DOCSLIB.ORG

Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy CHILDREN AND FAMILIES The RAND Corporation is a nonprofit institution that helps improve policy and EDUCATION AND THE ARTS decisionmaking through research and analysis. ENERGY AND ENVIRONMENT HEALTH AND HEALTH CARE This electronic document was made available from www.rand.org as a public service INFRASTRUCTURE AND of the RAND Corporation. TRANSPORTATION INTERNATIONAL AFFAIRS LAW AND BUSINESS Skip all front matter: Jump to Page 16 NATIONAL SECURITY POPULATION AND AGING PUBLIC SAFETY Support RAND SCIENCE AND TECHNOLOGY Purchase this document TERRORISM AND Browse Reports & Bookstore HOMELAND SECURITY Make a charitable contribution For More Information Visit RAND at www.rand.org Explore RAND Health View document details Limited Electronic Distribution Rights This document and trademark(s) contained herein are protected by law as indicated in a notice appearing later in this work. This electronic representation of RAND intellectual property is provided for non- commercial use only. Unauthorized posting of RAND electronic documents to a non-RAND website is prohibited. RAND electronic documents are protected under copyright law. Permission is required from RAND to reproduce, or reuse in another form, any of our research documents for commercial use. For information on reprint and linking permissions, please see RAND Permissions. This report is part of the RAND Corporation research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity. RESEARCH REPORT Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy Mark W. Friedberg • Peggy G. Chen • Kristin R. Van Busum • Frances M. Aunon Chau Pham • John P. Caloyeras • Soeren Mattke • Emma Pitchforth Denise D. Quigley • Robert H. Brook • F. Jay Crosson • Michael Tutty C O R P O R A T I O N RESEARCH REPORT Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy The RAND Corporation Mark W. Friedberg • Peggy G. Chen • Kristin R. Van Busum • Frances M. Aunon Chau Pham • John P. Caloyeras • Soeren Mattke • Emma Pitchforth Denise D. Quigley • Robert H. Brook American Medical Association F. Jay Crosson • Michael Tutty Sponsored by the American Medical Association HEALTH The research described in this report was sponsored by the American Medical Association, and was produced within RAND Health, a division of the RAND Corporation. Library of Congress Cataloging-in-Publication Data is available for this publication. ISBN 978-0-8330-8220-6 The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND’s publications do not necessarily reflect the opinions of its research clients and sponsors. Support RAND—make a tax-deductible charitable contribution at www.rand.org/giving/ contribute.html R® is a registered trademark. © Copyright 2013 RAND Corporation This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of RAND documents to a non-RAND website is prohibited. RAND documents are protected under copyright law. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Permission is required from RAND to reproduce, or reuse in another form, any of our research documents for commercial use. For information on reprint and linking permissions, please see the RAND permissions page (http://www.rand.org/pubs/permissions.html). RAND OFFICES SANTA MONICA, CA • WASHINGTON, DC PITTSBURGH, PA • NEW ORLEANS, LA • JACKSON, MS • BOSTON, MA DOHA, QA • CAMBRIDGE, UK • BRUSSELS, BE Preface The American Medical Association (AMA) has adopted, as a core strategic objective, the advancement of health care delivery and payment models that enable high-quality, affordable care and restore and preserve physician satisfaction. The AMA has undertaken this commit- ment in the belief that such change can and should result in a more sustainable and effective health care system with a highly motivated physician workforce. At the same time, the AMA has noted challenges for physicians interested in payment and delivery reform, including exist- ing variability in the degree of care integration, the need for new skills and resources, and the uncertainty created by the emergence of as yet untested new payment models. Therefore, the AMA’s objective includes facilitating transition, for physicians who are seeking a path to more integrated practice models, in a manner that supports professional satisfaction and practice sustainability. This objective is consistent with the mission of the AMA: To promote the art and science of medicine and the betterment of public health. This project, sponsored by the AMA, aimed to characterize factors that influence physi- cian professional satisfaction. By using a mixed-methods (primarily qualitative) design, the project sought to identify a broad array of potential targets for interventions to improve physi- cian professional satisfaction. In accordance with the AMA’s strategic objective and in the con- text of recent health reform legislation (including but not limited to the Affordable Care Act), changing fee-for-service payment rates, and perceived consolidation of independent physician practices