OBJECTIVES: A usual source of care is associated with better health outcomes. Dissatisfaction among family physicians and general practitioners (FP/GPs) may compromise the accessibility of a usual source of care and the quality of services. We examined the association between FP/GP dissatisfaction and an inability to deliver high-quality care.
STUDY DESIGN: We performed a secondary data analysis of the Community Tracking Study (CTS) Physician Survey (1996–1997).
POPULATION: The study included a nationally representative sample of more than 12,000 non-federal physicians practicing direct patient care in the United States.
OUTCOMES MEASURED: We measured associations of career dissatisfaction with physicians’ perceptions of their ability to provide high-quality care as defined by 6 survey items. Multivariate analyses controlled for the effects of personal, professional, and practice characteristics.
RESULTS: Among FP/GPs in 1996–1997, more than 17% were dissatisfied. Age was the most significant personal factor associated with dissatisfaction; 25.1% of those aged 55 to 64 years reported dissatisfaction compared with only 10.1% of those younger than 35 years. Other personal or professional characteristics significantly associated with FP/GP dissatisfaction included osteopathic training, graduation from a foreign medical school, full practice ownership, and an income of less than $100,000. Physicians dissatisfied with their careers were much more likely to report difficulties in caring for patients, strongly disagreeing (vs strongly agreeing, odds ratio [OR] 1.0) that they had enough clinical freedom (OR 7.89; 95% confidence interval [CI], 4.86-12.83); continuous patient relationships (OR 7.11; 95% CI, 4.90-10.33); no financial penalties for clinical decisions (OR 4.44; 95% CI, 3.13-6.31); adequate time with patients (OR 4.42; 95% CI, 2.84-6.87); ability to provide quality care (OR 4.26; 95% CI, 2.88-6.31); and sufficient communication with specialists (OR 3.57; CI, 2.20-5.80).
CONCLUSIONS: An inability to care for patients is significantly associated with career dissatisfaction. This relationship has implications for the achievement of policy objectives related to access, having a usual source of care, and quality.
- The proportion of family physicians and general practitioners (FP/GPs) dissatisfied with their overall medical careers (17.3%) was similar to that of specialists (18.0%), less than that of general internists (20.6%), and greater than that of general pediatricians (12.6%).
- Only 1 in 10 FP/GPs aged younger than 35 years were dissatisfied with their medical careers; 1 in 4 of those aged 55 to 64 years were dissatisfied.
- More than half of FP/GPs who strongly disagreed with the statement “I have the freedom to make clinical decisions that meet my patients’ needs” were dissatisfied with their medical careers.
Primary care is the foundation of the American health care system. The delivery of high-quality primary care contributes to improved health outcomes.1,2 Patients perceive primary care as an integral aspect of the health care system and appreciate the role of primary care providers in coordinating quality care.3 In addition to coordination of care, continuity with the same health care provider is highly valued by patients.4 Family physicians and general practitioners (FP/GPs) play a crucial role in providing coordinated and continuous primary health care. Of Americans reporting an individual provider as their usual source of care in 1996, 62% named a family physician or a general practitioner (compared with 16% naming an internist and 15% naming a pediatrician).5
A potential threat to the continued reliance on this vital FP/GP workforce is physician dissatisfaction. Physician dissatisfaction affects patient satisfaction6-8 and dissatisfied physicians can adversely influence patient behavior (eg, adherence to medical treatment),9 leading to a reduction in quality of care. A decrease in satisfaction among physicians can also affect access to care, since it can lead to physician attrition and higher turnover, which in turn can lead to disruption of care and inaccessibility of providers. The cost to hire a new physician is estimated to be $240,000 to $265,000.10
Dissatisfaction among today’s FP/GPs also has the potential to contribute to future shortages. The extent to which physicians voice dissatisfaction can dissuade medical school graduates from choosing careers in primary care.11 Some concerns are already being raised about a decrease in the number of new doctors seeking residencies in family practice for the fourth consecutive year. Information from the National Resident Matching Program indicates that only 11.2% of US seniors matched in family practice in 2001, compared with 13.6% in 2000.12 If this downward trend continues, it will exacerbate the problems of access to a usual source of care, especially in areas where the loss of FP/GPs will result in a drastic increase in the number of health professional shortage areas. In 1995, if FP/GPs had been removed from the 2298 US counties considered to have adequate numbers of primary care physicians, 1332 of these urban and rural counties would have been designated as shortage areas. In comparison, the simultaneous removal of internists, pediatricians, and obstetricians from these same counties would have created only 176 whole-county shortage areas.13