Abstract
Background: Physician quality of work life is a key factor in career choice, satisfaction, and retention. The majority of physicians are currently employed by large health care organizations where physician loss of autonomy is common, yet some physicians have opened micropractices. There have been no previous studies comparing physician satisfaction between employed physicians and micropractice physicians.
Methods: A previously validated survey of physician satisfaction was sent to 72 physicians practicing in a residency setting, 111 physicians in community, nonresidency setting, and 42 physicians in a micropractice setting.
Results: Physicians in micropractices had the lowest satisfaction with income, but the highest satisfaction with family time and the ability to provide continuity of care. Micropractice physicians rated the overall quality of medical care they provide higher than employed physicians. Micropractice physicians reported a much smaller scope of practice.
Conclusions: Overall, physicians in micropractices found more satisfaction in their work at the cost of decreased income and a narrower scope of practice.
Physician career satisfaction is low when there is a lack of control over the practice environment and increased perceived work demands.1 Since the 1950s, many physicians have left solo practice for larger health care organizations, with decreased satisfaction.2 Some physicians strive to achieve a practice with longer office visits, limited paperwork, and higher satisfaction using the micropractice model.3 Micropractice physicians are independent practitioners who have low overhead, allowing for extended visit time with patients.4 In our review of the literature, there were no studies comparing physician satisfaction between the micropractice model and larger practices. The purpose of our study was to examine this comparison.
Methods
Subjects
Physicians in the family medicine department at a large midwestern university, including 72 residency faculty physicians (RPs) and 111 community physicians (CPs) in nonresidency clinics as well as a national group of 42 micropractice physicians (MPs) were invited to take the online survey. Resident physicians were excluded. No other inclusion or exclusion criteria were applied.
Survey
The survey had 13 content questions in 3 categories (work satisfaction, practice issues, outcomes). Other questions asked about practice setting (rural, urban, suburban); 4 asked about the scope of practice. The 13 content questions came from a previously validated survey.5 Following the block of questions in each of the above categories was a space for open-ended comments.
Data Analysis
We used the χ2 test for nominal items and the Kruskal-Wallis test for ordinal scale items. We created a composite satisfaction score by adding the 8 satisfaction and outcome items, deleting 1 item (“plan to leave workgroup in near future”) because its addition lowered the overall internal consistency and reliability. The final 7-item scale had an internal reliability of α = 0.77 (acceptable). Parametric tests (analysis of variance and analysis of covariance) were used to analyze the composite score. Satisfaction measures were tested at a Bonferroni-corrected P = .004.
Results
Response rates for the 3 groups varied: 56.94% of RPs, 26.12% of CPs, and 52.38% of MPs. There were no statistically significant differences between practice models by sex, years since residency, and number of hours spent on patient care each week.
The 13 content questions and their responses are provided in Table 1. Table 2 includes selected comments from the survey. Comments were included if they were understandable and appropriate to the section.
More MPs practiced in a rural setting (41%), whereas CPs and RPs practiced in urban (34% and 48%, respectively) or suburban (55% and 33% respectively) settings (P = .031). RPs and CPs were more likely than MPs to provide inpatient care (90% and 84% vs 14%, respectively; P < .001) and practice obstetrics (68% and 45% vs 9%, respectively; P < .001). MPs were less likely than RPs and CPs to insert intrauterine and Implanon devices or perform circumcisions, colposcopy, and casting (P < .05 for all comparisons).
Years in current practice was considered a potential influence on other measures of satisfaction. We analyzed a subset of non-MPs consisting of only those with ≤10 years in practice. Nearly the exact same pattern of results as those for physician satisfaction was seen as when using the full sample of physicians.
Discussion
Overall, MPs were more satisfied with their work, yet many found they had to supplement their income or take a significant pay cut. As primary care struggles to attract medical students and primary care physicians show higher levels of burnout than other specialties,6 applying concepts from a micropractice model that lead to higher physician satisfaction may make primary care more appealing and reduce burnout.
Study Limitations
This is a small study, with a low response rate, particularly from CPs. The RPs and CPs practice in a single system, limiting our sample population. In addition, there is no current research on physician satisfaction; most data are from the early 2000s, making comparisons difficult.
Conclusions
MPs found more satisfaction in their work at the cost of a decreased income and narrower scope of practice. We believe that these results are relevant to discussions pertaining to the provision of primary care, medical student recruitment, and physician burnout.
Notes
This article was externally peer reviewed.
Funding: none.
Conflict of interest: none declared.
- Received for publication October 11, 2012.
- Revision received April 4, 2013.
- Accepted for publication April 23, 2013.
