Doctor discontent

OBJECTIVE: To examine the differences in physician satisfaction associated with open- versus closed-model practice settings and to evaluate changes in physician satisfaction between 1986 and 1997. Open-model practices refer to those in which physicians accept patients from multiple health plans and insurers (i.e., do not have an exclusive arrangement with any single health plan). Closed-model practices refer to those wherein physicians have an exclusive relationship with a single health plan (i.e., staff- or group-model HMO). DESIGN: Two cross-sectional surveys of physicians; one conducted in 1986 (Medical Outcomes Study) and one conducted in 1997 (Study of Primary Care Performance in Massachusetts). SETTING: Primary care practices in Massachusetts. PARTICIPANTS: General internists and family practitioners in Massachusetts. MEASUREMENTS: Seven measures of physician satisfaction, including satisfaction with quality of care, the potential to achieve professional goals, time spent with individual patients, total earnings from practice, degree of personal autonomy, leisure time, and incentives for high quality. RESULTS: Physicians in open- versus closed-model practices differed significantly in several aspects of their professional satisfaction. In 1997, open-model physicians were less satisfied than closed-model physicians with their total earnings, leisure time, and incentives for high quality. Open-model physicians reported significantly more difficulty with authorization procedures and reported more denials for care. Overall, physicians in 1997 were less satisfied in every aspect of their professional life than 1986 physicians. Differences were significant in three areas: time spent with individual patients, autonomy, and leisure time (P≤.05). Among open-model physicians, satisfaction with autonomy and time with individual patients were significantly lower in 1997 than 1986 (P≤.01). Among closed-model physicians, satisfaction with total earnings and with potential to achieve professional goals were significantly lower in 1997 than in 1986 (P≤.01). CONCLUSIONS: This study finds that the state of physician satisfaction in Massachusetts is extremely low, with the majority of physicians dissatisfied with the amount of time they have with individual patients, their leisure time, and their incentives for high quality. Satisfaction with most areas of practice declined significantly between 1986 and 1997. Open-model physicians were less satisfied than closed-model physicians in most aspects of practices. This research was supported by grant number R01 HS08841 from the Agency for Healthcare Research and Quality (formerly the Agency for Health Care Policy and Research) and by grant number 035321 from the Robert Wood Johnson Foundation, Funding from those sources permitted us to obtain survey data from Massachusetts primary care physicians in February 1997 and to analyze them, along with Medical Outcomes Study data, for this article. The Medical Outcomes Study (MOS) physician survey data used for these analyses were obtained in 1986 through a generous grant from the Henry J. Kaiser Family Foundation.     

A multifaceted study of hospital variables and interventions to improve inpatient satisfaction in a multi-hospital system

Knowing the areas of service, actions, and parameters that can influence patient perception about a service provided can help hospital executives and healthcare workers to devise improvement plans, leading to higher patient satisfaction.To identify inpatient satisfaction determinants, assess their relationships with hospital variables, and improve patient satisfaction through interventions.We studied the inpatient population of an eight-hospital tertiary medical center in 2015. The satisfaction determinants were based on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey answers and included clinical and organizational variables.Interventions began at the end of 2016 included bedside care coordination rounds (BCCR), medications best practices alert (BPA), connect transitions post-discharge calls (CONNECT Transitions) and a framework for provider-patient interactions called AIDET (Acknowledge, Introduce, Duration, Explain, and Thank). Substantial impact upon patient satisfaction was observed after the introduction of these interventions.Three groups were identified:

• 1.high satisfaction, which correlated with race, surgery, and cancer care;
• 2.low satisfaction, correlated with elderly, emergency room, intensive care unit, chronic obstructive pulmonary disease, and vascular diseases; and
• 3.neutral, correlated with hospital-acquired complications, several diagnostic procedures, and medical care delay.

Significant improvements in the 3 groups were achieved with interventions that optimize care provider interactions with patients and their families.Based on the HCAHPS-based analysis, we implemented new measures and programs for addressing coordination of care, improving patient safety, reducing the length of stay, and ultimately improving patient satisfaction.     

