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Gu M, Zheng L, Gu J, Wang S, Shi Y, Jiang F, Liu H, Tang YL. Would you choose to be a psychiatrist again? A large-sample nationwide survey of psychiatrists and psychiatry residents in China. Int J Ment Health Syst 2023; 17:43. [PMID: 38053204 DOI: 10.1186/s13033-023-00614-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/22/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND The mental health workforce sustainability in China suffers high rates of attrition and the intention to leave. Among current professionals, the intention to choose the same career is an interesting way to gauge their job satisfaction and other factors, and it may affect the career choices of younger generations. We aimed to survey the intention of psychiatrists and psychiatry residents to choose the same career if they could start over and to identify associated factors. METHODS We conducted an anonymous survey of psychiatrists in 41 tertiary psychiatric hospitals in China. We collected demographic data, work-related information, the sense of professional identity, job satisfaction, and burnout (Maslach Burnout Inventory), and we specifically asked each participant whether they would choose to be a psychiatrist again if they could. RESULTS Among 3,783 psychiatrists we surveyed, one-quarter responded that they would not choose to be a psychiatrist again if they had a choice, with less than half (47.2%) saying they would. Those who would not choose psychiatry again were more likely to have a negative (relative to positive) professional identity (OR = 7.47, P<0.001, 95%CI: 4.587-12.164); experience job burnout (OR = 2.945, P<0.001, 95%CI: 2.356-3.681); be dissatisfied with their job (OR = 2.739, P<0.001, 95%CI: 2.102-3.569) and excessive regulation (OR = 1.819, P<0.001, 95%CI: 1.487-2.226); have a heavy workload (OR = 1.749, P<0.001, 95%CI: 1.423-2.149) or a lower income (OR = 1.748, P<0.001, 95%CI: 1.415-2.161); be married (relative to single) (OR = 1.604, P = 0.004, 95%CI: 1.165-2.208); be dissatisfied with strained doctor-patient relationship (OR = 1.333, P = 0.005, 95%CI: 1.089-1.632); have more night shifts per month (OR = 1.055, P = 0.021, 95%CI: 1.008-1.104) or work longer hours per week (OR = 1.016, P = 0.001, 95%CI: 1.006-1.025). CONCLUSION Among psychiatrists in tertiary hospitals in China, those with a heavier workload, poor sense of professional identity, job dissatisfaction, and burnout were less likely to choose psychiatry again. Policymakers and hospital administrators need to take effective measures to improve psychiatrists' sense of professional identity and increase their intention to stay.
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Affiliation(s)
- Mengyue Gu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Liucheng Zheng
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Jingyang Gu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Song Wang
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Yudong Shi
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Feng Jiang
- Institute of Healthy Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, China.
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China.
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.
| | - Yi-Lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia, USA
- Atlanta VA Medical Center, Decatur, Georgia, USA
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Kim HA, Jung SH, Park IY, Kang SH. Hourly wages of physicians within medical fees based on the Korean relative value unit system. Korean J Intern Med 2020; 35:1238-1244. [PMID: 31870135 PMCID: PMC7487311 DOI: 10.3904/kjim.2018.452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/15/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS It is difficult to reach a social agreement on the appropriate level of compensation for professionals. This study was performed to examine the physician fee embedded in the relative value unit (RVU) system in comparison with the Korean hourly minimum wage. METHODS The Health Insurance Service Price and the Korean Classification of Procedural Terminology were used to obtain the hourly wages of physicians for designated health care services. In addition, the physician fee schedule at the United States Centers for Medicare and Medicaid Services and the Organisation for Economic Co-operation and Development (OECD) report on minimal wage were used. Health care service fees were selected based on laboratory, pathology, imaging, and procedure codes as well as examination fees. For calculation of physician labor costs per hour, physician workload × conversion factor was divided by the time involved. To calculate the proportion of physician labor fee in the total fee, the physician workload RVU for each service fee was divided by the total RVU. RESULTS A total of 27 physician fee codes were selected. Compared to the Korean hourly minimum wage in 2015, the average physician wages were greater by 2.80- fold for primary care and by 3.05-fold for tertiary care. The mean proportion of physician labor cost in the total cost was 0.19, which was significantly lower than that of corresponding procedures in the United States RVU (mean, 0.48). CONCLUSION The average Korean physician wages compared to the hourly minimum wage were disproportionately low compared to the USA and other reference OECD countries.
