Physicians' perceptions of the changing health care system: Comparisons bygender and specialties

This study was designed to investigate physicians' perceptions of changes i n the United States health care system impacting academic medicine, quality of care, patient referrals, cost, ethical and sociopolitical aspects of me dicine. A survey was mailed in 1998 to 1,272 physicians (graduates of Jeffe rson Medical College between 1987 and 1992); 835 physicians (66%) responded . Results showed that a substantial majority (92%) believed that learning t o work in a managed care environment should become an essential component o f medical education. Physicians perceived that current changes impair physi cians' autonomy (94%), and restrain physicians' freedom to provide optimal care (84%). A sizable majority (76%) endorsed patients' freedom to seek spe cialist care, and 55% believed that capitation reduces physicians' motivati on for long-term monitoring of patients. The majority endorsed universal he alth coverage (80%), and agreed to support rather than resist the changes ( 62%). Only 18% hold a positive view of the changes in the future. The major ity believed that medical education should prepare physicians to provide en d-of-life care (92%), and that organized medicine should take a stand on so cial issues that can influence the well-being of society (79%). Only 34% en dorsed the legalization of physician-assisted suicide. No gender difference s were observed, but a few differences were found between generalists and s pecialists. Results can help in understanding physicians' perceptions of cu rrent changes in the United States health care system, and in providing gui delines for the development of educational programs to prepare physicians t o face new challenges.