Views of managed care - A survey of students, residents, faculty, and deans at medical schools in the United States

Background and Methods Views of managed care among academic physicians and medical students in the United States are not well known. In 1997 we conduc ted a telephone survey of a national sample of medical students (506 respon dents), residents (494), faculty members (728), department chairs (186), di rectors of residency training in internal medicine and pediatrics (143), an d deans (105) at U.S. medical schools to determine their experiences in and perspectives on managed care. The overall rate of response was 80.1 percen t. Results Respondents rated their attitudes toward managed care on a 0-to-10 scale, with 0 defined as "as negative as possible" and 10 as "as positive a s possible." The expressed attitudes toward managed care were negative, ran ging from a low mean (+/-SD) score of 3.9+/-1.7 for residents to a high of 5.0+/-1.3 for deans. When asked about specific aspects of care, fee-for-ser vice medicine was rated better than managed care in terms of access (by 80. 2 percent of respondents), minimizing ethical conflicts (74.8 percent), and the quality of the doctor-patient relationship (70.6 percent). With respec t to the continuity of care, 52.0 percent of respondents preferred fee-for- service medicine, and 29.3 percent preferred managed care. For care at the end of life, 49.1 percent preferred fee-for-service medicine, and 20.5 perc ent preferred managed care. With respect to care for patients with chronic illness, 41.8 percent preferred fee-for-service care, and 30.8 percent pref erred managed care. Faculty members, residency-training directors, and depa rtment chairs responded that managed care had reduced the time they had ava ilable for research (63.1 percent agreed) and teaching (58.9 percent) and h ad reduced their income (55.8 percent). Overall, 46.6 percent of faculty me mbers, 26.7 percent of residency-training directors, and 42.7 percent of de partment chairs reported that the message they delivered to students about managed care was negative. Conclusions Negative views of managed care are widespread among medical stu dents, residents, faculty members, and medical school deans. (N Engl J Med 1999;340:928-36.) (C) 1999, Massachusetts Medical Society.