The effect of patient satisfaction scores on physician job satisfaction and burnout

Physician turnover rates and job stability in interventional spine and pain practices: Results of an IPSIS survey study

Background

Physician turnover and job instability have profound implications for healthcare systems, private facilities, and patient outcomes. High physician turnover disrupts continuity of care, impedes establishment of patient-physician relationships, and may compromise overall healthcare quality.

Objective

This survey study explores the rate of job turnover in the field of Interventional Spine and Pain Medicine, based on a 2022 survey of physicians of the International Pain and Spine Intervention Society.

Methods

A standardized, anonymous survey was distributed by email via Research Electronic Data Capture (REDCap) software to physician members of the International Pain and Spine Interventional Society (IPSIS).

Results

Our survey results indicate that interventional spine/pain physicians with initially lower starting salaries were more likely to leave their first job. We also found that those currently in a productivity-based compensation models were more likely to have left their first job.

Conclusions

Of the interventional pain and spine physicians who had been in practice for at least three years, over 65% reported leaving their initial job after training.

Novel Application of a Dynamic, In-room Survey Platform to Measure Surgical Team Satisfaction

OBJECTIVE

To elucidate the potential usage of continuous feedback regarding team satisfaction and correlations with operative performance and patient outcomes.

BACKGROUND

Continuous, actionable assessment of teamwork quality in the operating room (OR) is challenging. This work introduces a novel, data-driven approach to prospectively and dynamically assess health care provider satisfaction with teamwork in the OR.

METHODS

Satisfaction with teamwork quality for each case was assessed utilizing a validated prompt displayed on HappyOrNot Terminals placed in all ORs, with separate panels for circulators, scrub nurses, surgeons, and anesthesia providers. Responses were cross-referenced with OR log data, team familiarity indicators, efficiency parameters, and patient safety indicator events through continuous, semiautomated data marts. Deidentified responses were analyzed through logistic regression modeling.

RESULTS

Over a 24-week period, 4123 responses from 2107 cases were recorded. The overall response rate per case was 32.5%. Greater scrub nurse specialty experience was strongly associated with satisfaction (odds ratio: 2.15, 95% CI: 1.53-3.03, P < 0.001). Worse satisfaction was associated with longer than expected procedure time (odds ratio: 0.91, 95% CI: 0.82-1.00, P = 0.047), nighttime (0.67, 95% CI: 0.55-0.82, P < 0.001), and add-on cases (0.72, 95% CI: 0.60-0.86, P < 0.001). Higher material costs (22%, 95% CI: 6-37, P = 0.006) were associated with greater team satisfaction. Cases with superior teamwork ratings were associated with a 15% shorter length of hospital stay (95% CI: 4-25, P = 0.006).

CONCLUSIONS

This study demonstrates the feasibility of a dynamic survey platform to report actionable health care provider satisfaction metrics in real-time. Team satisfaction is associated with modifiable team variables and some key operational outcomes. Leveraging qualitative measurements of teamwork as operational indicators may augment staff engagement and measures of performance.

Physician Perceptions of Performance Feedback and Impact on Personal Well-Being: A Qualitative Exploration of Patient Satisfaction Feedback in Neurology

BACKGROUND

To understand neurologists' experiences and perspectives on patient satisfaction feedback and its impact on personal well-being and behavior.

METHODS

From May to June 2021, the researchers conducted 19 semistructured interviews with neurologists from a large academic medical center. Clinical Performance Feedback Intervention Theory informed a combined inductive and deductive thematic analysis of the qualitative data, which focused on perceptions of current feedback practices, its impact on physician behavior, and recommendations for improvement.

RESULTS

Participants tended to be female (n = 12/19, 63.2%), aged 30-39 (n = 8/19, 42.1%), white (n = 9/19, 47.4%), and were 10+ years into clinical practice (n = 18/19, 94.7%). Physicians were receptive to feedback overall, but perceptions varied by feedback type. Physicians preferred informal feedback (delivered unprompted directly by patients), given its tendency toward actionability. They disliked formal feedback (derived from anonymous surveys) due to low actionability, bias and validity issues, lack of contextual considerations, delivery through public reports, and links to financial incentives. Nearly all physicians reported formal feedback programs had the potential to negatively affect well-being and were not beneficial to their practice; a few reported adjusting their clinical practice to improve patient satisfaction performance. Five recommendations to improve patient satisfaction feedback programs emerged: Align on feedback intent, acknowledge survey limitations during program administration, increase actionability of feedback through specificity and control, support direct patient-physician feedback and problem resolution, and support empathetic integration of feedback.

CONCLUSION

Understanding physician perceptions of current approaches to patient satisfaction feedback offers the opportunity to shape subsequent collection and distribution methods to improve physician performance and optimize professional fulfillment.

Patient Satisfaction Scores Impact Pediatrician Practice Patterns, Job Satisfaction, and Burnout

Patient satisfaction (PS) surveying has become a commonly used measure of physician performance, but little is known about the impact on pediatricians. To investigate our hypothesis that PS surveys negatively impact pediatricians, we conducted a survey at an academic children's medical center. Of 155 eligible physicians, 115 responded (response rate 74%). Two-thirds (68%) did not find the PS score report useful and 88% did not feel that PS scores accurately reflect the physician's clinical ability. A third reported ordering tests, medications, or consultations due to pressure for higher PS scores. In addition, one-third agreed that PS surveys contribute to burnout and make it difficult to practice meaningful medicine. Overall, PS score reporting has a negative impact on pediatricians, especially those who are female, BIPOC (Black, Indigenous, and People of color), subspecialists, younger, and attended non-US medical schools. Further investigation into improved methods for providing feedback to pediatric physicians is warranted.

