Managed Care and Primary Physician Satisfaction

David Grembowski; Cornelia M. Ulrich; David Paschane; Paula Diehr; Wayne Katon; Diane Martin; Donald L. Patrick; Christine Velicer

doi:10.3122/jabfm.16.5.383

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Figure 1.
Conceptual model of physician satisfaction. Examples of primary physician characteristics include sex, specialty, board certification, and years in practice. Examples of market characteristics include the presence of managed health plans, penetration, and uninsured rate.

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Table 1.

Average Scores of Items in the Physician Satisfaction Scales (n = 498)

Criteria	Average
Physician Job Satisfaction
The care you provide to your patients	4.44 (0.63)
The degree of personal autonomy you have	3.65 (1.05)
The way you are paid for your services	3.22 (1.21)
The current volume of patients that you see	3.56 (1.05)
The way that your practice is managed	3.30 (1.12)
Your current work setting overall	3.71 (1.03)
Scale Score	3.65 (0.73)
Physician Referral Satisfaction
Your ability to retain control over the patients’ care after referral to specialist	3.62 (0.90)
Your ability to refer patients to the specialists who are best suited to help them	3.70 (0.98)
Your communication with specialists regarding outcomes of patients referrals	3.76 (0.87)
Scale Score	3.69 (0.73)

For each item, physicians rated their satisfaction on a scale of 1 (very dissatisfied) to 5 (very satisfied). Standard deviation presented in parentheses.

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Table 2.

Characteristics Associated with Physician Job and Referral Satisfaction: Bivariate Results

Characteristics	Sample Size	Average Physician Job Satisfaction	Average Physician Referral Satisfaction
Physician Characteristics
Gender
Male	321	3.72 (0.69)^**	3.74 (0.69)
Female	177	3.53 (0.79)	3.62 (0.79)
Race
White	425	3.68 (0.72)^*	3.70 (0.73)
Nonwhite	65	3.43 (0.73)	3.61 (0.72)
Specialty
Family practice	300	3.66 (0.70)	3.69 (0.72)
Internal medicine	163	3.60 (0.77)	3.65 (0.77)
General practice	30	3.68 (0.83)	3.94 (0.58)
Board-certified
Yes	343	3.63 (0.76)	3.72 (0.75)
No	125	3.65 (0.70)	3.63 (0.65)
Years in Practice
<15 years	229	3.56 (0.74)^*	3.57 (0.75)^**
≥15 years	243	3.70 (0.74)	3.82 (0.69)
Tolerance for uncertainty in patient care (range, 0–8)
<5	158	3.49 (0.70)^**	3.54 (0.69)^**
≥5	332	3.74 (0.73)	3.78 (0.72)
Physician Practice Characteristics
Patient visits per hour
<2.5	219	3.63 (0.75)	3.65 (0.80)
≥2.5	276	3.66 (0.72)	3.73 (0.67)
Administrative hours per week
<8	220	3.77 (0.73)^**	3.77 (0.76)^*
≥8	269	3.55 (0.72)	3.62 (0.70)
Percentage patients referred per month
<10	173	3.77 (.072)^**	3.73 (0.79)
≥10	322	3.58 (0.73)	3.67 (0.70)
Percentage female patients
<60	198	3.66 (0.66)	3.75 (0.71)
≥60	298	3.64 (0.77)	3.67 (0.74)
Percentage nonwhite patients
<10	144	3.70 (0.71)	3.77 (0.75)
≥10	351	3.63 (0.74)	3.66 (0.72)
Percentage patients ≤18 years
<15	245	3.65 (0.76)	3.71 (0.75)
≥15	251	3.66 (0.69)	3.69 (0.71)
Percentage patients ≥65 years
<20	166	3.67 (0.71)	3.65 (0.76)
≥20	330	3.64 (0.74)	3.72 (0.71)
Percentage patients from middle- or upper-class households
<60	184	3.55 (0.72)^*	3.61 (0.74)
≥60	308	3.71 (0.73)	3.74 (0.72)
Office Characteristics
Office type
Solo Primary	76	3.82 (0.66)^**	3.85 (0.62)^*
Group Primary	246	3.55 (0.78)	3.64 (0.75)
Multi-specialty	155	3.72 (0.66)	3.74 (0.70)
Number of providers
<8	227	3.74 (0.66)^*	3.69 (0.70)
≥8	270	3.57 (0.78)	3.70 (0.76)
Private Ownership
Yes	298	3.73 (0.70)^**	3.73 (0.70)^**
No	167	3.50 (0.70)	3.50 (0.76)
Difficulty/ease of referral
1 Very difficult	9	2.88 (0.95)^**	3.00 (0.67)^**
2	75	3.48 (0.72)	3.32 (0.84)
3	170	3.55 (0.72)	3.57 (0.64)
4	144	3.72 (0.72)	3.74 (0.68)
5 Very easy	96	3.90 (0.66)	4.20 (0.54)
Compensation and Care Management
Type of Compensation
Salary	319	3.56 (0.77)^**	3.68 (0.74)
Fee-for-service	170	3.83 (0.63)	3.72 (0.73)
Productivity bonus
Yes	260	3.54 (0.79)^**	3.62 (0.71)
No	238	3.78 (0.65)	3.78 (0.75)
Percentage patients in HMOs
<20	166	3.74 (0.73)	3.65 (0.73)
≥20	274	3.61 (0.73)	3.76 (0.70)
Financial withhold for referrals
Yes	137	3.50 (0.74)^**	3.47 (0.72)^**
No	361	3.71 (0.73)	3.78 (0.72)
Office prior approval required to refer to specialist inside the office
Yes	119	3.65 (0.73)	3.80 (0.69)
No	379	3.65 (0.74)	3.66 (0.74)
Office prior approval required to refer to specialist outside the office
Yes	270	3.58 (0.76)^*	3.73 (0.75)
No	228	3.74 (0.69)	3.65 (0.71)
Office follows written referral guidelines
Yes	196	3.63 (0.76)	3.73 (0.73)
No	302	3.66 (0.71)	3.67 (0.73)
Office follows written clinical guidelines for treating specific conditions
Yes	177	3.65 (0.73)	3.75 (0.77)
No	321	3.65 (0.74)	3.67 (0.71)

