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

Move It or Lose It: Summarizing Peer-reviewed Evidence for Practicing What You Preach

Physically active health care providers are more likely to provide physical activity (PA) counseling to their patients, but barriers in PA counseling exist. Common barriers include knowledge, time constraints, lack of reimbursement, as well as lack of personal habits. This article will summarize evidence-based knowledge regarding provider PA habits as a means of improving rapport, compliance, and empathy for patients when prescribing PA. Clinical pearls for successful PA counseling scenarios also will be discussed.

The effects of dialogue groups on physicians' work environment: A matter of gender?

BACKGROUND

Over the past decades, the work environment of physicians has been deteriorating, particularly for female physicians.

OBJECTIVES

In this study, we evaluated the effects of dialogue groups on the work environment of physicians in relation to gender.

METHODS

Sixty physicians (38 women) at Sachs' Children's Hospital in Stockholm, Sweden, participated in dialogue groups once a month during a period of one year. Assessments of their psychosocial work environment were performed before and after the intervention.

RESULTS

At baseline, female physicians experienced their work environment as less satisfactory compared to male physicians. After the intervention, the female physicians perceived improvements in more areas than their male colleagues.

CONCLUSIONS

Our study shows that female physicians at this clinic were disadvantaged in relation to the work environment, but, more importantly, the findings suggest that several of the disadvantages can be reduced. Dialogue groups appear to improve the physicians' work environment and promote gender equality.

New wine in an old bottle: does alienation provide an explanation of the origins of physician discontent?

We have witnessed transformational changes to the U.S. health care system over several decades. Alongside these changes is an increasing number of research reports and commentaries on physician workplace dissatisfaction and discontent. Primary care physicians, in particular, report dissatisfaction with conditions on the ground. Is there solid evidence concerning the magnitude of doctors' discontent, and how is it changing over time? Is it confined to the United States, or is it also occurring in other countries with different health care systems? Does physician discontent affect the processes, quality, and outcomes of medical care? This article addresses these questions. It considers the dimensions of physician dissatisfaction, whether there is a problem, and competing contributions to physician discontent. The authors suggest that the classic concept of alienation may build upon valuable earlier work and provide a new, coherent explanation of the workplace origins of physician discontent. Alienation theory combines both structural and psychological components associated with workplace discontent and has the potential to explain the changing position of knowledge workers (such as physicians) in the new economy.

Asian-Indian physicians' experience with managed care organizations

PURPOSE

There is anecdotal evidence that ethnic minority physicians are underrepresented in managed care contracts. The purpose of this paper, therefore, is to determine ethnic Asian-Indian physician-managed care organization experience and job satisfaction in the USA by age, gender, region and percent of patients in managed care organizations. DESIGN/METHODOLOGY/VALUE: A random (nation-wide) mail survey was conducted of 254 physicians who were American Association of Physicians of Indian Origin (AAPI) members during the period 1998 to 2000. Managed care experience was categorized into physician satisfaction; service quality rating; service limitations; difficulties acquiring and maintaining managed care contracts; and financial impact.

FINDINGS

Physicians in solo and group practice relied heavily on managed care enrolled patients. Limitations providing care to patients was a more serious problem than for those in staff-model health maintenance organization and hospital/clinic-based practices. Physician satisfaction was not significantly related to board certification, practice type, region and managed care participation. However, practice staff participating in managed care had the highest number of board-certified physicians.

RESEARCH LIMITATIONS/IMPLICATIONS

There was a low response rate (37 percent) to data collection using questionnaires.

PRACTICAL IMPLICATIONS

The paper underlines ethnic minority physicians' capability to get managed care contracts.

ORIGINALITY/VALUE

This is the first national study of Asian-Indian physicians and their managed care organization experience. Asian-Indian physicians are over-represented in the medical profession and hence the paper will interest those working and dealing with managed care organizations and their patients.

U.S. physician satisfaction: a systematic review

INTRODUCTION

There is concern in the US about the burden and potential ramifications of dissatisfaction among physicians. The purpose of this article is to systematically review the literature on US physician satisfaction.

METHODS

A MEDLINE search with the medical subject headings (MeSH) phrases: (physicians OR physician's role OR physician's women) AND (job satisfaction OR career satisfaction OR burnout), limited to humans and abstracts, with 1157 abstracts reviewed. After exclusions by 2 independent reviewers, 97 articles were included. Physician type sampled, sample size/response rate, satisfaction type, and satisfaction results were extracted for each study. Satisfaction trends were extracted from those studies with longitudinal or repeated cross sectional design. Variables associated with satisfaction were extracted from those studies that included multivariate analyses.

RESULTS

Physician satisfaction was relatively stable, with small decreases primarily among primary care physicians (PCPs). The major pertinent mediating factors of satisfaction for hospitalists include both physician factors (age and specialty), and job factors (job demands, job control, collegial support, income, and incentives).

CONCLUSIONS

The majority of factors associated with satisfaction are modifiable. Tangible recommendations for measuring and diminishing dissatisfaction are given.

The symbolic and material nature of physician identity: implications for physician-patient communication

This field study considers the implications of the symbolic and material nature of physician identity for communication with patients. In-depth interviews of physicians across multiple organizational contexts reveal that physician identity is a discursive process of situated meaning in which particular configurations of beliefs, values, and actions are constructed within specific contexts. The content of individual physician identity was related to the general environment of medicine and its local medical context. The identities of physicians working in private practice were linked to the economic, legal, and social environment of medicine, whereas physicians working as employees had identities related to working in a setting that buffered the effects of the environment. Specific implications of the symbolic and material nature of physician identity for physician-patient communication are examined. Understanding physician identity is important to health communication scholarship because of the ongoing and central nature of physicians in health-care decision making and delivery.

