Differences in the professional satisfaction of general internists in academically affiliated practices in the greater-Boston area. Ambulatory Medicine Quality Improvement Project Investigators

Factors Influencing Career Decisions and Satisfaction Among Newly Practicing Ophthalmologists

PURPOSE

To describe the career choices of newly practicing ophthalmologists and explore factors influencing career decisions and satisfaction.

METHODS

A cross-sectional study was conducted using data from an electronic survey of ophthalmologists who completed training within the prior 5 years. The survey included questions about demographic information, medical education, current practice, factors affecting career choices, and career satisfaction. Statistical comparisons were made based on gender, type of practice, subspecialty training, and practice area.

RESULTS

Surveys were completed by 696 (32%) newly practicing ophthalmologists, including 276 (40%) women, 179 (29%) academicians, and 465 (67%) subspecialists. A higher proportion of female respondents entered academics than male respondents (36% vs 26%, P = .009). Female and male respondents pursued fellowship training with similar frequency (64% vs 68%, P = .32), but men were more likely to seek vitreoretinal fellowships (30% vs 11%, P < .001) and women were more likely to undertake fellowships in pediatric ophthalmology (21% vs 8%, P < .001), uveitis (10% vs 2%, P = .002), and neuro-ophthalmology (6% vs 2%, P = .042). A total of 514 (83%) respondents reported being happy with work life.

CONCLUSIONS

The career choices of newly practicing ophthalmologists differ based on gender, type of practice, subspecialty training, and practice area. Many factors affect career decisions, and they have varying influence on subgroups within ophthalmology. Ophthalmologists have high levels of career satisfaction. This information may prove useful when developing workforce strategies to meet future eye care needs. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

Pathology in the Medical Profession?: Taking the Pulse of Physician Wellness and Burnout

CONTEXT

-In the past decades, physician wellness has diminished in every aspect of professional life. Burnout symptoms in the United States affect 30% to 68% of physicians overall-exceeding the levels of any other professional group. The ramifications of burnout present an underrecognized crisis in the health care system that carries the consequences of personal, professional, institutional, and societal costs.

OBJECTIVE

-To bring to light the elements of current medical practice that contribute to physician professional fulfillment and burnout. Intervention measures, steps toward burnout prevention, and the present limitations thereof are also addressed.

DATA SOURCES

-This narrative literature review was performed by using studies in PubMed (National Center for Biotechnology Information) and large online physician surveys, published through December 2015. Because of geographic differences, the review is primarily concentrated on physicians across specialties in the United States. Small studies and those of single disciplines were excluded.

CONCLUSIONS

-Many physicians learn to tolerate burnout symptoms despite negative personal consequences. Long-term work-related stress, however, may lead to the potential for negative effects on the quality of patient care, and to attrition. Interestingly, the factors that enhance physician fulfillment and those that may precipitate burnout symptoms are distinct. Optimization of physician well-being, therefore, requires tailored approaches in each of these 2 dimensions and is most likely to succeed if it includes approaches that are customized to career phase, physician specialty, and practice setting. Importantly, organization leaders must prioritize this issue and provide sustained support for wellness initiatives, to foster a culture that is conducive to physician well-being.

Attitudes of early-career cardiologists in Japan about their cardiovascular training programs

Understanding the perspective of early-career cardiologists is important to design effective responses to the challenges in modern cardiovascular (CV) training programs. We conducted a web-based survey on a total of 272 early-career cardiologists (within 10 postgraduate years) who registered for the 2011 annual Japanese Circulation Society Meeting. Main outcome measures were satisfaction with their training, confidence in their clinical skills, and professional expectations, scaled from 0 to 10. The median training time was 6 years, with 2 years for internal medicine and 4 years for CV disease. Most received their training in university hospitals at some point during their career (79.5%) and were interested in a subspecialty training, such as interventional cardiology (38.6%), electrophysiology (15.1%), and advanced heart failure (10.3%); only 9.6% showed interest in general cardiology. The respondents felt comfortable in managing common CV conditions such as coronary artery disease (average score 6.3 ± 2.4 on an 11-point Likert scale) but less so in peripheral arterial disease (3.8 ± 2.8), arrhythmias (3.7 ± 2.3), and congenital heart disease (2.9 ± 2.2). Their satisfaction rate with their CV training positively correlated with their clinical proficiency level and was associated with volume of coronary angiograms, percutaneous coronary interventions, and echocardiograms completed. In conclusion, the current young cardiologists have a positive perception of and interest in procedure-based subspecialty training, and their training satisfaction was related to volume of cardiac procedures. Additional effort is needed in enforcing the training in underappreciated subspecialty areas.