Comparison of satisfaction with care between two different models of HIV care delivery in St. Petersburg,Russia

Prior to 2010, medical care for people living with HIV/AIDS was provided at an outpatient facility near the center of St. Petersburg. Since then, HIV specialty clinics have been established in more outlying regions of the city. The study examined the effect of this decentralization of HIV care on patients’ satisfaction with care in clinics of St. Petersburg, Russia. We conducted a cross-sectional study with 418 HIV-positive patients receiving care at the St. Petersburg AIDS Center or at District Infectious Disease Departments (centralized and decentralized models, respectively). Face-to-face interviews included questions about psychosocial characteristics, patient's satisfaction with care, and clinic-related patient experience. Abstraction of medical records provided information on patients’ viral load. To compare centralized and decentralized models of care delivery, we performed bivariate and multivariate analysis. Clients of District Infectious Disease Departments spent less time in lines and traveling to reach the clinic, and they had stronger relationships with their doctor. The overall satisfaction with care was high, with 86% of the sample reporting high level of satisfaction. Nevertheless, satisfaction with care was strongly and positively associated with the decentralized model of care and Patient–Doctor Relationship Score. Patient experience elements such as waiting time, travel time, and number of services used were not significant factors related to satisfaction. Given the positive association of satisfaction with decentralized service delivery, it is worth exploring decentralization as one way of improving healthcare services for people living with HIV/AIDS.     

A Comparison of How Generalists and Fellowship‐Trained Geriatricians Provide “Geriatric” Care

OBJECTIVES: To determine whether outpatient care provided to older patients by fellowship‐trained geriatricians is distinguishable from that provided by generalists. DESIGN: Observational study. SETTING: Three primary care clinics of an academic medical center. PARTICIPANTS: Random sample of 140 adults aged 65 and older receiving primary care at one of the clinics. MEASUREMENTS: A medical chart review involving records of 69 patients receiving primary care from a fellowship‐trained geriatrician and 71 patients receiving primary care from a generalist (general internal medicine or family practice) was conducted; information pertaining to two practice behaviors relevant to the care of older adults—avoidance of inappropriate prescribing and proactive assessments for geriatric syndromes—was abstracted. RESULTS: Geriatricians scored 17.6 out of a possible 24 points, on average; generalists scored 14.2 (P<.001). Geriatricians scored higher than generalists on prescribing and geriatric syndrome assessments. In a linear regression model adjusting for patient age and number of comorbidities and clustering according to provider, provider specialty was strongly associated with overall score (β coefficient for specialty=6.75, P<.001; 95% confidence interval=4.57–8.94). CONCLUSION: The practice style of fellowship‐trained geriatricians caring for older adults appears to differ from that of generalists with regard to prescribing behavior and assessment for geriatric syndromes.     

The prevalence,determinants and the role of empathy and religious or spiritual beliefs on job stress,job satisfaction,coping, burnout,and mental health in medical and surgical faculty of a teaching hospital: A cross-sectional survey

ObjectiveSystematically ascertained data on job stress and burnout and their antecedents and mediators in health professionals from low- and middle-income countries are scant.MethodsThis cross sectional survey, conducted from July 2007 to August 2008, of consenting medical and surgical faculty of a large, charitable, teaching hospital aimed to evaluate: 1) the prevalence and sources of job stress and job satisfaction, and the ways used to cope with stress; 2) the prevalence of burnout and mental distress; and 3) the influence of age, gender, empathy and religious or spiritual beliefs on job stress, satisfaction, mental health and burnout.ResultsOf 345 respondents, high job stress on the Physician Stress and Satisfaction questionnaire were reported by 23%. However, 98% of faculty reported high levels of job satisfaction with deriving intellectual stimulation from teaching and a high level of responsibility identified as important contributory sources. Significantly more respondents aged < 45 years compared to older faculty achieved moderate or high scores on Emotional Exhaustion and Depersonalization. General Health Questionnaire-12 scores suggested psychiatric morbidity in 21%, particularly in younger faculty. High job stress was associated with high scores for Emotional Exhaustion and Depersonalization. High scores on the Jefferson Scale of Physician Empathy correlated with high scores of Emotional Exhaustion. Religious or spiritual beliefs strongly influencing attitudes to work were significantly associated with high levels of Personal Accomplishment.ConclusionsThis study provides data that will inform the design and implementation of interventions to reduce job stress and burnout and improve retention of faculty.