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Affiliation(s)
- Hyun Ah Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
- Correspondence to Hyun Ah Kim, M.D. Division of Rheumatology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang 14068, Korea
Tel: +82-31-380-1826 Fax: +82-31-381-8812 E-mail:
| | - Sung Hoon Jung
- Department of Internal Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Young Park
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Seong Hun Kang
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
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de Oliveira Vasconcelos Filho P, de Souza MR, Elias PEM, D'Ávila Viana AL. Physicians' job satisfaction and motivation in a public academic hospital. HUMAN RESOURCES FOR HEALTH 2016; 14:75. [PMID: 27923402 PMCID: PMC5142149 DOI: 10.1186/s12960-016-0169-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 11/22/2016] [Indexed: 05/20/2023]
Abstract
BACKGROUND Physician shortage is a global issue that concerns Brazil's authorities. The organizational structure and the environment of a medical institution can hide a low-quality life of a physician. This study examines the relationship between the hospital work environment and physicians' job satisfaction and motivation when working in a large public academic hospital. METHODS The study was restricted to one large, multispecialty Brazil's hospital. Six hundred hospital physicians were invited to participate by e-mail. A short version of the Physician Worklife Survey (PWS) was used to measure working satisfaction. Physicians were also asked for socio-demographic information, medical specialty, and the intention to continue working in the hospital. RESULTS Data from 141 questionnaires were included in the analyses. Forty-five physicians graduated from the hospital's university, and they did not intend to leave the hospital under any circumstance (affective bond). The motivating factor for beginning the career at the hospital and to continue working there were the connection to the medical school and the hospital status as a "prestigious academic hospital"; the physicians were more satisfied with the career than the specialty. Only 30% completely agreed with the statement "If I had to start my career over again, I would choose my current specialty," while 45% completely agreed with the statement "I am not well compensated given my training and experience." The greater point of satisfaction was the relationship with physician colleagues. They are annoyed about the amount of calls they are requested to take and about how work encroaches on their personal time. No significant differences between medical specialties were found in the analysis. CONCLUSIONS The participants were satisfied with their profession. The fact that they remained at the hospital was related to the academic environment, the relationship with colleagues, and the high prestige in which society holds the institution. The points of dissatisfaction were inadequate remuneration and the fact that work invaded personal time. Routinely, there is a need for organizations to examine the impact of their structures, policies, and procedures on the stress and quality of life of physicians.
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Affiliation(s)
- Paulo de Oliveira Vasconcelos Filho
- Department of Preventive Medicine, School of Medicine of University of São Paulo, Av. Dr Arnaldo, 455 2° andar, São Paulo, 01246-903, SP, Brazil.
- , .
- , 435/21 R Estado de Israel, Sao Paulo, 04022-001, SP, Brazil.