Satisfaction and motivation of general physicians toward their career

BACKGROUND

Human resource in health system especially in developing countries has main role in health promotion. Therefore their satisfaction and motivation are the key points in developing health system.

OBJECTIVE

To determine the motivation and satisfaction of general physicians (GP) towards their career.

METHODS

Using random sampling, 150 physicians were selected from comprehension commercial database list. Data were collected using a self-administered questionnaire that consisted of three sections; first demographic data, second work satisfaction and third questions toward biologic, dependent and growth motivation. Data were analyzed by SPSS version 16 with P<0.05.

RESULTS

From participants 64.7% of physicians were in age between 30-40 years and 27.3% were men. Only 5.3% of physicians who were employed for over 10 years were satisfied from their career. Satisfaction of career among female and male physicians was 8% and 24% respectively. The item of job safety sensation in biologic motivation had maximum scale (4.1±0.89). In dependent and growth motivations, value success sensation in job (4+-0.88) and make new skills and knowledge (4+-0.67) had maximum scale of mean. Relation of growth motivators with age (P<0.01), postgraduate duration (P<0.005) was significant. Dependent motivators had significant relation with age (P<0.04), postgraduate duration (P<0.01) and employment duration (P<0.002). Biological motivators had significant relation with sex (P<0.4) and satisfaction of work hours (P<0.007). Correlation of biological (r=0.44, P<0.001) and growth (r=0.7, P<0.001) motivators was significant.

CONCLUSION

Growth motivators score had higher ranking than other motivators. However, biological motivators especially job security and finance were also important and must be noticed from decision makers.

U.S. physician satisfaction: a systematic review

INTRODUCTION

There is concern in the US about the burden and potential ramifications of dissatisfaction among physicians. The purpose of this article is to systematically review the literature on US physician satisfaction.

METHODS

A MEDLINE search with the medical subject headings (MeSH) phrases: (physicians OR physician's role OR physician's women) AND (job satisfaction OR career satisfaction OR burnout), limited to humans and abstracts, with 1157 abstracts reviewed. After exclusions by 2 independent reviewers, 97 articles were included. Physician type sampled, sample size/response rate, satisfaction type, and satisfaction results were extracted for each study. Satisfaction trends were extracted from those studies with longitudinal or repeated cross sectional design. Variables associated with satisfaction were extracted from those studies that included multivariate analyses.

RESULTS

Physician satisfaction was relatively stable, with small decreases primarily among primary care physicians (PCPs). The major pertinent mediating factors of satisfaction for hospitalists include both physician factors (age and specialty), and job factors (job demands, job control, collegial support, income, and incentives).

CONCLUSIONS

The majority of factors associated with satisfaction are modifiable. Tangible recommendations for measuring and diminishing dissatisfaction are given.

[Continuity of medical care. Evaluation of a collaborative program between hospital and Primary Care]

The patients being treated in our health care system are becoming increasingly older and have a greater prevalence of chronic diseases. Due to these factors, these patients require greater and easier accessibility to the system as well as continuity of medical care. Collaboration between the different levels of health care has been instrumental in the success of the system and has produced changes in the hospital medical care protocol. Our hospital has developed a care model oriented towards the patient's needs, resulting in a higher grade of satisfaction among the medical professionals. In this paper, we have given a detailed description of part of our medical model, illustrating its different components and indicating several parameters of its evaluation. We have also reviewed the current state of the various models published on this topic. In summary, we believe that this medical care model presents a different approach to management that benefits patients, medical professionals and the health system alike.

Economic factors and the percentage of residency positions filled by United States medical graduates

OBJECTIVE

To study the association between economic factors and the percentage of specialty residency positions filled by U.S. medical graduates.

METHODS

Data from the 2004 National Resident Matching Program were used to estimate the percentage of residency positions filled by U.S. medical graduates in 15 major specialties. Data from the Medical Group Management Association, American Medical Association, and a major Massachusetts liability insurer were used to estimate the mean and median physician income, work hours, and the relative cost of professional liability insurance.

