Managed care, professional autonomy, and income - Effects on physician career satisfaction

CONTEXT. Career satisfaction among physicians Is a topic of importance to p hysicians In practice, physicians in training, health system administrators , physician organization executives, and consumers. The level of career sat isfaction derived by physicians from their work is a basic yet essential el ement In the functioning of the health care system. OBJECTIVE: To examine the degree to which professional autonomy, compensati on, and managed care are determinants of career satisfaction among physicia ns. DESIGN. Cross-sectional analysis using data from 1996-97 Community Tracking Study physician telephone survey. SETTING AND PARTICIPANTS: A nationally representative sample of 12,385 dire ct patient care physicians. The survey, response rate was 65%. MAIN OUTCOME MEASURE: Overall career satisfaction among U.S. physicians. RESULTS: Bivariate results show that physicians with low managed care reven ues are significantly more likely to be, "very satisfied" than are physicia ns with high managed care revenue (P <.05), and that physicians with low ma naged care revenues are significantly more likely to report higher levels o f clinical freedom than are physicians with high managed care revenue (P <. 05). Multivariate analyses demonstrate that, among our measures, traditiona l core professional values and autonomy are the most important determinants of career satisfaction after controlling for all other factors. Relative i ncome is also an important independent predictor. Multiple dimensions of pr ofessional autonomy hold up as strong, Independent predictors of career sat isfaction, while the effect of managed care does not. Managed care appears to exert its effect on satisfaction through its impact on professional auto nomy, not through income reduction. CONCLUSIONS: Our results suggest that when managed care (or other influence s) erode professional autonomy, the result is a highly negative Impact on p hysician career satisfaction.