Physician dissatisfaction influences medicare and medicaid care
Dissatisfaction correlates with the percentage of physicians who are willing to care for Medicare and Medicaid patients. A lower percentage of dissatisfied FP/GPs are accepting all new Medicaid patients than are their satisfied counterparts (34.6% vs 43.4%; P < .01); and a higher percentage of dissatisfied FP/GPs are taking no new Medicaid patients (33.5% vs 23.7%; P < .01). Similarly, a higher percentage of dissatisfied FP/GPs are accepting no new Medicare patients (11.3% vs 8.6%; P = .04) (Table 4).
RELATIONSHIP OF FP/GP DISSATISFACTION TO ACCESS FOR MEDICAID AND MEDICARE PATIENTS
|Characteristic||Satisfied FP/GPs (N = 2537) n (%)*||Dissatisfied FP/GPs (N = 569) n (%)*||P Value|
|Taking all new Medicaid patients||1024 (43.4)||198 (34.6)||<.01|
|Taking no new Medicaid patients||665 (23.7)||198 (33.5)||<.01|
|Taking all new Medicare patients||1519 (61.5)||325 (57.9)||0.13|
|Taking no new Medicare patients||227 (8.6)||70 (11.3)||0.04|
|*Unweighted number of survey respondents and weighted percent of US FP/GPs.|
|FP/GPs denotes family physicians/general practitioners.|
A substantial proportion of family physicians, approximately 1 in 5, were dissatisfied with their careers in 1996–1997. Associated characteristics of the dissatisfied group were older age, osteopathic training, and graduation from a foreign medical school. Neither type nor location of practice was a factor, although being a full owner of the practice was associated with greater dissatisfaction. Physicians earning less than $100,000 per year and FP/GPs for whom less than 10% or more than 30% of patients were in gatekeeping arrangements were more dissatisfied.
The strongest factors associated with dissatisfaction, however, were not personal or practice characteristics but the perceptions of family physicians about their ability to take good care of their patients. After we had controlled for personal and practice characteristics, dissatisfaction was much more likely when the family physicians felt they did not have (1) the freedom to make clinical decisions that met their patients’ needs, (2) a sufficient level of communication with specialists, (3) enough time with their patients, (4) the ability to provide high-quality patient care, (5) the freedom to make clinical decisions without financial conflicts of interest, or (6) the ability to maintain continuing relationships with their patients. 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 career.
These findings are consistent with previous findings concerning physician autonomy and the widespread backlash against constraints associated with managed care and gatekeeping. The findings draw attention from financial considerations toward clinical decision making as a critical factor in physicians’ career satisfaction. Understanding the basis of physician dissatisfaction is important because of the adverse effects of such dissatisfaction. It is difficult to imagine patients preferring to see a dissatisfied physician or to envision a visit with a dissatisfied FP/GP as superior to one with a satisfied physician. In addition, this analysis specifically demonstrates that dissatisfaction among family physicians can negatively affect groups of patients by impeding access to care for Medicaid and Medicare patients. Perhaps the key implication of these findings is the need for serious efforts to revise practice arrangements so that FP/GPs can make the best possible decisions for their patients.
There are important limitations to our analysis. The CTS Physician Survey is cross-sectional. While we do not know whether these physicians are more or less satisfied than they were in the past, recent evidence from surveys of primary care physicians in Massachusetts suggests that dissatisfaction has increased since 1986.17 As in all surveys, responses are subject to reporting error and response bias not accounted for by statistical adjustments. Our findings are associations between variables and do not establish causal relationships.
The finding that family physician dissatisfaction, after study results are controlled for personal and practice variables, is associated most strongly with a perceived inability to care for patients raises significant concerns. Dissatisfaction among a large proportion of family physicians threatens the well-being of patients. Given the extent to which the US health care system relies on family physicians, understanding why these physicians are dissatisfied and responding to these problems are important. This cross-sectional snapshot of dissatisfaction among family physicians suggests that patients would benefit from strategies that support rather than disrupt their ongoing relationships with family physicians and that permit their family physician to spend enough time with them to make decisions that are not constrained by financial or other conflicts of interest.