by larger delivery systems, the influences of physician practice model (e.g., physician ownership versus hospital or other corporate ownership) and practice sustainability on profes- sional satisfaction were of particularly high interest. The project began on October 22, 2012, and was completed on September 30, 2013. An advisory committee convened by the AMA provided input on key study activities, includ- ing data collection methods and interpretation of results. Committee membership is listed in Appendix A. Using project findings and input from other sources, including its membership and experts in physician practice design, the AMA plans to develop resources to assist physicians seeking to improve practice effectiveness, efficiency, sustainability, and professional satisfaction. This work was sponsored by the American Medical Association. The research was con- ducted by RAND Health, a division of the RAND Corporation. A profile of RAND Health, abstracts of publications, and ordering information can be found at www.rand.org/health. iii Contents Preface ........................................................................................................... iii Figures ........................................................................................................... xi Tables ...........................................................................................................xiii Executive Summary ...........................................................................................xv Acknowledgments .......................................................................................... xxiii Abbreviations ................................................................................................. xxv CHapteR ONE Introduction ..................................................................................................... 1 Methodology ..................................................................................................... 1 Organization of This Report .................................................................................... 2 CHapteR TWO Background: Scan of the Literature on Physician Professional Satisfaction ........................ 3 Overview .......................................................................................................... 3 Physician Demographics ........................................................................................ 4 Physician Age ................................................................................................... 4 Domestic Versus Foreign Medical School .................................................................. 4 Physician Race and Ethnicity ................................................................................ 5 Physician Specialty ............................................................................................. 5 Workplace Factors ................................................................................................ 6 Practice Structure .............................................................................................. 6 Geographic Location .......................................................................................... 6 Patient Population ............................................................................................. 7 Working Environment ........................................................................................ 7 Relationships with Coworkers ................................................................................ 8 Perceived Quality of Patient Care ............................................................................ 8 Electronic Health Records .................................................................................... 8 Physician Income .............................................................................................. 9 Health System Changes ........................................................................................
Load more

Recommended publications
  • Pharmacovigilance in the European Union
    Michael Kaeding Julia Schmälter · Christoph Klika Pharmacovigilance in the European Union Practical Implementation across Member States Pharmacovigilance in the European Union Michael Kaeding · Julia Schmälter Christoph Klika Pharmacovigilance in the European Union Practical Implementation across Member States Prof. Dr. Michael Kaeding Julia Schmälter Christoph Klika Universität Duisburg-Essen Duisburg, Deutschland ISBN 978-3-658-17275-6 ISBN 978-3-658-17276-3 (eBook) DOI 10.1007/978-3-658-17276-3 Library of Congress Control Number: 2017932440 © The Editor(s) (if applicable) and The Author(s) 2017. This book is published open access. Open Access This book is licensed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made. The images or other third party material in this book are included in the book's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the book’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.
