HMO physicians' use of referrals

Clinical uncertainty is a source of variation in medical decision-making as well as a source of work-related stress. Increasing enrollment in organize d health care systems has intensified interest in understanding referral ut ilization as well as issues such as physician dissatisfaction and burnout. We examined whether primary care physicians' affective reactions to uncerta inty and their job characteristics were associated with use of referrals an d burnout. Data came from mail surveys of primary care physicians practicin g in two large group model health maintenance organizations (HMOs) in the U SA. Consistent with past research, we found that younger physicians had hig her referral rates than older physicians, and that general internists had h igher rates than either family practitioners or pediatricians. Greater stre ss from uncertainty increased referrals and referrals were negatively corre lated with heavier work demands (patient visits per hour). Greater stress f rom uncertainty, perceived workload (too high) and a sense of loss of contr ol over the practice environment were associated with higher levels of burn out. (C) 1998 Elsevier Science Ltd. All rights reserved.