| | - Miriam Regina de Souza
- Department of Preventive Medicine, School of Medicine of University of São Paulo, Av. Dr Arnaldo, 455 2° andar, São Paulo, 01246-903, SP, Brazil
| | - Paulo Eduardo Mangeon Elias
- Department of Preventive Medicine, School of Medicine of University of São Paulo, Av. Dr Arnaldo, 455 2° andar, São Paulo, 01246-903, SP, Brazil
| | - Ana Luiza D'Ávila Viana
- Department of Preventive Medicine, School of Medicine of University of São Paulo, Av. Dr Arnaldo, 455 2° andar, São Paulo, 01246-903, SP, Brazil
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Schwamm LH. Telehealth: Seven Strategies To Successfully Implement Disruptive Technology And Transform Health Care. Health Aff (Millwood) 2014; 33:200-6. [DOI: 10.1377/hlthaff.2013.1021] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Lee H. Schwamm
- Lee H. Schwamm ( ) is executive vice chair of neurology and medical director of telehealth at Massachusetts General Hospital, in Boston. He directs the Massachusetts General Hospital and Partners TeleStroke Network
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Pane LA, Davis AB, Ottolini MC. Career satisfaction and the role of mentorship: a survey of pediatric hospitalists. Hosp Pediatr 2012; 2:141-148. [PMID: 24319918 DOI: 10.1542/hpeds.2011-0022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND OBJECTIVE Attending physicians' career satisfaction is associated with higher patient satisfaction, better patient care, and even medical student career choice. Previous studies indicate that adequate mentorship improves job satisfaction, but finding mentors may be challenging for some hospitalists. Little is known about pediatric hospitalist career satisfaction or the role of mentorship. The goal of this study was to assess career satisfaction among pediatric hospitalists, determine which interventions may improve satisfaction, and investigate the role of mentorship in satisfaction. METHODS This study included the use of an anonymous electronic cross-sectional survey sent to the American Academy of Pediatrics' Section on Hospital Medicine Listserv between November 2009 and January 2010. RESULTS A total of 222 pediatric hospitalists responded; 92% agreed with the statement, "Overall, I am pleased with my work." Of the 23 satisfaction statements, "I have adequate mentorship in my career" was rated lowest (< or = .001); only 44% agreed. Adequate mentorship was significantly correlated with overall career satisfaction, having sufficient opportunity for promotion, feeling valued by one's administration, and wishing to remain at one's current hospital. Adequate mentorship was negatively correlated with planning to change specialty or leave clinical medicine. Mentorship satisfaction did not differ by age, years as a hospitalist, gender, or practice setting. Of the 15 potential interventions, creating a formal mentorship program ranked in the top 5. Only increasing base salary received a significantly higher score. CONCLUSIONS Although surveyed hospitalists have substantial overall career satisfaction, lack of mentorship is a significant problem that spans the demographic spectrum. Establishing a mentorship program may be an effective way for hospitalist groups to improve satisfaction.
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Affiliation(s)
- Laurie A Pane
- Division of Hospital Medicine, Children's National Medical Center, Washington, District of Columbia, 20010, USA.
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Perneger TV, Deom M, Cullati S, Bovier PA. Growing discontent of Swiss doctors, 1998-2007. Eur J Public Health 2011; 22:478-83. [DOI: 10.1093/eurpub/ckr114] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Keefe B, Geron SM, Enguidanos S. Integrating social workers into primary care: physician and nurse perceptions of roles, benefits, and challenges. SOCIAL WORK IN HEALTH CARE 2009; 48:579-96. [PMID: 19860293 DOI: 10.1080/00981380902765592] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The primary aim of this article is to identify, from the perspective of primary care physicians and nurses, the challenges encountered in provision of health care to older adults and to identify potential roles, challenges, and benefits of integrating social workers into primary care teams. As more older adults live longer with multiple chronic conditions, primary care has been confronted with complex psychosocial problems that interact with medical problems pointing to a potential role for a social worker. From a policy perspective, the lack of strong evidence documenting the benefits that will accrue to patients and providers is a key barrier preventing the wider use of social workers in primary care. This article presents findings from three focus groups with primary care physicians and nurses to examine the perspectives of these key providers about the benefits and challenges of integrating social workers into the primary care team.
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Affiliation(s)
- Bronwyn Keefe
- Institute for Geriatric Social Work, School of Social Work, Boston University, Boston, Massachusetts 02215, USA.
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Lee HY, Park SE, Park EC, Hahm MI, Cho WH. Job satisfaction and trust in Health Insurance Review Agency among Korean physicians. Health Policy 2008; 87:249-57. [PMID: 18313789 DOI: 10.1016/j.healthpol.2007.12.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2007] [Revised: 12/19/2007] [Accepted: 12/23/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To measure Korean physicians' job satisfaction and to examine the relationship between trust in Health Insurance Review Agency (HIRA) and job satisfaction. METHODS Stratified sampling was used. The sample was representative of Korean office-based physicians; 1593 office-based physicians in Korea were surveyed by mail over a 4-week period using a self-administered questionnaire. Multivariate analysis using logistic regression was performed to investigate predictors of physicians' job satisfaction and to examine whether trust in HIRA was related to job satisfaction. RESULTS Overall, the job satisfaction of physicians was very low. The payment denial rate was not related to job satisfaction. Physicians who trusted HIRA were more likely to be satisfied with their job. CONCLUSIONS Physicians who trusted in the HIRA were more likely to report satisfaction. These results emphasize that trust in the HIRA is key to physicians' job satisfaction.