    [Show full text]
  • Stanford Health Policy Phd Handbook
    2016- 2017 STANFORD HEALTH A supplement to be used POLICY in conjunction with the Stanford Bulletin and the PHD Stanford Graduate Academic Policies and PROGRAM Procedures Handbook Stanford University School of Medicine STANFORD HEALTH POLICY PHD HANDBOOK Revised 11/2016. The department reserves the right to make changes at any time without prior notice. Stanford Health Policy PhD Handbook 2016-2017 CONTENTS INTRODUCTION ............................................................................................................................................. 3 PROGRAM DESCRIPTION........................................................................................................................... 3 PURPOSE OF THIS HANDBOOK ................................................................................................................. 4 STANFORD BULLETIN ................................................................................................................................ 4 GRADUATE ACADEMIC POLICIES AND PROCEDURES (GAP) ..................................................................... 4 PROGRAM INFORMATION ............................................................................................................................ 5 PROGRAM COMMITTEE, DIRECTORS & MANAGERS ................................................................................ 5 Program Director .................................................................................................................................. 5 Program Director
    [Show full text]
  • Drug Policy 101: Pharmaceutical Marketing Tactics
    Institute for Health Policy Drug Policy 101: Pharmaceutical Marketing Tactics This brief describes the types of marketing tactics that pharmaceutical companies use and the adverse impacts those tactics can have on patients, clinicians, and the health care system. Pharmaceutical marketing aims to shape both patient and clinician perceptions about a drug’s benefit. However, prescription drugs are not typical consumer products. Patients rely heavily on conversations with and advice from clinicians to make decisions, including when faced with choices about whether and which drugs are appropriate treatment options. In addition, patients often do not know the true cost of a prescription drug as it is often subsidized by insurance. Likewise, clinicians may be unaware of and not financially affected by the drug’s underlying cost. Therefore, they might not take into account considerable disparities in price between different, but comparably effective, options for patients. As a result, both patients and clinicians are often insulated from the direct financial impact of selecting a higher-priced product. Due to these dynamics, pharmaceutical marketing can significantly impact patient and clinician decisions that then greatly affect outcomes, in addition to draining government and health care Pharmaceutical companies spend billions system resources. on marketing $20.3B Marketing tactics can drive overprescribing through higher doses and longer courses of treatment than are necessary, as well as overuse $15.6B of newer, higher-priced drugs instead
    [Show full text]
  • Eugenics and Domestic Science in the 1924 Sociological Survey of White Women in North Queensland
    This file is part of the following reference: Colclough, Gillian (2008) The measure of the woman : eugenics and domestic science in the 1924 sociological survey of white women in North Queensland. PhD thesis, James Cook University. Access to this file is available from: http://eprints.jcu.edu.au/5266 THE MEASURE OF THE WOMAN: EUGENICS AND DOMESTIC SCIENCE IN THE 1924 SOCIOLOGICAL SURVEY OF WHITE WOMEN IN NORTH QUEENSLAND Thesis submitted by Gillian Beth COLCLOUGH, BA (Hons) WA on February 11 2008 for the degree of Doctor of Philosophy in the School of Arts and Social Sciences James Cook University Abstract This thesis considers experiences of white women in Queensland‟s north in the early years of „white‟ Australia, in this case from Federation until the late 1920s. Because of government and health authority interest in determining issues that might influence the health and well-being of white northern women, and hence their families and a future white labour force, in 1924 the Institute of Tropical Medicine conducted a comprehensive Sociological Survey of White Women in selected northern towns. Designed to address and resolve concerns of government and medical authorities with anxieties about sanitation, hygiene and eugenic wellbeing, the Survey used domestic science criteria to measure the health knowledge of its subjects: in so doing, it gathered detailed information about their lives. Guided by the Survey assessment categories, together with local and overseas literature on racial ideas, the thesis examines salient social and scientific concerns about white women in Queensland‟s tropical north and in white-dominated societies elsewhere and considers them against the oral reminiscences of women who recalled their lives in the North for the North Queensland Oral History Project.
