When Doctors Believe They Are Not Providing Good Care: The Sources of Professional Distress in the American Health Care System

What is the relationship between a physician’s practice setting and his or her level of professional distress? Using the Community Tracking Study survey, researchers at the New York Academy of Medicine constructed four broad measures of professionalism: autonomy, conflict of interest, competence, and ability to act effectively in serving patients’ interests. Measures of practice setting include physicians’ practice size, the type of organization in which they practice, exposure to managed care, and compensation arrangements. They hypothesized that managed care alone influences this sense of professionalism both directly and indirectly, directly through cost containment and management, and indirectly through its influence on physician practice groups and the health delivery system in general. In addition to the CTS Physician Survey (including the Restricted Use data set), the researchers used the Area Resource File and InterStudy data. The study’s objective was to obtain a profile of how practice environment effects physician morale, in order to inform policymakers and other stakeholders on how they might resolve the tension between physician autonomy and accountability with that of managed care organizations.