Changes in career satisfaction among primary care and specialist physicians, 1997-2001
Changes in career satisfaction among primary care and specialist physicians, 1997-2001
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DOI：
10.1001/jama.289.4.442
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发表时间：
2003-01-22
影响因子：
120.7
通讯作者：
Blumenthal, D
中科院分区：
文献类型：
--
作者：
Landon, BE;Reschovsky, J;Blumenthal, D
在过去的十年里，许多力量改变了医学实践。有证据表明，医生越来越不满意，在这种environment.Objectives描述的职业满意度的变化，在一个大的，全国代表性的样本医生，并检查市场和实践因素与变化的医生satisfactions.Design和设置数据收集的前3轮社区跟踪研究（CTS）医师调查，1996-1997年对美国60个地点的医生进行的一系列全国代表性电话调查（第一轮：12 385个答复者;答复率为65%），1998-1999年（第二轮：12 280名答复者;答复率为61%）和2000-2001年（第三轮：12 389名答复者;答复率为59%）。第二轮和第三轮调查包括前一轮抽样的医生，参与者为每周至少花费20小时直接护理患者的初级保健和专科医生。主要结果测量医生对其职业的总体满意度的变化以及特定地点不满意医生的比例。结果1997年和2001年，大部分下降发生在1997年和1999年之间。在初级保健医生中，1997年有42.4%的人非常满意，专家中有433%的人非常满意，而2001年分别为38.5%和41.4%。在那些报告说他们有点满意的人中，几乎有同样的增长。总体平均值掩盖了60个研究中心之间的显著差异。在随机选择的12个进行更深入研究的研究中心中，有些或非常不满意的受访者比例从密歇根州兰辛的8.8%（1999）到弗拉的迈阿密的34.2%（1997）不等。在1997年至1999年期间，25.6%的初级保健医生报告满意度下降，18.1%报告满意度提高，而在1999年至2001年期间，报告满意度上升（19.8%）和下降（20.4%）的百分比大致相等。专科医生的结果相似。在多变量模型中，满意度变化的最强和最一致的预测因素是临床自主性措施的变化，包括工作时间的增加和医生为患者获得服务的能力。暴露于管理式医疗的变化弱相关的变化satisfaction.Conclusions我们的研究结果表明，在这段时间内，整体医生的满意度水平并没有显着变化。此外，各地点的满意度和满意度的变化也有很大差异。而不是收入下降，威胁到医生的自主权，他们的能力，以管理他们的日常病人的互动和他们的时间，他们的能力，以提供高质量的护理是最强烈的变化与满意度。
Context A number of forces have changed the practice of medicine in the past decade. Evidence suggests that physicians are becoming less satisfied in this environment.Objectives To describe changes in career satisfaction in a large, nationally representative sample of physicians and to examine market and practice factors associated with changes in physician satisfaction.Design and Setting Data were collected from the first 3 rounds of the Community Tracking Study (CTS) Physician Survey, a series of nationally representative telephone surveys of physicians in 60 US sites conducted in 1996-1997 (round 1: 12385 respondents; 65% response rate), 1998-1999 (round 2: 12 280 respondents; 61% response rate), and 2000-2001 (round 3: 12 389 respondents; 59% response rate) for the Center for Studying Health System Change. The second and third rounds of the survey included physicians sampled in the previous round, as well as new physicians.Participants Primary care and specialist physicians who spent at least 20 hours per week in direct patient care activities.Main Outcome Measures Changes in physicians' overall satisfaction with their career and the proportion of dissatisfied physicians in particular sites.Results Physician satisfaction levels declined marginally between 1997 and 2001, with most of the decline occurring between 1997 and 1999. Among primary care physicians, 42.4% were very satisfied in 1997, as were 433% of specialists, compared with 38.5% and 41.4%, respectively, in 2001. There were nearly equal increases in those who reported that they were somewhat satisfied. Overall means mask significant differences across the 60 sites. Among 12 sites randomly selected for more intensive study, the proportion of respondents who were somewhat or very dissatisfied ranged from 8.8% of physicians in Lansing, Mich (1999), to 34.2% in Miami, Fla (1997). Between 1997 and 1999, 25.6% of primary care physicians reported decreased satisfaction and 18.1% reported improved satisfaction, while approximately equal percentages reported increased (19.8%) and decreased (20.4%) satisfaction between 1999-2001. Findings were similar for specialist physicians. In multivariable models, the strongest and most consistent predictors of change in satisfaction were changes in measures of clinical autonomy, including increases in hours worked and physicians' ability to obtain services for their patients. Changes in exposure to managed care were weakly related to changes in satisfaction.Conclusions Our findings demonstrate that overall physician satisfaction levels over this time period did not change dramatically. in addition, satisfaction and changes in satisfaction vary greatly among sites. Rather than declining income, threats to physicians autonomy, to their ability to manage their day-to-day patient interactions and their time, and to their ability to provide high-quality care are most strongly associated with changes in satisfaction.