    [Show full text]
  • National Prevention Strategy AMERICA’S PLAN for BETTER HEALTH and WELLNESS
    National Prevention Strategy AMERICA’S PLAN FOR BETTER HEALTH AND WELLNESS June 2011 National Prevention, Health Promotion and Public Health Council For more information about the National Prevention Strategy, go to: http://www.healthcare.gov/center/councils/nphpphc. OFFICE of the SURGEON GENERAL 5600 Fishers Lane Room 18-66 Rockville, MD 20857 email: [email protected] Suggested citation: National Prevention Council, National Prevention Strategy, Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General, 2011. National Prevention Strategy America’s Plan for Better Health and Wellness June 16, 2011 2 National Prevention Message from the Chair of the National Prevention,Strategy Health Promotion, and Public Health Council As U.S. Surgeon General and Chair of the National Prevention, Health Promotion, and Public Health Council (National Prevention Council), I am honored to present the nation’s first ever National Prevention and Health Promotion Strategy (National Prevention Strategy). This strategy is a critical component of the Affordable Care Act, and it provides an opportunity for us to become a more healthy and fit nation. The National Prevention Council comprises 17 heads of departments, agencies, and offices across the Federal government who are committed to promoting prevention and wellness. The Council provides the leadership necessary to engage not only the federal government but a diverse array of stakeholders, from state and local policy makers, to business leaders, to individuals, their families and communities, to champion the policies and programs needed to ensure the health of Americans prospers. With guidance from the public and the Advisory Group on Prevention, Health Promotion, and Integrative and Public Health, the National Prevention Council developed this Strategy.
    [Show full text]
  • A Systematic Review of Key Issues in Public Health 1St Edition Pdf, Epub, Ebook
    A SYSTEMATIC REVIEW OF KEY ISSUES IN PUBLIC HEALTH 1ST EDITION PDF, EPUB, EBOOK Stefania Boccia | 9783319374826 | | | | | A Systematic Review of Key Issues in Public Health 1st edition PDF Book Immigrants and refugees of al There are claims that energy drink ED consumption can bring about an improvement in mental functioning in the form of increased alertness and enhanced mental and physical energy. Urbanization: a problem for the rich and the poor? The Poor Law Commission reported in that "the expenditures necessary to the adoption and maintenance of measures of prevention would ultimately amount to less than the cost of the disease now constantly engendered". They could also choose sites they considered salubrious for their members and sometimes had them modified. Berridge, Virginia. Rigby, Caroline J. Urban History. Reforms included latrinization, the building of sewers , the regular collection of garbage followed by incineration or disposal in a landfill , the provision of clean water and the draining of standing water to prevent the breeding of mosquitoes. Environmental health Industrial engineering Occupational health nursing Occupational health psychology Occupational medicine Occupational therapist Safety engineering. An inherent feature of drug control in many countries has been an excessive emphasis on punitive measures at the expense of public health. Once it became understood that these strategies would require community-wide participation, disease control began being viewed as a public responsibility. The upstream drivers
    [Show full text]
  • Course Title: Introduction to Health Systems and Policy Course
    PUBLIC HEALTH CORE COURSE Course Title: Introduction to Health Systems and Policy Course Number: PHCO 0501: Fall 2019 Course Prerequisite(s): None Course Location: Newark: Room 1023 Course Date & Time: Monday, 6-8 PM Course Instructor: Michael K. Gusmano, PhD ([email protected]; 732.235.9754) Office Hours: By Appointment Only Course Assistant: None Course Website: CANVAS Required Course Text: None Course Description: This course is a requirement for all public health students. As such, the course focuses on issues of health care organization and policy that are relevant to all public health practitioners. Students are introduced to the history, organization, financing and regulations of health services in the United States. Emphasis is placed on the principles of access, cost and quality of care in the changing economic environment; the social determinants of health; disparities in health and health services both nationally and globally; the public health system and the health and health care issues of vulnerable populations; and the systems of care available to these groups. Competencies Addressed: The competencies addressed in this course include: 1. Explain the social, political, and economic determinants of health and how they contribute to population health and health inequities; 2. Compare the organization, structure and function of health care, public health and regulatory systems across national and international settings; 3. Discuss the means by which structural bias, social inequities and racism undermine health and create challenges to achieving health equity at organizational, community and societal levels; 4. Discuss multiple dimensions of the policy-making process, including the roles of ethics and evidence; 5.
