Article Figures & Data
Tables
Likert Ratings Settings P value Community Micropractice Residency Work satisfaction How satisfied are you with your current income? 1 = not satisfied, 5 = very satisfied 2.76 (0.49) 2.32 (0.58) 3.21 (0.36) 0.38 How satisfied are you with the amount of family time you have? 1 = not satisfied, 5 = very satisfied 2.97 (0.44 4.09 (0.45) 2.34 (0.32) <.001* How would you rate the quality of the working relationships among physicians in your work group? 1 = poor, 5 = excellent 3.79 (0.43) 4.39 (0.42) 3.97 (0.33) .099 How satisfied are you with your ability to provide continuity of care? 1 = not satisfied, 5 = very satisfied 3.45 (0.44) 4.50 (0.46) 3.50 (0.33) <.001* Practice issues How often do you work under time pressure? 1 = never, 5 = always 4.07 (0.31) 2.50 (0.42) 4.05 (0.21) <.001* Do you agree or disagree that the amount of paperwork you process is reasonable? 1 = strongly disagree, 5 = strongly agree 2.21 (0.37) 2.86 (0.57) 2.13 (0.33) .089 How much influence do you have over management decisions that affect your practice? 1 = very little, 5 = very much 2.72 (0.39) 4.64 (0.49) 2.32 (0.36) <.001* How often are you able to match the amount of time you have to spend with patients to the level of complexity of each patient's case? 1 = never, 5 = always 3.29 (0.28) 4.62 (0.25) 3.03 (0.24) <.001* Outcomes How satisfied are you with your opportunities to fully utilize your skills in your practice situation? 1 = not satisfied, 5 = very satisfied 3.55 (0.36) 4.38 (0.44) 3.58 (0.3) .001* How satisfied are you with being a physician? 1 = not satisfied, 5 = very satisfied 4.00 (0.36) 4.00 (0.53) 4.39 (0.25) NS Given your work situation in total, how would you rate the overall quality of the medical care you are able to provide? 1 = poor, 5 = excellent 4.21 (0.18) 4.68 (0.27) 4.26 (0.2) .003* To what extent are you able to achieve your overall professional goals within your current practice situation? 1 = not at all, 5 = very much 3.66 (0.38) 4.50 (0.5) 3.86 (0.33) .001* I plan to leave my practice in the near future. 1 = strongly disagree, 5 = strongly agree 2.66 (0.54) 1.52 (0.42) 2.50 (0.39) .004* Data are shown as means (95% confidence intervals) of Likert scale ratings. Bolded values indicate significant differences between micropractice and residency/community physicians.
↵* Values are significant at P < .004 (Kruskal-Wallis tests).
Work satisfaction Community physicians “I'm mainly dissatisfied by the disparity in pay between primary care and specialties; I would argue other specialties pay should be lowered/brought into line with primary care.” “The dissatisfaction with income arises because of the lack of valuing primary care relative to specialist medicine.” “Clinic is too big …. Would love to get back to a smaller footprint type of clinic.” “The perk of the larger group was having less call and less rounding. Both of these while nice, have distanced us from personalized healthcare—and I suspect job satisfaction.” “I get discouraged with all the uncompensated time—phone calls, dictations. I am often working from home or on my days off to complete these things.” Residency physicians “As far as the ability to provide continuity of care, I am not sure the teaching clinics could do a worse job of prioritizing this if they tried.” “Always battling the tension between clinical productivity and other rewarding aspects of academic practice (teaching, research, leadership).” “The nature of being a residency educator is that continuity will be diffused, so I accept that.” Micropractice physicians “I would not trade this model for anything short of bankruptcy.” “Income aside … I have never been as happy practicing medicine as I am now.” “Though I make enough money for me I feel that I deserve to make more money for the amount of work I put in.” “I am very satisfied with the ultra flexibility of my schedule.” Practice issues Community physicians: “I don't enjoy my work as much as I could if I were to have more time to learn and teach patients. The standard clinic template does not allow for much flex time to address more complicated issues ‘on the spot’; this is the difficulty of trying to be ‘efficient’ while trying to be ‘thorough’.” “Insurance continues to be a major challenge to offering appropriate care.” Residency physicians “Always a struggle with the schedule. [The] 99214 level often does not reflect the time needed for complex chronic disease management, especially in the elderly.” Micropractice physicians “I am not able to perform some of the procedures I previously was able to perform—colposcopy, flexible sigmoidoscopy, for example. I cannot afford this equipment, would not have the numbers to support their purchase, do not have staff to assist, do not have the room for it.” “I take all the time needed to see the patient, know about them and their family. It is very rewarding this type of practice.” “Haven't been able to do as much minor surgery without an assistant but plan to do more when I hire an MA.” Outcomes Community physicians ‘I am hopeful, and optimistic, that changes … in regard to pay and adjustment in the model of compensation … will more accurately reflect the work we do in patient panel management. If this change does not occur, it will make me more inclined to seek out jobs with less time constraint, which are paid for the work done.” “[My] confidence in the organization's ability to respond to market changes and commit resources to primary care and family medicine is at [an] all time low.” Residency physicians “I feel pressure to produce, to reach protocol standards, to have patients be ‘very satisfied’ with my care … all while needing to be scholarly. It doesn't feel like I am left with any time to think deeply about anything.” “I do not feel compensation based on RVU production encourages me to practice my style of primary care medicine; I would prefer a salary model with incentives for providing optimum evidence based medical care.” Micropractice physicians “I am satisfied with the work I do professionally but I am not satisfied with the factors that impinge—low reimbursements and ceaseless demands for prior authorization.” MA, medical assistant; RVU, relative value units.
In this issue
Does Micropractice Lead to Macrosatisfaction?
