Perceived Complexity of Care, Perceived Autonomy, and Career Satisfaction Among Primary Care Physicians

David Katerndahl; Michael Parchman; Robert Wood

doi:10.3122/jabfm.2009.01.080027

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Figure 1.
Predicted probability of career satisfaction as interaction between patient complexity and perceived autonomy.

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Table 1.

Characteristics of Primary Care Physicians and Their Practices Included in the Three Waves of the Community Tracking Survey

Characteristic	1996–1997 (n = 7197)	1998–1999 (n = 7264)	2000–2001 (n = 7673)
Physician Characteristics (%)
Gender (female)	25	29	32
Race (white)	—	77	76
Specialty
Internal medicine	33	33	33
Family medicine	44	42	43
Pediatrics	23	24	24
Began practice (after 1975)	73	79	84
Salaried	53	55	53
Practice environment
Number of practices (% one practice)	92	92	92
Weeks practicing in 1995 (mean ± SD)	47.8 ± 2.7	47.8 ± 2.6	47.7 ± 2.7
Hours per week in direct patient care (mean ± SD)	42.7 ± 12.9	42.2 ± 12.9	44.3 ± 13.1
Type of practice (% solo practice)	25	22	22
Number of physicians at practice (mean ± SD)	26.2 ± 54.6	26.2 ± 54.2	—
Number of assistants (mean ± SD)	3.2 ± 5.8	3.2 ± 5.8	—
Reimbursement
% Medicaid (mean ± SD)	15.0 ± 18.4	15.5 ± 18.5	15.8 ± 18.6
% Medicare (mean ± SD)	27.7 ± 23.0	27.4 ± 22.9	27.9 ± 22.9
% Managed Care (mean ± SD)	47.5 ± 28.2	51.0 ± 27.8	49.4 ± 27.8
Cares for both adults and children (%)	40	39	—
Complexity of expected care (% greater than it should be)	24.5	24.8	27.0
Perceived autonomy (% having freedom)	85.8	83.5	86.2
Career satisfaction (% satisfied with career)	80.7	80.0	79.7

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Table 2.

Staged Logistic Regressions for 1996 to 1997 Panel

Variables	Physician Variables Only	Physician + Practice Variables	Physician + Practice + Effect Variables	Physician + Practice + Effect + Perception Variables
Physician variables
Race (white)	—	—	—	—
Gender (female)	-0.042 (0.077)	-0.008 (0.085)	-0.003 (0.087)	-0.051 (0.089)
Salaried	0.392 (0.062)^§	0.001 (0.091)	0.007 (0.092)	-0.033 (0.095)
Specialty
Internal medicine	0.781 (0.293)^†	0.835 (0.355)^*	0.821 (0.356)^*	0.721 (0.387)
Family practice	0.963 (0.292)^§	0.872 (0.357)^*	0.890 (0.358)^*	0.746 (0.390)
Pediatrics	1.368 (0.299)^§	1.399 (0.364)^§	1.411 (0.365)^§	1.251 (0.397)^‡
Began practice after 1975	0.401 (0.067)^§	0.311 (0.077)^§	0.316 (0.078)^§	0.360 (0.081)
Importance of control over decisions (very important)	—	—	—	—
Practice variables
Weeks practicing per year (n)		-0.023 (0.013)	-0.021 (0.014)	-0.018 (0.014)
Hours per week in patient care (n)		0.001 (0.003)	0.000 (0.003)	0.002 (0.003)
Multiple practices		-0.187 (0.121)	-0.190 (0.122)	-0.120 (0.128)
Solo practice		-0.676 (0.094)^§	-0.681 (0.095)^§	-0.678 (0.098)^§
No assistants		-0.155 (0.078)^*	-0.144 (0.079)	-0.070 (0.082)
Frequently obtain high quality services
Ancillary Services		0.451 (0.104)^§	0.441 (0.106)^§	0.230 (0.111)^*
Imaging		0.337 (0.147)^*	0.309 (0.150)^*	0.184 (0.155)
Mental health care		0.241 (0.069)^§	0.245 (0.070)^§	0.120 (0.072)
Referrals		0.744 (0.139)^§	0.750 (0.142)^§	0.592 (0.147)^§
Revenue
From Medicaid (%)		0.001 (0.002)	0.001 (0.002)	0.001 (0.002)
From Medicare (%)		-0.003 (0.002)^*	-0.003 (0.002)^*	-0.004 (0.002)^*
From managed care (%)		-0.007 (0.001)^§	-0.006 (0.001)^§	-0.006 (0.001)^§
Care for adults and children		0.194 (0.165)	0.194 (0.167)	0.198 (0.172)
Patients with formulary (%)		—	—	—
Effect variables
Moderate effect on practice
Computer-generated patient data			0.085 (0.072)	0.087 (0.074)
Guidelines			-0.102 (0.073)	-0.030 (0.075)
Patient profiles			-0.004 (0.075)	0.093 (0.078)
Reminders			-0.035 (0.075)	0.027 (0.077)
Patient surveys			-0.065 (0.074)	-0.082 (0.076)
Computer-generated treatment alternative			0.037 (0.082)	0.025 (0.085)
Information Technology (IT) uses (n)			—	—
Perceptions variables
Expected complexity				-0.683 (0.079)^§
Perceived autonomy				0.873 (0.086)^§
Χ² (p)	145.50 (0.000)	360.55 (0.000)	359.97 (0.000)	567.02 (0.000)
-2LogL	6890.3	5903.5	5766.9	5486.5
Hosmer-Lemeshow Χ² (p)	5.13 (0.645)	13.20 (0.105)	9.37 (0.312)	25.79 (0.001)
Nagelkerke Adjusted R²	0.032	0.088	0.089	0.140