The effect of patient satisfaction scores on physician clinical decision making: A possible factor driving utilization of opioid prescriptions, magnetic resonance imaging, and interventional spine procedures

Objective

To survey the effect of patient satisfaction scores on pain physicians' medical decision making, with an emphasis on resource utilization.

Design

Email-based Survey.

Methods

Setting & Subjects: A 23-question survey was approved for dissemination to membership of a medical society and emailed to all members. The survey was also available online and via a promoted QR code.

Results

An email with link to the survey was viewed 1,116 times, and clicked on 223 times, with 75 members completing the survey online once the link was clicked. Thirty-three additional physicians directly accessed the survey online and completed it. Seventy-seven percent of physicians reported that patient satisfaction scores were tracked by their institution and were used as a consideration in financial compensation (22%) or performance review (36%). Over half of the physicians surveyed reported feeling that satisfaction scores would decline if they did not order MRI imaging, prescribe opioids or provide work restrictions/disability. Thirty percent reported to have performed a spine injection due to concern about patient satisfaction scores. Twenty-one reported that they had prescribed an opioid medication because of this concern. Lastly 25% and 24% have filled out disability paperwork or provided a disability parking placard respectively.

Conclusions

Over half of physicians surveyed reported having ordered physical therapy, MRIs, opioid medications, spine injections, or provided disability documentation over concern about how providing or not providing such things impacts patient satisfaction scores. This may be an unintended consequence of the current emphasis placed on patient satisfaction scores.

Racial and Gender Differences in Patient Satisfaction Scores Among Oncologists

BACKGROUND

Patient satisfaction scores (PSS) have been adopted in health care reimbursement and faculty promotion metrics. Oncology patients face a challenging prognosis, where PSS may be perceived differently. We hypothesized that PSS differed based on gender and racial demographics of oncologists.

MATERIALS AND METHODS

This was an institutional review board exempt cross-sectional study utilizing PSS data for outpatient oncologists within a large comprehensive cancer center. Patient demographics included age, gender, race/ethnicity, geographical residence, and disease site. Characteristics of oncologists included gender and race/ethnicity. We used PSS ≥95 to make comparisons. The association between patient and physician characteristics were evaluated using the t test and χ2 test.

RESULTS

A total of 15,849 oncology patients were identified between 2011 and 2020. Survey respondents were predominantly female (53.2%), white (93.4%), between 50 and 70 years of age (55.3%), and living in an urban setting (63.6%). There were 303 oncologists with the majority being male (64.4%) and white (58.1%). Compared with white oncologists, Asian and Hispanic oncologists received lower PSS (P=0.001 and 0.0085, respectively). On subset analysis, these differences were significant among patients older than 50 years, living in rural counties, and reporting white or non-Hispanic race/ethnicity, or among patients of either gender (all P<0.05). Patients with genitourinary malignancies provided lower PSS for female oncologists (P=0.005).

CONCLUSIONS

Asian and Hispanic oncologists were more likely to receive lower PSS. In addition, female oncologists treating genitourinary malignancies received lower PSS. Appropriate statistical adjustments are needed for PSS among oncologists to account for race, gender, and physician subspecialization to allow for equitable professional opportunities across demographics.

Psychological Capital and Job Satisfaction Among Chinese Residents: A Moderated Mediation of Organizational Identification and Income Level

The present study examined the mediating effect of organizational identification on the relationship between psychological capital and job satisfaction, and whether the mediation was moderated by income level. A total of 310 Chinese residents were surveyed using the Psychological Capital Scale, Organizational Identification Scale, Job Satisfaction Scale, and a demographic questionnaire. The findings showed a significant positive correlation between psychological capital and job satisfaction of residents, and this relationship was partially mediated by organizational identification. Moreover, income level played a moderating role in the relationship between organizational identification and job satisfaction. For residents with more income, their organizational identification influenced their job satisfaction more strongly than those with less income. The current study contributes to a better understanding of the relationship between psychological capital and job satisfaction. Implications for resident management and policymaking are discussed.

How Feedback Is Given Matters: A Cross-Sectional Survey of Patient Satisfaction Feedback Delivery and Physician Well-being

OBJECTIVE

To evaluate how variation in the way patient satisfaction feedback is delivered relates to physician well-being and perceptions of its impact on patient care, job satisfaction, and clinical decision making.

PARTICIPANTS AND METHODS

A cross-sectional electronic survey was sent to faculty physicians from a large academic medical center in March 29, 2019. Physicians reported their exposure to feedback (timing, performance relative to peers, or channel) and related perceptions. The Professional Fulfillment Index captured burnout and professional fulfillment. Associations between feedback characteristics and well-being or perceived impact were tested using analysis of variance or logistic regression adjusted for covariates.

RESULTS

Of 1016 survey respondents, 569 (56.0%) reported receiving patient satisfaction feedback. Among those receiving feedback, 303 (53.2%) did not believe that this feedback improved patient care. Compared with physicians who never received feedback, those who received any type of feedback had higher professional fulfillment scores (mean, 6.6±2.1 vs 6.3±2.0; P=.03) but also reported an unfavorable impact on clinical decision making (odds ratio [OR], 2.9; 95% CI, 1.8 to 4.7; P<.001). Physicians who received feedback that included one-on-one discussions (as opposed to feedback without this channel) held more positive perceptions of the feedback's impact on patient care (OR, 2.0; 95% CI, 1.3 to 3.0; P=.003), whereas perceptions were less positive in physicians whose feedback included comparisons to named colleagues (OR, 0.5; 95% CI, 0.3 to 0.8; P=.003).

CONCLUSION

Providing patient satisfaction feedback to physicians was associated with mixed results, and physician perceptions of the impact of feedback depended on the characteristics of feedback delivery. Our findings suggest that feedback is viewed most constructively by physicians when delivered through one-on-one discussions and without comparison to peers.