May I long experience the joy of healing: professional and personal wellbeing among physicians from a Canadian province

Background

The development of best practices to promote physician wellbeing at the individual and organisational levels is receiving increased attention. Few studies have documented how physicians perceive their wellbeing in these contexts. The purpose of this qualitative study is to identify and discuss the reported factors that hinder wellbeing, as well as the reported factors that would promote wellbeing among physicians.

Methods

There were 165 physicians from a province of Canada who wrote their open-ended responses to two questions, as part of a larger self-report questionnaire. The questions asked what causes them stress, and what interventions should be implemented at organisational/institutional levels. The largest specialty was family medicine, followed by internal medicine, and surgical disciplines, with 58% of participants male. A general inductive approach was used to analyze the data and themes and sub-themes were discovered using the socio-ecological model as the framework.

Results

Reponses were both personal and professional which resulted in the emergence of four major themes to reflect this diversity. These themes were external constraints on the practice of medicine, issues at the professional/institutional levels, issues at the individual practice level, and work/life balance. The work/life balance theme received the highest number of responses followed by external constraints on the practice of medicine. In the major theme of work-life balance, work-life conflict received the most responses, and in the major theme of external constraints on practice of medicine, lack of resources (human and material) and restrictions to autonomy received the most responses. Ideas for interventions in the work/life balance theme were health promotion, and healthy workplace initiatives. In the second largest theme, suggested ideas for interventions were collegiality/professionalism and policy formulation at the health care system.

Conclusion

Our findings have implications for governance and health policy, health human resources and education. In particular, the socio-ecological framework was a useful framework to analyse physician wellbeing due to its applicability for issues at the structural, organisational, and individual levels. Future research should target interventions at the organisational and institutional levels to address work-life conflict and job dissatisfaction.

[State of internal communication in primary care]

OBJECTIVES

To study internal communication between primary care health professionals

DESIGN

Cross-sectional, descriptive.

SETTING

Catalan Health Institute Costa de Ponent Primary Care Area, Spain.

PARTICIPANTS

All workers in the area (n=3565).

MEASUREMENTS

Three part questionnaire: a) sociodemographic questions; b) questions scoring from 0 to 10 the current importance and operation of certain aspects; and c) questions on new communication tools.

RESULTS

Of those sent a questionnaire, 39% (n=1388) responded, with a mean age of 43.2 years (95% CI, 42.75- 43.65), 28.9% being male. The major differences between importance and current events were said to be "to be informed of projects before they appear in the communication media," "by official routes and not by rumour," and "to be aware of projects of other teams." The least communicated within teams. The doctors considered upward communication to be more important. Doctors are those who appreciate communication within teams better and the professionals of the users services unit (UAU) less so. Doctors are the ones who give more importance to being informed of projects at the time. 55% do not use the intranet, mainly due to lack of time. The second reason is that they find it difficult. Sixty-two per cent read e-mail >2-3 times per week. Eighty-nine per cent want an electronic bulletin. The older workers use new technologies less.

CONCLUSIONS

Downward, upward, and sideways communication needs to be improved, particularly upwards by doctors, and that of the teams for the UAU professionals. Intranet tools must be provided that make the work easier and training in handling new technologies must be offered.

Understanding interpersonal communication processes across health contexts: advances in the last decade and challenges for the next decade

Interpersonal communication processes are central to the provider-patient interaction and in relationships with someone who is ill or needs care. The last decade of research has documented the ways communication processes predict better outcomes in the provider-patient interaction and key constructs for consideration in close relationships in which a health issue in some way defines the relationship. The current article highlights findings from the previous decade and the ways previous findings serve as a theoretical and methodological foundation for more sophisticated analysis of interpersonal communication processes in health contexts. A relational perspective serves as a link between the provider-patient relationship and close relationships with someone with a health issue. Implications for provider-patient contexts, medical education, and close relationships highlight future directions for theory building, health literacy, health outcomes, family communication, developmental issues, and a life span perspective.

The PhoenixCare Program

In response to a perceived need for patient access to palliative care and supportive services prior to hospice eligibility, Phoenix-based Hospice of the Valley (HOV) applied for and received a 3-year demonstration grant (1999-2001) from The Robert Wood Johnson (RWJ) Promoting Excellence in End-Of-Life Care Project. HOV established the PhoenixCare project as a demonstration of palliative and coordinated care (case management) services for seriously chronically ill individuals still undergoing active treatment of their disease within a managed care setting. The model emphasized patient/family self-empowerment and prevention. The goal was to demonstrate that it was possible to expand the scope of care for the seriously chronically ill, add palliative care, and improve patient quality of life at less (or no more) cost than that for a comparable group of managed care patients not receiving PhoenixCare services. The model proved most useful to patients willing and able to assume a degree of control over their own care. Physicians referred fewer than 5% of the patients enrolled while managed care plan case managers and hospital discharge planners referred 83%, suggesting that in organized systems of care physicians are not a primary source for patient referrals. The structure and content of the PhoenixCare model, its general acceptability to patients, physicians and managed care plans, and its applicability to other sites are discussed in this article. Outcomes from the study will be published in a subsequent paper.