All data provided as β (SE).
* P ≤ .05.
† P ≤ .01.
‡ P ≤ .005.
§ P ≤ .001.

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Table 3.

Staged Logistic Regressions for 1998 to 1999 Panel

Variables	Physician Variables Only	Physician + Practice Variables	Physician + Practice + Effects Variables	Physician + Practice + Effect + Perception Variables
Physician Variables
Race (white)	0.259 (0.070)^§	0.209 (0.079)^†	0.183 (0.082)^*	-0.171 (0.085)^*
Gender (female)	0.000 (0.070)	0.010 (0.079)	0.009 (0.080)	0.061 (0.083)
Salaried	0.396 (0.060)^§	0.097 (0.084)	0.110 (0.085)	0.108 (0.088)
Specialty
Internal medicine	0.609 (0.307)^*	0.716 (0.359)^*	0.707 (0.360)^*	0.775 (0.371)^*
Family practice	0.865 (0.306)^‡	0.732 (0.360)^*	0.767 (0.362)^*	0.782 (0.373)^*
Pediatrics	1.208 (0.311)^§	1.276 (0.368)^§	1.274 (0.370)^§	1.298 (0.381)^§
Began practice after 1975	0.291 (0.072)^§	0.349 (0.082)^§	0.351 (0.083)^§	0.331 (0.087)^§
Importance of control of decisions (Very Important)	—	—	—	—
Practice variables
Weeks practicing per year (n)		-0.032 (0.014)^*	-0.031 (0.014)^*	-0.021 (0.014)
Hours per week in patient care (n)		-0.003 (0.003)	-0.003 (0.003)	-0.001 (0.003)
Multiple practices		-0.221 (0.117)	-0.196 (0.119)	-0.199 (0.123)
Solo practice		-0.211 (0.094)^*	-0.188 (0.095)^*	-0.197 (0.099)^*
No assistants		-0.185 (0.078)^*	-0.155 (0.080)	-0.104 (0.083)
Frequently obtain high-quality services
Ancillary services		0.418 (0.094)^§	0.419 (0.095)^§	0.253 (0.099)^*
Imaging		0.647 (0.142)^§	0.602 (0.144)^§	0.406 (0.149)^†
Mental health care		0.522 (0.070)^§	0.531 (0.070)^§	0.381 (0.073)^§
Referrals		0.405 (0.141)^‡	0.414 (0.142)^‡	0.209 (0.146)
Revenue
From Medicaid (%)		0.002 (0.002)	0.002 (0.002)	0.001 (0.002)
From Medicare (%)		-0.003 (0.002)	-0.004 (0.002)^*	-0.004 (0.002)^*
From managed care (%)		-0.004 (0.001)^‡	-0.004 (0.001)^‡	-0.003 (0.001)^*
Care for adults and children		0.269 (0.165)	0.249 (0.167)	0.305 (0.172)
Patients with formulary (%)		—	—	—
Effect variables
Moderate effect on practice
Computer-generated patient data			0.100 (0.070)	0.067 (0.073)
Guidelines			-0.129 (0.072)	-0.090 (0.074)
Patient profiles			0.025 (0.075)	0.066 (0.077)
Reminders			-0.052 (0.073)	0.018 (0.075)
Patient surveys			-0.016 (0.070)	-0.020 (0.073)
Computer-generated treatment alternative			0.128 (0.075)	0.162 (0.078)^*
Information Technology (IT) uses (n)			—	—
Perceptions variables
Expected complexity				-0.539 (0.078)^§
Perceived autonomy				1.029 (0.081)^§
Χ² (p)	146.93 (0.000)	371.54 (0.000)	370.72 (0.000)	614.67 (0.000)
-2LogL	7127.1	6079.5	5968.9	5637.2
Hosmer-Lemeshow Χ² (p)	14.26 (0.075)	11.48 (0.176)	12.35 (0.136)	11.20 (0.191)
Nagelkerke Adjusted R²	0.032	0.089	0.090	0.149