RESULTS

The percentage of residency positions filled by United States medical graduates varied by specialty. In 2004, U.S. graduates filled more than 90% of the residency positions in orthopedics, plastic surgery, and neurosurgery. In contrast, U.S. graduates filled fewer than 60% of the residency positions in internal medicine and family medicine. A positive correlation between mean annual income and the percentage of residency positions filled by U.S. medical graduates (r = 0.78, P < .001) was observed across the 15 specialties studied. In a multivariate analysis, professional liability costs were not associated with the percentage of residency positions filled by U.S. graduates after controlling for annual income (P = .46).

CONCLUSION

Economic factors are associated with the percentage of specialty positions filled by U.S. medical graduates. Procedure-based and hospital-based specialties with an above-average annual income are most likely to have their residency positions filled by U.S. medical graduates.

LEVEL OF EVIDENCE

III.

Work, career satisfaction, and the position of general internists in the south of Spain

BACKGROUND

A progressive dissatisfaction has been noted among many internists, and the future of the specialty represents a matter of concern. The objectives of this study were to analyze career satisfaction among 182 internists from 34 hospitals in the south of Spain and to assess the opinion of 47 other health care professionals who frequently interact with internists on the present and future role of the specialty.

METHODS

Ours was a multi-institutional, cross-sectional survey of internists that focused on demographics/practice characteristics, education/research, career satisfaction, and opinions regarding the future of internal medicine. Also included were interactive, interdisciplinary focus groups of family physicians, sub-specialists, and managers. The internists were asked to complete a questionnaire that contained items and factors that were measured on a 5-point Likert scale and quantitatively analyzed; the opinions of the focus groups were qualitatively analyzed.

RESULTS

The internists surveyed dedicated most of their time to treating hospitalized patients rather than to diagnostic procedures and technical assessment. Some 54% and 57% of the internists pursued continuing medical education and research, respectively, in their free time. The internists were satisfied with the content of their work and with their interpersonal relationships, but they were dissatisfied with their physical/instrumental environment, management policies, and degree of work stability. No differences were detected in relation to age, gender, community factor, or professional category. With regard to the future of the specialty, the main opportunity detected by internists was a closer collaboration with primary care. An analysis of the strengths, weaknesses, future opportunities and threats to internal medicine expressed by the seven focus groups was highly concordant and added worthwhile information and clear proposals for the development of the specialty.

CONCLUSIONS

Internists in the south of Spain were satisfied with the content of their work and dissatisfied with health care management and job stability. The future of internal medicine was felt to lie in a deeper collaboration between internists and their colleagues in primary care.

Race and family history assessment for breast cancer

OBJECTIVE

Studies have demonstrated disparities in breast cancer screening between racial and ethnic groups. Knowledge of a woman's family history of breast cancer is important for initiating early screening interventions. The purpose of this study was to determine whether differences exist in the collection of family history information based on patient race.

DESIGN

Cross-sectional patient telephone interview and medical record review.

SETTING

Eleven primary care practices in the Greater Boston area, all associated with Harvard Medical School teaching hospitals.

PARTICIPANTS

One thousand seven hundred fifty-nine women without a prior history of breast cancer who had been seen at least once by their primary care provider during the prior year.

MEASUREMENTS AND MAIN RESULTS

Data were collected on patients regarding self-reported race, family breast cancer history information, and breast cancer screening interventions. Twenty-six percent (462/1,759) of the sample had documentation within their medical record of a family history for breast cancer. On multivariate analysis, after adjusting for patient age, education, number of continuous years in the provider's practice, language, and presentation with a breast complaint, white women were more likely to be asked about a breast cancer family history when compared to nonwhite women (odds ratio, 1.68; 95% confidence interval, 1.21 to 2.35).

CONCLUSIONS

The majority of women seen by primary care providers do not have documentation of a family breast cancer history assessment within their medical record. White women were more likely to have family breast cancer information documented than nonwhites.

Practice, clinical management, and financial arrangements of practicing generalists

OBJECTIVE

To describe the practice settings, financial arrangements, and management strategies experienced by generalist physicians and identify factors associated with reporting pressure to limit referrals, pressure to see more patients, and career dissatisfaction.

