Views of Managed Care — A Survey of Students, Residents, Faculty, and Deans at Medical Schools in the United States

Simon, Steven R.; Pan, Richard; Sullivan, Amy; Clark‐Chiarelli, Nancy; Connelly, Maureen T.; Peters, Antoinette S.; Singer, J. David; Inui, Thomas S.; Block, Susan D.

doi:10.1056/nejm199903253401206

Cited by 94 publications

(62 citation statements)

References 13 publications

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“…This is consistent with other data suggesting that physicians frequently experience managed care practices as negatively impacting the doctorpatient relationship. 29 In our study, the vast majority (more than 85%) also indicated that inadequate reimbursement from health insurers represented another significant obstacle to the utilization of mind-body methods. From a policy standpoint, these findings suggest that our current health care delivery system may, in many respects, be antithetical to the biopsychosocial model.…”

Section: Policy Implicationsmentioning

confidence: 51%

Barriers to the Integration of Psychosocial Factors in Medicine: Results of a National Survey of Physicians

Astin¹,

Soeken²,

Sierpina³

et al. 2006

The Journal of the American Board of Family Medicine

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Purpose: Examine physicians' attitudes toward the incorporation of psychosocial factors in diagnosis and treatment and identify barriers to the integration of evidence-based mind-body methods.Method: Random sample of primary care physicians and physicians from selected non-primary specialties was drawn. A total of 1058 physicians completed a 12-page survey.Results: The response rate was 27%. Although a majority of physicians seem to recognize the importance of addressing psychosocial issues, approximately one third believe that addressing such factors would lead to minimal or no improvements in outcomes. A minority reports their training regarding the role of psychosocial factors was effective, and relatively few indicate interest in receiving further training in these areas.Males were less likely to believe in the importance of addressing psychosocial factors. Additional factors included perceptions that training was poor in these areas; feelings of low self-efficacy to address psychosocial issues and the perception that such factors are difficult to control; lack of knowledge of the evidence-base supporting the role of psychosocial factors; and lack of time and inadequate reimbursement to address the psychosocial domain.Conclusions: These results suggest the need for more comprehensive training in the role of psychosocial factors in health. In addition, the finding that physicians identify lack of time and inadequate reimbursement as significant barriers suggests that the current health care delivery system may, in many respects, be antithetical to the biopsychosocial model. (J Am Board Fam Med 2006;19:557-65.)The call for greater recognition of the role of psychological and sociocultural factors in medicine is certainly not new. Engel 1 published a seminal article almost 30 years ago calling for an expansion of the biomedical model to a biopsychosocial one. However, despite such calls for reform, studies suggest that psychosocial factors continue to be overlooked or frequently missed in clinical encounters 2-7 and tend to still be underemphasized in medical education. 8,9 Studies also suggest that empirically supported mind-body interventions for such common health problems as pain and insomnia 10,11 are used by only a minority of patients suffering from these conditions. 12Consistent with these findings, in October 2004, the National Institutes of Health issued a request for applications (RFA) focused on "strengthening behavioral and social science curricula in medical school." This RFA grew out of an Institute of Medicine report issued earlier that same year in which the authors noted that "no physician's education would be complete without an understanding of the role played by behavioral and social factors in human health and disease, knowledge of the ways in which these factors can be modified, and an appreciation of how personal life experiences influence physician-patient relationships."Although there is a growing body of evidence pointing to the role that psychosocial factors such as stress can play i...

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Section: Policy Implicationsmentioning

confidence: 51%

Barriers to the Integration of Psychosocial Factors in Medicine: Results of a National Survey of Physicians

Astin¹,

Soeken²,

Sierpina³

et al. 2006

The Journal of the American Board of Family Medicine

View full text Add to dashboard Cite

show abstract

“…Further, Conrad argues that the economic environment of the past two decades has shifted the driving forces of medicalization away from professional claims-making, to external construction by vested commercial interests. These changes correspond with physicians' attitudes towards managed care reaching their nadir (Simon et al, 1999).…”

Section: Medicalization -Creating the Demand For Servicesmentioning

confidence: 61%

Physicians Providing Alternative Medicine Boundary Crossing and the Emergence of Integrative Medicine

Lockwood¹

2000

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provision during the years 1996 and 1998, but never since. These surveys were unique because they specifically inquired as to whether CAM was provided by a physician, among other types of professionals. This dissertation defines early integrative medicine (MDCAM) as CAM therapies provided by physicians. Because the MDCAM subpopulation is small, MEPS surveys for 1996 and 1998 were combined (N=39,314) to improve statistical power.The theoretical approach employed Abbott's (1988) theory of a system of professions, in which MDCAM represents a professional strategy of client differentiation through the social boundary mechanism of borrowing (Tilly, 2004) specific CAM therapies to satisfy consumer demand. The utility of the theory of a system of professions is discussed for its ability to decouple conceptual-level claims from observable workplace-level behaviors.Nearly one million Americans received CAM therapies from their physicians during the period, and this professional behavior was found in every region of the country. Services provided by physicians included spiritual healing, massage and acupuncture; national population prevalence estimates are provided. This is meaningful because physicians, at the time, were at risk for disciplinary action for providing CAM.

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“…In the long-run, these options would likely involve a heavier reliance on managed care policies. Yet broad evidence suggests dissatisfaction, both from patients and from physician providers, with the managed care option (Simon et al 1999). How might the cost savings from reducing geographical variation be gained even under the status quo, where fee-for-service accounts for the majority of Medicare enrollees?…”

Section: Discussion and Policy Implicationsmentioning

confidence: 99%

Regional Inequality in Medicare Spending: The Key to Medicare Reform?

Skinner¹,

Wennberg²

2000

NBER/Frontiers in Health Policy Research

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Views of Managed Care — A Survey of Students, Residents, Faculty, and Deans at Medical Schools in the United States

Abstract: Negative views of managed care are widespread among medical students, residents, faculty members, and medical school deans.

Cited by 94 publications

References 13 publications

Barriers to the Integration of Psychosocial Factors in Medicine: Results of a National Survey of Physicians

Barriers to the Integration of Psychosocial Factors in Medicine: Results of a National Survey of Physicians

Physicians Providing Alternative Medicine Boundary Crossing and the Emergence of Integrative Medicine

Regional Inequality in Medicare Spending: The Key to Medicare Reform?

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