Bivariate tests used analysis of variance. For continuous variables, statistical tests were performed by dividing the distribution at the median.
* P < .05.
** P < .01

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Table 3.

Partial Correlations of the Determinants of Physician Job Satisfaction

		Correlations Controlling for
		Characteristic	Bivariate Correlations	Physician Characteristics	Physician and Practice Characteristics	Physician Practice, and Office Characteristics	All Other Characteristics
Compensation and Care Management
Salary compensation	−.18^**	−.15^**	−.16^**	−.15^**	−.16^**
Productivity bonus	−.17^**	−.15^**	−.12^*	−.08	−.06
Financial withhold for referrals	−.13^**	−.07	−.05	−.03	−.06
Percentage patients in HMOs	−.05	−.02	−.04	−.09	−.07
Office prior approval required to refer to specialist inside the office	−.00	.04	.05	.04	.03
Office prior approval required to refer to specialist outside the office	−.11^*	−.05	−.04	−.04	−.03
Office follows written referral guidelines	−.02	.01	.03	.08	.05
Office follows written clinical guidelines for treating specific conditions	−.00	.01	.01	.09	.05
Office Characteristics
Solo practice	.11^*	.08	.09		.02
Primary group	−.14^**	−.14^*	−.16^**		.01
Multispecialty group	.07	.09	.11		.05
Number of physicians	−.08	−.14^*	−.14^*		−.24^**
Private ownership	.15^**	.14^**	.13^*		.05
Easy to refer	.23^**	.19^**	.16^**		.20^**
Physician Practice Characteristics
Patient visits per hour	−.03	−.05			−.01
Administrative hours per week	−.14^**	−.13^*			−.16^**
Percentage patients referred per month	−.11^*	−.05			−.01
Percentage female patients	−.09	−.06			−.08
Percentage nonwhite patients	−.10^*	−.04			.04
Percentage patients ≤18 years	−.02	.01			−.01
Percentage patients ≥65 years	−.00	−.00			.03
Percentage patients from middle- or upper-class households	.14^**	.13^*			.10
Physician Characteristics
Female	−.13^**				.00
White	.12^*				.10
Family practice	.02				.06
General practice	.01				−.02
Board-certified	−.01				.00
Years in practice	.12^*				−.05
Tolerance for uncertainty	.15^**				.16^**

* P < .05.
** P < .01

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Table 4.

Partial Correlations of the Determinants of Physician Referral Satisfaction

		Correlations Controlling for
		Characteristic	Bivariate Correlations	Physician Characteristics	Physician and Practice Characteristics	Physician Practice, and Office Characteristics	All Other Characteristics
Compensation and Care Management
Salary compensation	−.03	.05	.02	.04	−.00
Productivity bonus	−.10^*	−.05	−.08	−.02	−.01
Financial withhold for referrals	−.19^**	−.17^**	−.14^*	−.08	−.08
Percentage patients in HMOs	.18^**	.20^**	.19^**	.08	.06
Office prior approval required to refer to specialist inside the office	.08	.06	−.05	−.01	−.04
Office prior approval required to refer to specialist outside the office	.05	.11	−.07	.02	.02
Office follows written referral guidelines	.04	.06	−.05	.01	−.01
Office follows written clinical guidelines for treating specific conditions	.05	.09	.08	.03	−.00
Office Characteristics
Solo practice	.09	−.01	.01		.07
Primary group	−.07	−.05	−.05		.05
Multispecialty group	.04	.06	.06		.06
Number of physicians	.09	.11^*	.08		.02
Private ownership	.07	.01	.05		.01
Easy to refer	.39^**	.37^**	.36^**		.31^**
Physician Practice Characteristics
Patient visits per hour	.03	.04			.03
Administrative hours per week	−.09	−.10			−.09
Percentage patients referred per month	−.06	.01			.02
Percentage female patients	−.06	−.11^*			−.06
Percentage nonwhite patients	−.02	.11^*			.09
Percentage patients ≤18 years	−.10^*	−.02			−.02
Percentage patients ≥65 years	.08	.10			.05
Percentage patients from middle- or upper-class households	.06	−.03			−.01
Physician Characteristics
Female	−.08				.09
White	.04				.08
Family practice	−.01				.02
General practice	.08				.06
Board-certified	.06				.09
Years in practice	.18^**				.08
Tolerance for uncertainty	.17^**				.18^**