MEASURING PHYSICIAN ATTITUDES TOWARD COST, UNCERTAINTY, MALPRACTICE, AND UTILIZATION REVIEW

Objective: To develop a reliable measure of physician attitudes postul ated to influence resource utilization. Design: Statements related to attitudes that may influence resource use were culled from the literat ure and informal discussions with physicians. Setting: Academic medica l center. Participants: All faculty and housestaff in internal medicin e, pediatrics, family medicine, and surgery at an academic medical cen ter were surveyed. The response rate was 59% (n = 428). Results: Explo ratory factor analysis of all internal medicine surveys revealed four prominent domains. These closely corresponded with our a-priori hypoth esized domains and were interpreted as cost-consciousness, discomfort with uncertainty, fear of malpractice, and annoyance with utilization review. A replication of the analysis using 25 survey items and conduc ted on the remainder of the data (surgeons, pediatricians, and family practitioners) revealed a similar four-factor solution. Scales were co nstructed for each of the four domains. Cronbach's alpha ranged from 0 .66 to 0.88. Discomfort from uncertainty and fear of malpractice were moderately correlated (r = 0.42); other scale-scale correlations were modest. Of the four attitude measures, only cost-consciousness was ass ociated with lower self-estimates of resource use. Both annoyance with utilization review and fear of malpractice increased as the proportio n of time spent in patient care increased. Conclusions: Although vario us physician attitudes and beliefs have been hypothesized to influence health services resource use, reliable and valid measures for most of these have not been developed. The authors developed a 19-item survey instrument designed to measure these attitudes reliably. The four sca les developed in this study may help identify physician attitudes that are important determinants of physician decision making and help fost er a better understanding of physicians' reactions and acculturation t o different practice environments.