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Research Questions

  1. What factors influence physician professional satisfaction?
  2. What are the implications of these factors for patient care, health systems, and health policy?

Abstract

One of the American Medical Association's core strategic objectives is to advance health care delivery and payment models that enable high-quality, affordable care and restore and preserve physician satisfaction. Such changes could yield a more sustainable and effective health care system with highly motivated physicians. To that end, the AMA asked RAND Health to characterize the factors that lead to physician satisfaction. RAND sought to identify high-priority determinants of professional satisfaction that can be targeted within a variety of practice types, especially as smaller and independent practices are purchased by or become affiliated with hospitals and larger delivery systems. Researchers gathered data from 30 physician practices in six states, using a combination of surveys and semistructured interviews. This report presents the results of the subsequent analysis, addressing such areas as physicians' perceptions of the quality of care, use of electronic health records, autonomy, practice leadership, and work quantity and pace. Among other things, the researchers found that physicians who perceived themselves or their practices as providing high-quality care reported better professional satisfaction. Physicians, especially those in primary care, were frustrated when demands for greater quantity of care limited the time they could spend with each patient, detracting from the quality of care in some cases. Electronic health records were a source of both promise and frustration, with major concerns about interoperability between systems and with the amount of physician time involved in data entry.

Key Findings

The Importance of Delivering High-Quality Care

  • When physicians perceived themselves as providing high-quality care or their practices as facilitating their delivery of such care, they reported better professional satisfaction.
  • Obstacles to such care could originate within the practice (e.g., a practice leadership unsupportive of quality improvement ideas) or could be imposed externally (e.g., payers refusing to cover necessary medical services).

The Pros and Cons of Electronic Health Records

  • Physicians approved of EHRs in concept and appreciated having better ability to remotely access patient information and improvements in quality of care.
  • However, for many physicians, the current state of EHR technology significantly worsened professional satisfaction in multiple ways.
  • Aspects of current EHRs that were particularly common sources of dissatisfaction included poor usability, time-consuming data entry, interference with face-to-face patient care, inefficient and less fulfilling work content, inability to exchange health information, and degradation of clinical documentation.

The Value of Income Stability and Fairness

  • Few physicians reported dissatisfaction with their current levels of income.
  • However, physicians reported that income stability was an important contributor to overall professional satisfaction.
  • Payment arrangements that were perceived as fair, transparent, and aligned with good patient care enhanced professional satisfaction.

The Cumulative Burden of Regulations

  • Physicians and practice managers described the cumulative burden of externally imposed rules and regulations as having predominantly negative effects on professional satisfaction.
  • At the time of the study, "meaningful use" rules for EHRs were the regulations most commonly singled out by physicians and practice leaders.

Recommendations

  • Physician practices need a knowledge base and resources for internal improvement.
  • As physician practices affiliate with large hospitals and health systems, paying attention to professional satisfaction may improve patient care and health system sustainability.
  • When implementing new and different payment methodologies, the predictability and perceived fairness of physician incomes will affect professional satisfaction.
  • Better EHR usability should be an industrywide priority and a precondition for EHR certification.
  • Reducing the cumulative burden of rules and regulations may improve professional satisfaction and enhance physicians' ability to focus on patient care.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Background: Scan of the Literature on Physician Professional Satisfaction

  • Chapter Three

    Methods

  • Chapter Four

    Conceptual Model

  • Chapter Five

    Characteristics of the Survey Sample

  • Chapter Six

    Quality of Care

  • Chapter Seven

    Electronic Health Records

  • Chapter Eight

    Autonomy and Work Control

  • Chapter Nine

    Practice Leadership

  • Chapter Ten

    Collegiality, Fairness, and Respect

  • Chapter Eleven

    Work Quantity and Pace

  • Chapter Twelve

    Work Content, Allied Health Professionals, and Support Staff

  • Chapter Thirteen

    Payment, Income, and Practice Finances

  • Chapter Fourteen

    Regulatory and Professional Liability Concerns

  • Chapter Fifteen

    Health Reform

  • Chapter Sixteen

    Conclusions

  • Appendix A

    Advisory Committee Members

  • Appendix B

    Interview Guides

  • Appendix C

    Practice Structural Questionnaire

  • Appendix D

    Physician Experience Survey

  • Appendix E

    Physician Experience Survey Scale Calculation

Research conducted by

The research described in this report was sponsored by the American Medical Association, and was produced within RAND Health, a division of the RAND Corporation.

This report is part of the RAND Corporation research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

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