PHYSICIAN EMPLOYMENT STATUS AND PRACTICE PATTERNS

BACKGROUND. Many physicians today are employed by another physician, g roup, hospital, HMO, or other organization, However, the differences i n the characteristics, practice patterns, and patient outcomes of self -employed and employed physicians are not well understood. METHODS. Th e practices of 108 community family physicians in northeast Ohio were assessed using a multimethod cross-sectional design. Physician charact eristics were assessed by questionnaire. Direct observation of 3536 co nsecutive patient visits was used to measure time use and the delivery of preventive services recommended by the US Preventive Services Task Force. Patient satisfaction was assessed with the Medical Outcomes St udy (MOS) 9-item Visit Rating Form. RESULTS. Employed physicians were more likely to be female, in group practice, work fewer hours, and see fewer patients. Job satisfaction was similar between the two groups, but employed physicians reported greater satisfaction with leisure and family time. Employed physicians spent more time per patient visit, s cheduled a larger percentage of well-care visits, and were more likely to refer to specialists. Employed physicians also spent a greater pro portion of their patients' visit time performing history-taking and el iciting family information, and a lesser proportion of time on physica l examination, planning treatment, providing health education, and cha tting. Recommended screening and health habits counseling preventive s ervices were more likely to be delivered by employed physicians. Patie nt satisfaction was similar for the two groups. CONCLUSIONS. Primary c are physician characteristics and practice patterns differ by employme nt status. The consequences of the trend toward a largely employed phy sician workforce as reported in this study should be carefully conside red.