All data provided as β (SE).
* P ≤ .05.
† P ≤ .01.
‡ P ≤ .005.
§ P ≤ .001.

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Table 4.

Staged Logistic Regressions for 2000 to 2001 Panel

Variables	Physician Variables Only	Physician + Practice Variables	Physician + Practice + Effects Variables	Physician + Practice + Effect + Perceptions Variables
Physician Variables
Race (white)	0.080 (0.071)	0.049 (0.080)	0.081 (0.083)	0.069 (0.085)
Gender (female)	-0.024 (0.068)	-0.079 (0.076)	-0.083 (0.077)	-0.077 (0.079)
Salaried	0.341 (0.060)^§	0.056 (0.076)	0.049 (0.077)	0.022 (0.079)
Specialty
Internal medicine	-0.034 (0.331)	-0.092 (0.379)	-0.076 (0.380)	-0.159 (0.395)
Family practice	0.143 (0.331)	0.106 (0.378)	0.113 (0.379)	0.048 (0.394)
Pediatrics	0.700 (0.336)^*	0.732 (0.387)	0.759 (0.387)^*	0.653 (0.403)
Began practice after 1975	0.103 (0.080)	0.261 (0.091)^‡	0.243 (0.092)^†	0.232 (0.094)^*
Importance of control of decisions (very important)	-0.046 (0.066)	-0.078 (0.073)	-0.068 (0.073)	-0.028 (0.075)
Practice variables
Weeks practicing per year (n)		-0.040 (0.013)^‡	-0.036 (0.013)^†	-0.030 (0.014)^*
Hours per week in patient care (n)		-0.011 (0.003)^§	-0.011 (0.003)^§	-0.010 (0.003)^§
Multiple practices		-0.168 (0.118)	-0.171 (0.119)	-0.184 (0.121)
Solo practice		-0.369 (0.084)^§	-0.351 (0.085)^§	-0.308 (0.087)^§
No assistants		—	—	—
Frequently obtain high-quality services
Ancillary services		0.444 (0.094)^§	0.446 (0.095)^§	0.267 (0.099)^†
Imaging		0.284 (0.142)^*	0.301 (0.143)^*	0.164 (0.147)
Mental health care		0.404 (0.070)^§	0.374 (0.070)^§	0.270 (0.072)^§
Referrals		0.545 (0.126)^§	0.564 (0.127)^§	0.379 (0.132)^‡
Revenue
From Medicaid (%)		0.003 (0.002)	0.003 (0.002)	0.003 (0.002)
From Medicare (%)		-0.002 (0.002)	-0.003 (0.002)	-0.002 (0.002)
From managed care (%)		-0.004 (0.001)^‡	-0.004 (0.001)^‡	-0.003 (0.001)^*
Care for adults and children		—	—	—
Patients with formulary (%)		-0.001 (0.002)	-0.001 (0.002)	-0.001 (0.002)
Effect variables
Moderate effect on practice
Computer-generated patient data			—	—
Guidelines			0.005 (0.071)	0.038 (0.072)
Patient profiles			-0.047 (0.074)	0.016 (0.076)
Reminders			—	—
Patient surveys			0.176 (0.071)^*	0.212 (0.073)^‡
Computer-generated treatment alternative			—	—
Information Technology (IT) uses (#)			0.026 (0.018)	0.025 (0.019)
Perceptions variables
Expected complexity				-0.437 (0.078)^§
Perceived autonomy				0.934 (0.085)^§
Χ² (p)	118.04 (0.000)	345.96 (0.000)	352.36 (0.000)	516.59 (0.000)
-2LogL	7251.3	6198.6	6108.4	5855.8
Hosmer-Lemeshow Χ² (p)	3.69 (0.884)	13.54 (0.095)	5.84 (0.665)	6.88 (0.549)
Nagelkerke Adjusted R²	0.025	0.081	0.083	0.122