Perceptions of practice problems encountered by family physicians, pediatricians, and orthopedic surgeons

Readiness for Medicaid managed care reform initiatives: a profile of rural family physicians

Medicaid managed care is now an important factor in the financing of rural health care delivery. The participation of rural family physicians in Medicaid managed care is vital for the rural poor to access health services. This study examined 855 family physicians practicing in nonmetropolitan counties across the United States to determine their readiness to participate in Medicaid managed care. Physicians were asked about their experience with prepaid programs and the factors that would influence their participation in such a program. A shortage of health care providers and low reimbursement rates were most frequently cited as barriers to successful implementation. Physicians who had participated in prepaid programs in the past but were no longer participating had the most negative opinions about the potential for Medicaid managed care programs to enhance care for the poor in their communities. Overall, physicians reported potential for the program to improve access and quality of care, but they also expressed reservations about the financial and administrative effects on their practices. These results reveal that negative attitudes were associated with prepaid programs that failed to meet expectations, but physicians also expressed an optimism about the potential to serve the poor within a managed care model.

Bringing the physician back in: communication predictors of physicians' satisfaction with managed care

Data from a survey of physicians in a west coast city (n = 356) are used to measure physicians' extra-occupational sources of dissatisfaction. Data revealed a significant relationship between physicians' satisfaction and their managed care experience, their communication with managed care organizations, and views of managed care practice. Results suggest that managed care currently plays a large and significant role in predicting physicians' satisfaction. The importance of communication between physicians and managed care organizations is illustrated in the strength of the relationships between communication variables and managed care decisions. Furthermore, in assessing the strength of the relationship, regression analysis reveals that communication with managed care accounts for the largest percentage of variance in physicians' satisfaction. The results of this study suggest that communication with managed care organizations affects physicians' satisfaction with every facet of the organizational environment, including leading physicians who report problematic communication with managed care organizations to say that they would be less likely to choose the same career path again.

Primary care and nonprimary care physicians' concerns in practice and perceptions of medical school curriculum

The purpose of the present study is to address the issue of physicians' concerns in practice and their perception of a medical school's curriculum with an emphasis on comparisons between primary and nonprimary care physicians. The sample consisted of 663 physicians who graduated from Jefferson Medical College (JMC) between 1982 and 1986, and also responded to a mailed questionnaire. Comparisons were made between physicians in primary care (n=234) and in nonprimary care (n=429) specialties on their responses regarding concerns in medical practice and evaluation of the medical school curriculum. Primary care physicians were more concerned about the time for their professional development whereas nonprimary care physicians were more concerned about an oversupply of physicians in their specialties, prospective hospital payment, and malpractice litigation. Regardless of the specialties, the physicians overall seemed very concerned about their personal time. Interpersonal skills were regarded by all respondents as an important aspect of the medical school's curriculum. The importance of psychological, social, and cultural factors in the curriculum was strongly supported by these physicians' responses, particularly among primary care and women physicians.