Study finds organizations can affect physician job satisfaction
Wisconsin family physicians employed by large health care organizations are less happy on the job and more likely to want to leave their positions than those in independent practice, according to a new study co-authored by Industrial and Systems Engineering Assistant Professor Ben-Tzion Karsh.
A team led by Karsh and Family Medicine Emeritus Professor John Beasley surveyed hundreds of family doctors throughout Wisconsin about their job satisfaction, including their perceived ability to achieve professional goals and their working relationships with other doctors. The results, published in the December 6 issue of the Annals of Family Medicine, showed striking differences between doctors working for health maintenance organizations (HMOs), hospitals and other large institutions and those employed independently in smaller, physician-owned groups.
“What was most telling for us is that people who worked as independents were not only more satisfied in general with being a doctor, but also enjoyed some other very tangible benefits,” says Karsh. “For example, the independents were more satisfied with the amount of family time they had and with their ability to influence management decisions. They even felt they were able to deliver a higher quality of care to their patients.”
In addition to patient care, physician job satisfaction can impact the relationships between doctors and other health care professionals, such as nurses, says Beasley. And because replacing a doctor who leaves can cost upward of $250,000, physician discontent may contribute to rising health care costs.
A long-time family physician with ties to many doctors around the state, Beasley began discussing these matters with Karsh when the two met in 1999. Many factors known to affect work life quality relate to issues of control, says Karsh, such as the inability to limit workload or balance home and work responsibilities.
Because of the medical profession's strong tradition of independence, says Beasley, “We don't usually think about doctors having those types of problems. But I thought, now that so many physicians are working for these large organizations, maybe they're starting to feel more like everyday employees whose activities are directed chiefly by management. So, we became very interested in whether the organizations doctors work for influence their perceptions of their working conditions, and how likely they are to leave their organizations.”
Using information from the scientific literature and from focus groups with family doctors and nurses, the team developed a comprehensive set of survey questions. Nearly 1500 members of the Wisconsin Academy of Family Physicians, or 90 percent of all the state's family doctors, were sent the survey and asked to respond. In the end, 47 percent, or more than 700, did. Thirteen percent of those in the sample worked independently and 87 percent for large health care organizations.
Although Beasley and Karsh knew they might eventually look for differences between these groups, this intent was hidden from the survey takers to prevent biased results. Only in a short demographic section at the survey's end were doctors asked about the type of organization they worked for.
“The survey simply stated, ‘We're interested in learning more about how you feel about your work,’ and that was it,” says Karsh. “That was part of what was so compelling about the differences we observed. They came out very naturally.”
The greatest disparities the team found were in perceived influence over management decisions and quality of working relationships within groups. Independents, the study's statistical analysis showed, were more satisfied with both, suggesting that doctors at large organizations may lack social support and control over their situations relative to their independent peers.
While most people willingly accept a certain lack of freedom on the job, doctors are unique in this regard, says Karsh.
“There is almost no other profession that holds such strong expectations of autonomy,” he says. “And that creates a major conflict when you impose a management structure.”
Beasley and Karsh plan to conduct follow-on studies to identify specific organizational factors, such as leadership style, workplace culture or communication structures, which HMOs and hospitals could potentially adjust to improve the work lives of their employees. The overall goal is better health care.
“My primary interest is in science that makes it possible for doctors and nurses to perform at their peak levels. And John's primary interest is in making things good for the patient,” says Karsh. “So, by collaborating we can really tackle the full picture.”
The project was funded by the Wisconsin Academy of Family Physicians and the UW-Madison Center for Quality and Productivity Improvement. Its other authors include research program manager Mary Ellen Hagenauer and Professor of Family Medicine Lucille Marchand of UW-Madison, and Francois Sainfort of the Georgia Institute of Technology.