Contact: Lisa Brunette
(608) 263-5830
la.brunette@hosp.wisc.edu

HMO Physicians Generally Experience Less Job Satisfaction

Physicians who work in health maintenance organizations are generally less satisfied with their jobs and more likely to leave their practices than are physicians in other settings, a national survey of more than 2,300 physicians revealed.

The survey also found that time pressure was a major source of dissatisfaction among all physicians, but that HMO physicians were most likely to want additional time with patients, according to Mark Linzer, MD, of the University of Wisconsin, and colleagues.

"Crucial medical outcomes have been linked to physician satisfaction, including prescribing behavior, patient adherence to medications, patient satisfaction, and quality of care," said Linzer. "The amount of additional time that physicians said they would need to provide quality care ranged from 1 to 6 minutes per patient. What remains to be tested is whether providing physicians with these small increments of time would increase job satisfaction and the quality of care."

The researchers analyzed survey responses from a nationwide sample of 2,326 physicians. Most of the respondents (57 percent) were in group practices, and nine percent were in HMOs. Physicians completed questionnaires assessing their satisfaction in 10 specific domains, including autonomy; personal time; income; patient care issues; community; administration; resources; and relationships with patients, colleagues, and other staff. There were also measures of career, specialty, and job satisfaction in general.

HMO physicians were considerably more satisfied than other physicians on autonomy and administrative issues, but were less satisfied with the resources available and their relationships with other staff members and the community. Overall, physicians who practiced in small groups, large groups, and academic settings were significantly more satisfied with their jobs than were the HMO physicians.

Time pressure appears to contribute significantly to job dissatisfaction among all physicians. Ratings on seven of 10 measures of job satisfaction declined significantly as perceived time pressure increased. General measures of job satisfaction also decreased as perceived time pressures increased. HMO physicians were most likely to feel that pressure, with 61 percent saying they needed more time with patients compared with 51 percent of those in large single specialty group practices, 48 percent of those in small group practices, and 37 percent of those in solo practice.

HMO physicians were also two to four times more likely to say they intended to leave their current practice within the next two years than were those in small group, large group, and solo private practices, the researchers found.

The research appears in the July issue of the Journal of General Internal Medicine.

"This high intent to leave, coupled with the low global satisfaction, suggests that group and staff model HMO physicians may be a relatively unstable group," said Linzer. "Periodic surveying of HMO physicians concerning sources of satisfaction and dissatisfaction could allow timely interventions that would maintain quality and preserve the quality of care."

The Physician Worklife Study was supported by the Robert Wood Johnson Foundation, administered by the Society of General Internal Medicine, and conducted by the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill.

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The Journal of General Internal Medicine, a monthly peer-reviewed journal of the Society of General Internal Medicine, publishes original articles on research and education in primary care. For information about the journal, contact Renee F. Wilson at (410) 955-9868.