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The influence of organizational structure on physician satisfaction: findings from a national survey
Background:
The term managed care encompasses a variety of organizational arrangements between physicians and health plans. At one extreme, physicians are plan employees; at the other, physicians have contracts with multiple plans. How these arrangements affect physicians' satisfaction with managed care is not well known.
Objective:
To explore the effect of organizational structure on physician satisfaction.
Design:
Telephone survey of 751 practicing internists. The response rate for the 15-minute survey was 64%. SAMPLING STRATEGY: The random sample was taken from the membership of the American College of Physicians-American Society of Internal Medicine. Federal employees, retirees, physicians, and students who spent less than half of their time in patient care were excluded.
Results:
689 Physicians indicated that they were affiliated with a managed care plan: 9% were salaried employees, 6% had an exclusive contract with one plan, and 85% had a variety of nonexclusive arrangements with multiple plans. Among plan employees, 32% reported they were very satisfied with the managed care organization in which they worked. The corresponding figure was 19% among physicians with an exclusive contract and 5% among those with multiple contracts. A similar pattern of responses was seen when physicians were asked about their perception of the commitment of managed care to quality. Although 64% of plan employees responded that there was a great deal of commitment, the corresponding figure was 35% among physicians with an exclusive contract and only 7% among those with multiple contracts.
Conclusions:
Physicians who are salaried employees of a staff- or group-model HMO report the highest satisfaction with managed care.