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Affiliation(s)
- Hoo-Yeon Lee
- National Cancer Control Research Institute, National Cancer Center, Republic of Korea
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Aseltine RH, Reisine S, Schilling EA, Kennedy J. Dental practice satisfaction with preferred provider organizations. BMC Health Serv Res 2007; 7:184. [PMID: 18005426 PMCID: PMC2194688 DOI: 10.1186/1472-6963-7-184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Accepted: 11/15/2007] [Indexed: 11/25/2022] Open
Abstract
Background Despite their increasing share of the dental insurance market, little is known about dental practices' satisfaction with preferred provider organizations (PPOs). This analysis examined practice satisfaction with dental PPOs and the extent to which satisfaction was a function of communications from the plan, claims handling and compensation. Methods Data were collected through telephone surveys with dental practices affiliated with MetLife between January 2002 and December 2004. Each respondent was asked a series of questions related to their satisfaction with a systematically selected PPO with which they were affiliated. Six different PPO plans had sufficient observations to allow for comparative analysis (total n = 4582). Multiple imputation procedures were used to adjust for item non-response. Results While the average level of overall satisfaction with the target plan fell between "very satisfied" and "satisfied," regression models revealed substantial differences in overall satisfaction across the 6 PPOs (p < .05). Statistically significant differences between plans in overall satisfaction were largely explained by differences in the perceived adequacy of compensation. However, differences in overall satisfaction involving two of the PPOs were also driven by satisfaction with claims handling. Conclusion Results demonstrate the importance of compensation to dental practice satisfaction with PPOs. However, these results also highlight the critical role of service-related factors in differentiating plans and suggest that there are important non-monetary dimensions of PPO performance that can be used to recruit and retain practices.
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Affiliation(s)
- Robert H Aseltine
- University of Connecticut School of Dental Medicine, Department of Oral Health and Diagnostic Sciences, Division of Behavioral Sciences and Community Health, MC 3910, 263 Farmington Avenue, Farmington, CT 06030-3910, USA.
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DeVoe J, Fryer GE, Straub A, McCann J, Fairbrother G. Congruent satisfaction: is there geographic correlation between patient and physician satisfaction? Med Care 2007; 45:88-94. [PMID: 17279025 PMCID: PMC4918746 DOI: 10.1097/01.mlr.0000241048.85215.8b] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
CONTEXT Satisfaction among both physicians and patients is optimal for the delivery of high-quality healthcare. Although some links have been drawn between physician and patient satisfaction, little is known about the degree of satisfaction congruence among physicians and patients living and working in geographic proximity to each other. OBJECTIVE We sought to identify patients and physicians from similar geographic sites and to examine how closely patients' satisfaction with their overall healthcare correlates with physicians' overall career satisfaction in each selected site. METHODS We undertook a cross-sectional analysis of data from 3 rounds of the Community Tracking Study (CTS) Household and Physician Surveys (1996-1997, 1998-1999, 2000-2001), a nationally representative telephone survey of patients and physicians. We studied randomly selected participants in the 60 CTS communities for a total household population of 179,127 patients and a total physician population of 37,238. Both physicians and patients were asked a variety of questions pertaining to satisfaction. RESULTS Satisfaction varied by region but was closely correlated between physicians and patients living in the same CTS sites. Physician career satisfaction was more strongly correlated with patient overall healthcare satisfaction than any of the other aspects of the healthcare system (Spearman's rank correlation coefficient 0.628, P<0.001). Patient trust in the physician was also highly correlated with physician career satisfaction (0.566, P<0.001). CONCLUSIONS Despite geographic variation, there is a strong correlation between physician and patient satisfaction living in similar geographic locations. Further analysis of this congruence and examination of areas of incongruence between patient and physician satisfaction may aid in improving the healthcare system.
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Affiliation(s)
- Jennifer DeVoe
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon 97239, and Cincinnati Children's Hospital Medical Center, Epidemiology and Biostatistics, Health Policy & Clinical Effectiveness, Cincinnati, Ohio, USA.
