should be assessed and optimized. Whether providing more time for patient encounters would improve job satisfaction in HMOs or other practice settings remains to be determined. (+info)
A study of junior doctors to investigate the factors that influence career decisions.
(38/1262)
Both pre-registration house officers and general practitioner (GP) registrars agree on several desirable and undesirable factors that define their ideal career. These relate to fulfilling clinical work and preservation of a meaningful personal life. Many young doctors regret their choice of medicine as a career because of poor job conditions and stress and perceive career advice as inadequate. GP's influence over junior doctors at the time of their career decision making is very limited compared with that of consultants. (+info)
Job satisfaction of doctors in Negeri Sembilan.
(39/1262)
A cross sectional study was carried out in Negeri Sembilan to identify factors associated with job satisfaction of doctors serving in Ministry of Health and their intentions to resign. All Ministry of Health doctors currently working in Negeri Sembilan were included in the study and data collection was done via a self-administered postal questionnaire. The response rate was 69.4%. Out of those who responded, only 31.3% had global job satisfaction, with the majority dissatisfied. Intention to resign was high among 32.7% of the respondents. Factors found to be significantly associated with job satisfaction were age, job designation, income, duration of service and intention to resign. Intention to resign was found to be significantly associated with ethnicity and income. From logistic regression, predictors of job satisfaction identified were age, place of first graduation, and satisfaction with status and autonomy, satisfaction with career development, satisfaction with workload and satisfaction with transfers. Predictors of intention to resign were race, income and global job satisfaction. (+info)
The impact of an inpatient physician program on quality, utilization, and satisfaction.
(40/1262)
OBJECTIVE: To evaluate an inpatient physician system initiated in June 1996 for all patients of a health maintenance organization admitted to the general medicine service of an urban teaching hospital. In the new program, attending physician duties were transferred from the patient's own general internist to another internist serving on a hospital-based rotation. STUDY DESIGN: Cohort with historical controls. PARTICIPANTS AND METHODS: We compared the following measures before and after the new inpatient physician program began: (1) hospital length of stay and total charges, (2) outcomes related to quality of care, (3) primary care physician satisfaction, and (4) housestaff satisfaction. Differences before and after initiation of the inpatient physician program were evaluated using multivariate analyses to adjust for patient differences and secular trends. RESULTS: There were 2265 patients discharged from the general medical service in the year following implementation of the inpatient physician program. Postintervention average length of stay decreased from 3.5 to 3.0 days (P < .001). In multivariate analyses, average length of stay was reduced by 0.3 days (P = .008), and total hospital charges were reduced an average of $426 per admission (P = .001). In-hospital mortality rates, percentage of patients discharged home directly, and 30-day readmission rates did not change significantly in the postintervention period. Satisfaction among primary care physicians was high, with 90% of those answering a survey responding that they would recommend a similar program to other primary care groups. Medical housestaff satisfaction with their educational experience also increased. CONCLUSIONS: Implementation of an inpatient physician program at this institution significantly decreased resource utilization while maintaining or improving quality of care. Satisfaction with the program was high among primary care internists and housestaff. (+info)