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Health Care Delivery/Clinical Practice

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Doctors' dissatisfaction grew steadily over the last decade

If Massachusetts is representative of the Nation as a whole, physicians' satisfaction with their professional lives has declined substantially in the last 15 years. This is the finding of a recent study sponsored by the Agency for Healthcare Research and Quality (HS08841) in conjunction with the Robert Wood Johnson Foundation. The researchers compared findings from surveys of Massachusetts primary care physicians in 1986 and in 1997.

By 1997, fewer than two-thirds of physicians were satisfied with most areas of practice, and fewer than half were content with the time they spent with patients, the amount of leisure time they had, and incentives for providing high quality care, as compared with physicians in 1986. However, respondents in both 1986 and 1997 said they were satisfied with the quality of care they were able to provide.

This research shows that changes in the way health care is delivered affect more than the patients. Both the public and private sectors need to work together to help health care professionals adapt to changes in the structure and organization of America's health care system, according to lead author Allison Murray, M.D., M.P.H., of the University of Calgary.

Dr. Murray and her colleagues also studied differences in the experiences of physicians working in different types of medical practices. Nearly half of physicians in practices that contract with multiple insurers reported one or more insurance company denials of patient care in the prior year. Physicians in these practice arrangements were highly dissatisfied with the procedures required for obtaining health plan authorization for patient care, compared with physicians who worked exclusively with one health plan. In addition, fewer than half of the physicians indicated that they would recommend the health plans with which they were associated to family members or friends.

According to AHRQ grantee Dana Gelb Safran, Sc.D., of the New England Medical Center, many of these physicians began practicing decades ago in a system with virtually no oversight or restraint on spending. From their perspective, the changes in their professional lives have been profound and, for the most part, unwelcome. If we had tracked physician satisfaction in other parts of the country with health care markets similar to Massachusetts, we would expect similar findings, concludes Dr. Safran.

Dr. Safran points out that there are many reasons why physician satisfaction is important. Numerous studies have reported that dissatisfaction leads to increased physician turnover, which in turn leads to decreased continuity of care for patients and increased costs to the medical system. Other research has shown a positive relationship between physician satisfaction and patient satisfaction. Physician satisfaction also affects the morale of health care workers and staff who work closely with the physicians.

In conclusion, Dr. Safran noted that the changes that have come to the medical profession over the past 10-15 years have put enormous pressure on physicians with regard to their productivity and performance. And, as America's health care system continues to evolve, the satisfaction of patients and health care professionals alike will need to be monitored to assure the future quality of health care services.

For details, see, "Doctor discontent: A comparison of physician satisfaction in different delivery system settings, 1986 and 1997," by Dr. Murray, Jana E. Montgomery, Sc.M., Hong Chang, Ph.D., and others, in the July 2001 Journal of General Internal Medicine 15, pp. 451-459.

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