    [Show full text]
  • Unintended Consequences: How Federal Regulations and Hospital Policies Can Leave Patients in Debt
    UNINTENDED CONSEQUENCES: HOW FEDERAL REGULATIONS AND HOSPITAL POLICIES CAN LEAVE PATIENTS IN DEBT Carol Pryor and Robert Seifert The Access Project Heller School for Social Policy and Management, Brandeis University and Deborah Gurewich, Leslie Oblak, Brian Rosman, and Jeffrey Prottas Schneider Institute for Health Policy Heller School for Social Policy and Management, Brandeis University June 2003 Support for this research was provided by The Commonwealth Fund. The views presented here are those of the authors and should not be attributed to The Commonwealth Fund or its directors, officers, or staff. Copies of this report are available from The Commonwealth Fund by calling its toll-free publications line at 1-888-777-2744 and ordering publication number 653. The report can also be found on the Fund’s website at www.cmwf.org. CONTENTS About the Authors..........................................................................................................iv Executive Summary.........................................................................................................v Introduction and Background ..........................................................................................1 Study Methodology .........................................................................................................4 Federal Laws and Regulations..........................................................................................4 Prohibitions on Waiving Coinsurance, Copayments, and Deductibles for Medicare Beneficiaries ....................................................................................5
    [Show full text]
  • Hospital Detentions for Non-Payment of Fees a Denial of Rights and Dignity Hospital Detentions for Non-Payment of Fees: a Denial of Rights and Dignity
    Research Paper Robert Yates, Tom Brookes and Eloise Whitaker Centre on Global Health Security | December 2017 Hospital Detentions for Non-payment of Fees A Denial of Rights and Dignity Hospital Detentions for Non-payment of Fees: A Denial of Rights and Dignity Summary • In some parts of the world it is common practice for patients to be detained in hospital for non-payment of healthcare bills. • Such detentions occur in public as well as private medical facilities, and there appears to be wide societal acceptance in certain countries of the assumed right of health providers to imprison vulnerable people in this way. • The true scale of these hospital detention practices, or ‘medical detentions’, is unknown, but the limited academic research to date suggests that hundreds of thousands of people are likely to be affected every year, in several sub-Saharan African countries and parts of Asia. Women requiring life-saving emergency caesarean sections, and their babies, are particularly vulnerable to detention in medical facilities. • Victims of medical detention tend to be the poorest members of society who have been admitted to hospital for emergency treatment, and detention can push them and their families further into poverty. They may also be subject to verbal and/or physical abuse while being detained in health facilities. • The practice of detaining people in hospital for non-payment of medical bills deters healthcare use, increases medical impoverishment, and is a denial of international human rights standards, including the right not to be imprisoned as a debtor, and the right to access to medical care. • At the root of this problem are the persistence of health financing systems that require people to make high out-of-pocket payments when they need healthcare, and inadequate governance systems that allow facilities to detain patients.
    [Show full text]
  • The Effects and Role of Direct-To-Physician Marketing in the Pharmaceutical Industry: an Integrative Review
    Yale Journal of Health Policy, Law, and Ethics Volume 5 Issue 2 Yale Journal of Health Policy, Law, and Article 8 Ethics 2005 The Effects and Role of Direct-to-Physician Marketing in the Pharmaceutical Industry: An Integrative Review Puneet Manchanda Elisabeth Honka Follow this and additional works at: https://digitalcommons.law.yale.edu/yjhple Part of the Health Law and Policy Commons, and the Legal Ethics and Professional Responsibility Commons Recommended Citation Puneet Manchanda & Elisabeth Honka, The Effects and Role of Direct-to-Physician Marketing in the Pharmaceutical Industry: An Integrative Review, 5 YALE J. HEALTH POL'Y L. & ETHICS (2005). Available at: https://digitalcommons.law.yale.edu/yjhple/vol5/iss2/8 This Article is brought to you for free and open access by Yale Law School Legal Scholarship Repository. It has been accepted for inclusion in Yale Journal of Health Policy, Law, and Ethics by an authorized editor of Yale Law School Legal Scholarship Repository. For more information, please contact [email protected]. Manchanda and Honka: The Effects and Role of Direct-to-Physician Marketing in the Pharmaceutical Industry The Effects and Role of Direct-to-Physician Marketing in the Pharmaceutical Industry: An Integrative Review Puneet Manchanda, M.Phil., Ph.D.* and Elisabeth Honkat INTRODUCTION The pharmaceutical industry plays a vital role in the world's economy, as well as in ensuring the welfare of its citizens. In the United States, this industry constitutes a large and important part of the economy. In 2002, health care expenditure in the United States reached $1.6 trillion, accounting for fifteen percent of total GNP.' This percentage is also growing over time-it was seven percent in 1970.2 An important component of the health care industry is the pharmaceutical industry-in 2002, its size was estimated at $193 billion.