DESIGN

Cross-sectional mail survey.

PARTICIPANTS AND SETTING

Six hundred nineteen generalist physicians (62% response rate) caring for managed care patients in 3 Minnesota health plans during 1999.

MEASUREMENTS AND MAIN RESULTS

Twenty-six percent of physicians reported pressure to limit referrals. In adjusted analyses, female physicians and those who were board certified acted as gatekeepers for most of their patients, received incentives based on performance reports and quality profiles, and received direct income from capitation, and were more likely than others to report this pressure (all P <.05). Sixty-two percent reported pressure to see more patients. In adjusted analyses, this pressure was more frequent among physicians in practices owned by health systems, those using physician extenders, and among physicians paid by salary with performance adjustment or those receiving at least some capitation (all P <.05). One-quarter (24%) of physicians were dissatisfied with their career in medicine. In adjusted analyses, physicians reporting pressure to limit referrals (risk ratio, 1.12; 95% confidence interval, 1.01 to 1.19) and those reporting pressure to see more patients (risk ratio, 1.37; 95% confidence interval, 1.08 to 1.66) were more likely to be dissatisfied than other physicians.

CONCLUSIONS

Pressures to limit referrals and to see more patients are common, particularly among physicians paid based on productivity or capitation, and they are associated with career dissatisfaction. Whether future changes in practice arrangements or compensation strategies can decrease such physician-reported pressures, and ultimately improve physician satisfaction, will be an important area for future study.

Is the professional satisfaction of general internists associated with patient satisfaction?

BACKGROUND

The growth of managed care has raised a number of concerns about patient and physician satisfaction. An association between physicians' professional satisfaction and the satisfaction of their patients could suggest new types of organizational interventions to improve the satisfaction of both.

OBJECTIVE

To examine the relation between the satisfaction of general internists and their patients.

DESIGN

Cross-sectional surveys of patients and physicians.

SETTING

Eleven academically affiliated general internal medicine practices in the greater-Boston area.

PARTICIPANTS

A random sample of English-speaking and Spanish-speaking patients (n = 2,620) with at least one visit to their physician (n = 166) during the preceding year.

MEASUREMENTS

Patients' overall satisfaction with their health care, and their satisfaction with their most recent physician visit.

MAIN RESULTS

After adjustment, the patients of physicians who rated themselves to be very or extremely satisfied with their work had higher scores for overall satisfaction with their health care (regression coefficient 2.10; 95% confidence interval 0.73-3.48), and for satisfaction with their most recent physician visit (regression coefficient 1.23; 95% confidence interval 0.26-2.21). In addition, younger patients, those with better overall health status, and those cared for by a physician who worked part-time were significantly more likely to report better satisfaction with both measures. Minority patients and those with managed care insurance also reported lower overall satisfaction.

CONCLUSIONS

The patients of physicians who have higher professional satisfaction may themselves be more satisfied with their care. Further research will need to consider factors that may mediate the relation between patient and physician satisfaction.

Physician experiences with, and ratings of, managed care organizations in Massachusetts

BACKGROUND

Physicians can provide important information about how managed care plans affect the delivery of health care. Assessments of the quality of managed care plans have rarely used physician evaluations.

OBJECTIVES

To elicit physician evaluations of managed care plans and to determine factors associated with those evaluations.

RESEARCH DESIGN

Physicians were asked in a mail survey to evaluate a managed care plan they were associated with.

SUBJECTS

Probability sample of 1,336 physicians associated with the five largest managed care health plans in Massachusetts.

MEASURES

Physicians were asked about the extent to which the management strategies used by a plan influenced their clinical behavior and about the quality of care available to their patients.

RESULTS

Evaluations of the plans were significantly different among the eight units evaluated. Some differences between divisions within plans were as large as differences among plans. Physicians reported that the use of education and peer influence influenced their clinical behavior and facilitated the provision of high quality care more than did rules and regulations or financial incentives. Physicians evaluated most positively plans, which they said used educational strategies more than other plans and which used rules and regulations and financial incentives less. Physicians tended to rate staff and group model plans more positively than did other plans.

CONCLUSIONS

Physicians can provide important information about the extent to which the organization and operation of managed care plans affect the provision of high quality care.