A comparison of physician satisfaction in different delivery system settings, 1986 and 1997

OBJECTIVE: To examine the differences in physician satisfaction associated with open- versus closed-model practice settings and to evaluate changes in physician satisfaction between 1986 and 1997. Open-model practices refer t o those in which physicians accept patients from multiple health plans and Insurers (i.e., do not have an exclusive arrangement with any single health plan). Closed-model practices refer to those wherein physicians have an ex clusive relationship with a single health plan (i.e., staff- or group-model HMO). DESIGN: Two cross-sectional surveys of physicians, one conducted in 1986 (M edical Outcomes Study) and one conducted in 1997 (Study of Primary Care Per formance In Massachusetts). SETTING: Primary care practices in Massachusetts. PARTICIPANTS: General internists and family practitioners in Massachusetts. MEASUREMENTS: Seven measures of physician satisfaction, including satisfact ion with quality of care, the potential to achieve professional goals, time spent with individual patients, total earnings from practice, degree of pe rsonal autonomy, leisure time, and incentives for high quality. RESULTS. Physicians in open- versus closed-model practices differed signifi cantly in several aspects of their professional satisfaction. In 1997, open -model physicians were less satisfied than closed-model physicians with the ir total earnings, leisure time, and incentives for high quality. Open-mode l physicians reported significantly more difficulty with authorization proc edures and reported more denials for care. Overall, physicians In 1997 were less satisfied in every aspect of their professional life than 1986 physic ians. Differences were significant in three areas: time spent with Individu al patients, autonomy, and leisure time (P less than or equal to .05). Amon g open-model physicians, satisfaction with autonomy and time with individua l patients were significantly lower in 1997 than 1986 (P less than or equal to .01). Among closed-model physicians, satisfaction with total earnings a nd with potential to achieve professional goals were significantly lower In 1997 than in 1986 (P less than or equal to .01). CONCLUSIONS: This study finds that the state of physician satisfaction in M assachusetts is extremely low, with the majority of physicians dissatisfied with the amount of time they have with individual patients, their leisure time, and their incentives for high quality. Satisfaction with most areas o f practice declined significantly between 1986 and 1997. Open-model physici ans were less satisfied than closed-model physicians in most aspects of pra ctices.