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Health Care Delivery

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Clinical autonomy seems to be the key to career satisfaction among both primary care and specialist physicians

Satisfaction among U.S. primary care and specialist physicians declined only marginally between 1997 and 2001. However, physicians practicing at some sites were far more likely to be dissatisfied than others. This decline in satisfaction was usually associated with less clinical autonomy, especially the ability to obtain medical services for patients. Managed care penetration within physicians' practices had little apparent effect on changes in satisfaction, according to a survey supported in part by the Agency for Healthcare Research and Quality (HS10803) and conducted by researchers at the Center for Studying Health Systems Change.

These differences in satisfaction may be related to subtle or unmeasured differences in managed care organizations in different communities or in how physicians' organizations respond to managed care, suggests lead author, Bruce E. Landon, M.D., M.B.A., of Harvard Medical School. Dr. Landon and his colleagues analyzed a nationally representative survey of U.S. primary care and specialist physicians in 60 U.S. sites in three rounds, 1996-1997, 1998-1999, and 2000-2001. Overall levels of career satisfaction among physicians during this time period did not change dramatically.

Among primary care physicians (PCPs), 42.4 percent were very satisfied in 1997, as were 43.3 percent of specialists, compared with 38.5 percent and 41.4 percent, respectively, in 2001. However, there was significant variation in local markets.

Among 12 sites selected for more intensive study, the proportion of physicians who were somewhat or very dissatisfied ranged from 8.8 percent of those in Lansing, MI (1999) to 34.2 percent in Miami, FL (1997). Rather than declining income, threats to physicians' autonomy, their ability to manage their day-to-day patient interactions and their time, and their ability to provide high quality care were most strongly associated with variations in satisfaction.

More details are in "Changes in career satisfaction among primary care and specialist physicians, 1997-2001," by Dr. Landon, James Reschovsky, Ph.D., and David Blumenthal, M.D., M.P.P., in the January 22, 2003 Journal of the American Medical Association 289(4), pp. 442-449.


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