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Rey JM, Walter G, Giuffrida M. Australian psychiatrists today: proud of their profession but stressed and apprehensive about the future. Aust N Z J Psychiatry 2004; 38:105-10. [PMID: 14961926 DOI: 10.1080/j.1440-1614.2004.01320.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To examine the levels of satisfaction and stress of Australian psychiatrists. METHOD A survey was mailed in December 2002 to all Fellows of the Royal Australian and New Zealand College of Psychiatrists residing in Australia; 1039 out of 2059 (50%) returned the questionnaire. RESULTS The large majority of respondents (79%) were proud of being a psychiatrist. Most (88%) reported being satisfied with their work. Reasons for dissatisfaction varied between public and private psychiatrists. Private psychiatrists nominated litigation/indemnity issues as the most frequent (69%) while the most common for public psychiatrists was lack of beds (47%). The main reason for satisfaction was helping patients get better (72%). Sixty-two percent found their work in the previous 12 months to be stressful. Dissatisfied psychiatrists were 11 times as likely to report being stressed as those satisfied. In the previous 12 months, 34% reported having had a threat of legal action, 39% had to answer a formal complaint, 67% had been verbally or physically abused by patients or relatives and 29% had patients who had suicided. Overall, psychiatrists were more pessimistic about the future than optimistic and 15% said they would not do psychiatry again. There were few differences according to state of origin or type of practice. However, females differed from males in several areas. CONCLUSION Helping patients was reported as the main source of satisfaction for Australian psychiatrists while not being able to provide the best care for patients was described as one of the main reasons for dissatisfaction. Although most Australian psychiatrists are satisfied and proud of their profession, they are stressed and often experience verbal or physical abuse and threats of legal action and complaints. They are apprehensive about the future. The increasing number of females in the profession, their higher levels of stress and dissatisfaction, and other differences from males must be taken into account as the profession reshapes its future. There is a need for regular surveys of this kind.
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Affiliation(s)
- Joseph M Rey
- University of Sydney, New South Wales, Australia. Coral Tree Family Service, PO Box 142, North Ryde, NSW 1670, Australia.
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Abstract
Attempts to reform the US health care system in the 1980s and 1990s were inspired by the system's inability to adequately provide access, ensure quality, and restrain costs. In the era of managed care, after the Clinton administration's failed legislative effort at reform, access, quality, and costs are still problems, and medical professionals are increasingly dissatisfied. To aid understanding of why the system is now so dysfunctional, I have drawn upon discussions with thoughtful physicians about their direct experience. They raised important concerns not usually considered by health care reformers. Their central concern was about the abandonment of medicine's core values. They felt that health care has become dominated by large, bureaucratic organizations which may not honor these core values. Patients and physicians are often caught in conflicts between competing interests and demands. Those who work in health care may be subject to perverse incentives that discourage ethical practice. Health care leaders may be ill-informed, incompetent, self-interested, or even dishonest. Examples of attacks on the scientific basis of medicine have become more frequent. These worrying trends are not confined to the US. Physicians elsewhere should be skeptical of approaches to health care reform derived from the American model. European doctors should ensure the new health care initiatives do not undermine their core values or the best interests of their patients.
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Affiliation(s)
- Roy M. Poses
- Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, 111 Brewster St., 02860, Pawtucket, RI, USA
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Abstract
Utilization management encompasses a diverse set of activities designed to influence the use of health care services and thereby constrain health care resource consumption. Utilization management, which has become one of the most widely used cost-containment approaches, has engendered debate and controversy. Physicians have been outspoken critics of utilization management because it has limited their clinical autonomy and has contributed to an intolerable administrative burden. Insurance carriers, managed care plans, and third-party payers have defended the use of utilization management as an imperfect-but necessary-practice that is needed to reduce consumption of unnecessary or inappropriate health care services. This review examines the operation and effects of three widely used utilization management procedures: prospective utilization review, case management, and physician gatekeeping programs. In addition, it explores the future role of utilization management in the health care system and outlines a set of principles that we believe should be used to guide the development of utilization management strategies in the future.
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Affiliation(s)
- Thomas M Wickizer
- Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, Washington 98195-7660, USA.
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