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This dissertation is composed of three papers covering different aspects of physicians' working lives.
The first paper is a qualitative systematic review of demographic, workplace, and health system factors related to physician professional satisfaction. Our search of the EBSCO PubMed and CINAHL databases yielded 2064 unique publications (as well as 15 from a hand search), and 71 of these met the inclusion criteria for the review. We found consistent evidence that physician professional satisfaction is positively associated with age, an academic workplace, non-participation in health management organizations, strong relationships with co-workers and practice leadership, the perception of delivering high quality patient care, and income. We also found emerging evidence that satisfaction is negatively associated with electronic health records, and positively associated with participation in patient centered medical homes and capitation programs.
The second paper is a qualitative thematic analysis of semi-structured interviews with primary care physicians about administrative work and physician job roles. I interviewed twenty-eight family physicians and internists in the Chicago, Los Angeles, and Miami areas about their perceptions of administrative work. I found three major themes: (1) administrative work was not central to primary care physicians' job role beliefs, (2) among solo practitioners, the need for autonomy was worth the responsibility of administrative work, (3a) "below license" work should be delegated to non-physicians, and (3b) team-based care reduces administrative work for primary care physicians and helps clarify job roles.
The third paper is a quantitative multivariable analysis of sex differences in physician income using a multi-region survey. Four hundred and forty-three (67% response rate; 226 men; 177 women) practicing physicians from six states (Colorado, Massachusetts, North Carolina, Texas, Washington, and Wisconsin) responded to the survey. Male physicians earned higher annual incomes than female physicians in the sample (mean $291,188 vs. $202,973; difference $88,216, 95% confidence interval [CI] $61,612 to $114,819). In our adjusted multivariable analysis, this difference dropped by nearly 70% to $29,007 (95% CI $8568 to $49,446) after excluding physicians who work more than the 95th percentile in hours, Winsorizing income at the 95th percentile, and controlling for hours worked, composition of work hours (patient care, teaching, research, and administration), physician specialty, percent of patient care time spent providing procedures, and practice random effects.
Table of Contents
Chapter One
Introduction
Chapter Two
A systematic review of physician professional satisfaction in the United States
Chapter Three
Administrative work and job role beliefs in primary care physicians: a qualitative analysis of semi‐structured interviews
Chapter Four
Differences in physician income by sex in a multi‐region survey
Chapter Five
Conclusion
Research conducted by
This document was submitted as a dissertation in September 2017 in partial fulfillment of the requirements of the doctoral degree in public policy analysis at the Pardee RAND Graduate School. The faculty committee that supervised and approved the dissertation consisted of of Peggy Chen (chair), Gery Ryan, and Michael Tutty.
This publication is part of the RAND Corporation Dissertation series. Pardee RAND dissertations are produced by graduate fellows of the Pardee RAND Graduate School, the world's leading producer of Ph.D.'s in policy analysis. The dissertations are supervised, reviewed, and approved by a Pardee RAND faculty committee overseeing each dissertation.
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