    [Show full text]
  • First Do No Harm: Mandatory Influenza Vaccination Policies for Healthcare Personnel Help Protect Patients
    First Do No Harm: Mandatory InfluenzaV accination Policies for Healthcare Personnel Help Protect Patients First Do No Harm: Mandatory Influenza Vaccination Policies for Healthcare Personnel Help Protect Patients view the complete list: Refertothepositionstatementsoftheleadingmedicalorganizationslistedbelowtohelp www.immunize.org/honor-roll/ youdevelopandimplementamandatoryinfluenzavaccinationpolicyatyourhealthcare influenza-mandates institutionormedicalsetting.Policytitles,publicationdates,links,andexcerptsfollow. American Academy of Family Physicians (AAFP) American Public Health Association (APHA) AAFP Mandatory Influenza Vaccination of Health Care Personnel (6/11) Annual Influenza Vaccination Requirements for Health Workers (11/9/10) ▶ www.aafp.org/news-now/health-of-the-public/20110613 ▶ www.apha.org/policies-and-advocacy/public-health-policy-statements/ mandatoryfluvacc.html policy-database/2014/07/11/14/36/annual-influenza-vaccination- “TheAAFPsupportsannualmandatoryinfluenzaimmunizationforhealthcare requirements-for-health-workers personnel(HCP)exceptforreligiousormedicalreasons(notpersonalprefer- “Encouragesinstitutional,employer,andpublichealthpolicytorequireinfluenza ences).IfHCParenotvaccinated,policiestoadjustpracticeactivitiesduringflu vaccinationofallhealthworkersasapreconditionofemploymentandthere- seasonareappropriate(e.g.wearmasks,refrainfromdirectpatientcare).” afteronanannualbasis,unlessamedicalcontraindicationrecognizedinnational guidelinesisdocumentedintheworker’shealthrecord.” American Academy of Pediatrics (AAP)
    [Show full text]
  • Principles for Health Care Reform
    444 East Algonquin Road Arlington Heights, IL 60005-4664 ASPS POSITION STATEMENT 847-228-9900 www.plasticsurgery.org ASPS PRINCIPLES FOR HEALTH CARE REFORM While the ACA resulted in a number of desirable reforms, including coverage of pre-existing conditions, removal of lifetime caps, and coverage of children to age 26, the American health care system remains beset by a number of serious problems. Health insurance costs continue to rise, and private insurers draw ever-more-narrow networks, threatening broad access to care. Health system consolidation has exploded, threatening the viability of private practice and increasing costs to patients, taxpayers, and insurers. Well-meaning efforts to use alternative payment methods to reward the value of care, rather than the volume, have resulted in systems ill-equipped to integrate, analyze and reward specialist services. These systems threaten the viability of independent medical practices across the country, while causing physicians to retire early or sell their practices to large corporations and hospitals As the 115th Congress begins and a new administration takes power, policymakers are poised to again undertake health care reform. The following are key principles that the American Society of Plastic Surgeons believes must accompany such an effort. MAKE PATIENT ACCESS TO CARE PRIORITY ONE Patients should have timely access to high-quality medical care from the appropriate provider. To advance this goal, health care reform must - o Maximize the availability of high-quality, affordable coverage. o Prohibit denial or cancellation of coverage for pre-existing conditions. o Prohibit denial or cancellation of policies when a patient becomes sick. o Prohibit annual and lifetime caps.
    [Show full text]