Conditions of Practice and Quality of Care: Physicians' Perceptions

Grant Description: Do physicians’ practice characteristics (the size and complexity of the organization(s) in which they practice) have an effect on providers’ career satisfaction, their perceived ability to provide care, and their perceived ability to obtain necessary services for their patients? Researchers at the University of California at Davis tested the hypothesis that certain practice conditions facilitate the delivery of perceived high quality patient care, whereas other types of conditions impede perceived high quality care delivery. The researchers had four objectives to: 1) generate national estimates of physicians’ self-reported career satisfaction, ability to provide care and ability to obtain services for patients; 2) estimate the community-level effects of managed care, physician supply and other factors on these self-reported measures; 3) estimate the effect of individual physician characteristics on these self-reported measures; and 4) create a baseline analytic file for tracking future changes in physician satisfaction and quality of care. Measures of physician satisfaction, ability to provide care and obtain services for patients were drawn from responses to specific questions on the CTS Physician Survey. In addition to the CTS Physician Survey, they used the CTS Household Survey and the Area Resource File. The goal of this study was to help policymakers, medical students and physicians, and consumers identify forms of practice organization that are most likely to result in high quality of care.

Policy Summary: Physicians’ satisfaction with their careers in general is relatively high (80 percent satisfied). However, they have two substantial concerns. First, more than one-third cannot maintain the kinds of continuing relationships with patients to promote high quality care. Second, more than two-thirds cannot obtain needed mental health services for their patients. Explaining these difficulties is much easier than solving them. Physicians perceive problems with continuity of care because insurance arrangements cause patients to switch physicians more than they once did. They perceive problems with mental health care because access to psychiatric specialty services is nearly non-existent for the uninsured and may be severely constrained (through mental-health carve-outs and/or benefit limits) even for the insured. Policies to facilitate continuity of care and to increase access to mental health specialty services are needed. Physician satisfaction varies by specialty. The surprise is that physicians at greatest risk for dissatisfaction are not generalists (such as family physicians) or low paid cognitive specialists (such as pediatricians), but rather procedurally-oriented specialists such as otolaryngologists, obstetricians, ophthalmologists, and orthopedic surgeons. These results are adjusted for income; without this adjustment, the satisfaction of proceduralists would move much closer to the mean. Among cognitive specialists, general internists stand out as the least satisfied. Pediatricians are among the most satisfied of all. If there is a crisis in physician morale and if this crisis needs solving, the place to begin is with procedural specialists and general internists. Obstetrician-gynecologists represent a special case where the trouble is particularly acute. Physicians’ career satisfaction is strongly related to perceptions of being able to deliver quality care and obtain needed services for patients. System change designed to improve the delivery of care will likely influence physician satisfaction as well.