Physician career satisfaction varies across markets

April 1, 2003

Pharmaceutical Representative

Career satisfaction for doctors shows significant variation across local healthcare markets.

Career satisfaction for doctors shows significant variation across local healthcare markets, and nationally, 18% of physicians are somewhat or very dissatisfied with their careers, according to a multiyear physician survey by researchers at Harvard Medical School and the Washington-based Center for Studying Health System Change. The study, which appeared in the Journal of the American Medical Association (vol. 289, no. 4), also showed that, overall, physician career satisfaction levels have been relatively consistent from year to year, and a clear majority of physicians nationally are satisfied with their careers.

The study surveyed more than 12,000 primary care and specialist physicians in 1997, 1999 and 2001. In each of the three years, roughly 80% of primary care and specialist physicians were somewhat or very satisfied with their careers, and nearly 18% were somewhat or very dissatisfied with their careers.

Local markets

The study also investigated physician career satisfaction in 12 randomly selected local markets (Boston; Cleveland; Greenville, SC; Indianapolis; Lansing, MI; Little Rock, AR; Miami; northern New Jersey; Phoenix; Orange County, CA; Seattle; and Syracuse, NY) to determine some of the root causes of satisfaction and dissatisfaction.

According to study coauthor James Reschovsky of HSC, market-level changes such as new state regulations, health plan mergers and changes in hospital competition likely play a role in how satisfied a physician is with his or her career.

For example, Phoenix physicians were more than twice as likely to be dissatisfied with their careers in 2001 as doctors in Lansing. Nearly one in four Phoenix physicians reported being somewhat or very dissatisfied with his or her career in medicine, compared with about one in 10 Lansing physicians in 2001.

Researchers did link variation in market-level physician satisfaction with the degree of capitated contracting in local markets. Higher proportions of capitated managed care revenue were associated with decreases in market-level physician satisfaction.

Causes of dramatic change

Findings from recent HSC site visits may explain some of the more dramatic local changes. For example, the merger of two large health plans in the Syracuse market may have increased plans' leverage over physicians. In northern New Jersey, the state adopted more stringent oversight of managed care plans, including requirements for prompt payment - changes that may have resulted in increased physician autonomy.

In contrast to the wide variation in physician satisfaction across the 12 local markets, the study found that national levels of physician satisfaction changed little between 1997 and 2001, dipping slightly between 1997 and 1999, but holding steady between 1999 and 2001.

According to HSC, trends in physician satisfaction may reflect changes in managed care plan practices, which have often tried to limit physicians' clinical autonomy. Many physicians dislike these restrictions, prompting a backlash against managed care. Many health plans now offer broader provider networks and have eased restrictions on care by eliminating prior approvals for specialty referrals, as well as certain tests and procedures.

Consistent with these trends, the study also found that physician autonomy - including freedom to make clinical decisions in the best interests of patients, having enough time with patients and maintaining continuing relationships with patients - had more influence than income on changes in physician satisfaction. PR

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