Original Research

Does Career Dissatisfaction Affect the Ability of Family Physicians to Deliver High-Quality Patient Care?

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References

Most studies reporting physician dissatisfaction have identified high levels of physician concern over a perceived loss of autonomy.14-17 Additionally, physicians are dissatisfied about the potential adverse effects on patient care resulting from system barriers, including restricted access for patients, increased administrative burdens for providers, and the lack of a comprehensive approach to provision of services.14-22 These studies, however, have generally been limited to a specific geographic region14-20 or a specialty group other than FP/GPs.21,22 In addition, other physician dissatisfaction reports have contained only narrow analyses of how specific factors, such as income, financial incentives, or autonomy, influence satisfaction levels.23-26

To our knowledge, the possible relationship of physician dissatisfaction with the inability to care for patients has been examined only in limited studies (eg, those that compare capitated and noncapitated care).27 Moreover, few studies have systematically reviewed predictors of dissatisfaction among FP/GPs. In this paper, we report findings related to these important issues using data from a recent national survey in which more than 12,000 primary care physicians and specialists commented on their current experiences as medical professionals in the US health care system. We hypothesized that FP/GPs who identify difficulties in providing quality care to patients also report higher levels of dissatisfaction. We also expected that physician dissatisfaction would relate to access to care, particularly for very needy populations whose care is government regulated. Therefore, we ascertained the extent to which dissatisfied FP/GPs who stay in the workforce are less likely to serve the poor and the elderly by accepting new Medicaid and Medicare patients when compared with their satisfied counterparts.

Methods

Data source

Data for this study were from the Community Tracking Study (CTS) Physician Survey (1996–1997).28 This survey, sponsored by the Robert Wood Johnson Foundation, was part of a major project by the Center for Studying Health System Change, a Washington, DC–based organization affiliated with Mathematica Policy Research, Inc. Information for the survey was collected from a nationally representative sample of nonfederal physicians performing direct patient care.

The sample frame of physicians was obtained from master files of the American Medical Association and the American Osteopathic Association. The sample included office-based and hospital-based physicians who spend at least 20 hours per week in direct patient care in the continental United States. Residents and fellows were excluded, as were physicians in certain specialties such as radiology, anesthesiology, and pathology. The survey followed a complex design of 60 sites supplemented by a small, independently drawn national sample.28,29 Telephone interviews were conducted with 12,291 physicians from August 1996 to August 1997 with a 65% response rate.30,31 The rate of nonresponse to individual survey items was very low, typically less than 3%. Primary care physicians were oversampled. The 3166 FP/GPs accounted for 44.3% of primary care doctors surveyed and 25.8% of the total sample.

Study variables

Dependent Variable: Career Satisfaction. The dependent variable for most analyses was medical career dissatisfaction. Respondents were asked, “Thinking very generally about your overall career in medicine, would you say that you are currently very satisfied, somewhat satisfied, somewhat dissatisfied, very dissatisfied, or neither satisfied or dissatisfied?” For comparative analysis, those reporting “neither satisfied or dissatisfied” were eliminated and the 4 remaining responses were collapsed into 2 categories. Physicians who reported feeling very satisfied or somewhat satisfied were classified as “satisfied”; those who reported feeling somewhat dissatisfied or very dissatisfied were classified as “dissatisfied.”

Independent Variables. The explanatory variables of primary interest were indicators to assess physicians’ perceptions of their ability to provide high-quality medical care. This determination was measured by 6 survey questions with 5-point response categories that ranged from “strongly agree” to “strongly disagree.” Table 1 presents the measures of quality of care. Physician dissatisfaction was also potentially influenced by other factors assessed in the survey. Analyses were statistically controlled for the personal, professional, and practice characteristics that appear in Table 2 to examine the relationship of physicians’ dissatisfaction with the perception of their ability to provide high-quality care.

TABLE 1
PATIENT CARE CHARACTERISTICS ASSOCIATED WITH FP/GP DISSATISFACTION (N = 3166)

StatementMultivariate Odds Ratio (95% CI)
The level of communication I have with specialists about the patients I refer to them is sufficient to ensure the delivery of high-quality care. (n = 3102)1.0
  Agree strongly1.25 (1.01-1.55)
  Agree somewhat1.15 (0.48-2.74)
  Neither agree nor disagree2.37 (1.67-3.37)
  Disagree somewhat3.57 (2.20-5.80)
  Disagree strongly
It is possible to maintain the kind of continuing relationships with patients over time that promote the delivery of high-quality care. (n = 3082)1.0
  Agree strongly1.89 (1.39-2.58)
  Agree somewhat3.17 (1.38-7.29)
  Neither agree nor disagree4.90 (3.71-6.46)
  Disagree somewhat7.11 (4.90-10.33)
  Disagree strongly
I can make clinical decisions in the best interests of my patients without the possibility of reducing my income. (n = 3074)1.0
  Agree strongly1.23 (0.92-1.65)
  Agree somewhat1.51 (0.89-2.58)
  Neither agree nor disagree2.61 (1.91-3.56)
  Disagree somewhat4.44 (3.13-6.31)
  Disagree strongly
I have adequate time to spend with my patients during typical office/patient visits. (n = 310)1.0
  Agree strongly0.81 (0.58-1.14)
  Agree somewhat1.15 (0.58-2.30)
  Neither agree nor disagree1.39 (1.02-1.88)
  Disagree somewhat4.42 (2.84-6.87)
  Disagree strongly
I have the freedom to make clinical decisions that meet my patients’ needs. (n = 3100)1.0
  Agree strongly1.55 (1.25-1.93)
  Agree somewhat3.25 (1.50-7.02)
  Neither agree nor disagree3.73 (2.84-4.89)
  Disagree somewhat7.89 (4.86-12.83)
  Disagree strongly
It is possible to provide high-quality care to all my patients. (n = 3099)1.0
  Agree strongly1.20 (0.94-1.52)
  Agree somewhat0.98 (0.37-2.61)
  Neither agree nor disagree2.70 (1.88-3.89)
  Disagree somewhat4.26 (2.88-6.31)
  Disagree strongly
NOTE: A higher odds ratio indicates that this response is more strongly associated with physician dissatisfaction. Ns vary because not all physicians answered every item on the survey.
FP/GP denotes family physician/general practitioner.

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