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Managed Care and Primary Physician Satisfaction

Center for Cost and Outcomes Research (DG, PD, DM, DLP), University of Washington, Seattle
Department of Health Services (DG, CMU, PD, DM, DLP), University of Washington, Seattle
Department of Biostatistics (PD), University of Washington, Seattle
Department of Psychiatry (WK), University of Washington, Seattle
Department of Epidemiology (CMU, CV), University of Washington, Seattle
Department of Geography (DP), University of Washington, Seattle
Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, Seattle, Washington (CMU)

Correspondence: Address correspondence to David Grembowski, PhD, Department of Health Services, University of Washington, 1959 NE Pacific Street, Box 357660, Seattle, Washington 98195-7660 (e-mail:grem{at}u.washington.edu)

Background: We examined whether physician compensation, financial incentives, and care management tools were associated with primary physician job and referral satisfaction. Our study was guided by a conceptual model of physician satisfaction derived from published evidence.

Methods: A cross-sectional survey was performed of 495 primary physicians (family practitioners, general practitioners, general internists) in the Seattle metropolitan area in 1997.

Results: Bivariate analyses revealed that salary compensation, productivity bonuses, and withholds for referrals were associated with job and referral dissatisfaction. However, after controlling for physician, practice, and office characteristics, only the association between salary payment and job dissatisfaction remained significant. Practice in offices with more physicians had the strongest association with physician job dissatisfaction.

Conclusions: Although managed care features are correlated with physician job and referral dissatisfaction, the source of dissatisfaction may originate from being an employed physician in a large medical group with more physicians, which may be more likely to impose bureaucratic controls that limit physician autonomy.