Managed care, physician job satisfaction, and the quality of primary care

Abstract

OBJECTIVE:To determine the associations between managed care, physician job satisfaction, and the quality of primary care, and to determine whether physician job satisfaction is associated with health outcomes among primary care patients with pain and depressive symptoms.DESIGN: Prospective cohort study. SETTING:Offices of 261 primary physicians in private practice in Seattle.PATIENTS: We screened 17,187 patients in waiting rooms, yielding a sample of 1,514 patients with pain only, 575 patients with depressive symptoms only, and 761 patients with pain and depressive symptoms; 2,004 patients completed a 6-month follow-up survey. MEASUREMENTS AND RESULTS:For each patient, managed care was measured by the intensity of managed care controls in the patient's primary care office, physician financial incentives, and whether the physician read or used back pain and depression guidelines. Physician job satisfaction at baseline was measured through a 6-item scale. Quality of primary care at follow-up was measured by patient rating of care provided by the primary physician, patient trust and confidence in primary physician, quality-of-care index, and continuity of primary physician. Outcomes were pain interference and bothersomeness, Symptom Checklist for Depression, and restricted activity days. Pain and depression patients of physicians with greater job satisfaction had greater trust and confidence in their primary physicians. Pain patients of more satisfied physicians also were less likely to change physicians in the follow-up period. Depression patients of more satisfied physicians had higher ratings of the care provided by their physicians. These associations remained after controlling statistically for managed care. Physician job satisfaction was not associated with health outcomes. CONCLUSIONS:For primary care patients with pain or depressive symptoms, primary physician job satisfaction is associated with some measures of patient-rated quality of care but not health outcomes.

Systematic review of the links between human resource management practices and performance

“…Some studies satisfied all but one of the criteria, and so had to be excluded. For example, non-longitudinal design, by performing data collection of two different types of data at two different times (two cross-sectional studies rather than a single longitudinal study), 677,678 studying the impact of an intervention on both the intermediate outcome and the patient outcome, but not assessing the impact of the one on the other 679 or by considering a patient care outcome not of interest, for example hospital admissions 680 or adherence to therapy. 681 A previous review has also noted the lack of longitudinal studies examining the impact of nurses' job satisfaction on key patient outcomes.…”

Physician Job Satisfaction and Working Conditions in Japan

“…Job satisfaction is associated with the health conditions of workers including mental or psychological problems such as burnout, low self-esteem, depression, and anxiety 7) . Job dissatisfaction affects patient-rated quality of care and is strongly related to early retirement and cut back of working hours 5,8) . Several factors relating to working conditions have been identified to be associated with physician job satisfaction in other countries [9][10][11][12][13] .…”

Specialty Selection and Relative Job Satisfaction of Family Physicians and Medical Specialists in Austria

“…Consequently, we cannot judge whether a lower relative job satisfaction has indirect effects on physicians' health or the professional performance of physicians in our population. However, it has been shown that patients with pain or depressive symptoms treated by primary care physicians with a higher job satisfaction are more satisfied with the quality of care than those treated by physicians with a lower job satisfaction (21). In view of the importance of the role played by family physicians in the health system, the high burden of burnout in family physicians (22) and lower relative job satisfaction of the large group of family physicians who had originally aspired to be specialists, we can assume that the unsatisfactory specialty allocation procedures could have negative implications for patient-rated quality of care.…”