Measuring physician attitudes toward cost, uncertainty, malpractice, and utilization review

Area of Science:

• Health Services Research
• Medical Education
• Physician Behavior

Background:

• Physician attitudes are hypothesized to influence healthcare resource utilization.
• Existing measures for these attitudes are often unreliable or lack validation.
• Understanding these attitudes is crucial for effective healthcare management.

Purpose of the Study:

• To develop and validate a reliable survey instrument to measure physician attitudes impacting resource utilization.
• To identify key attitudinal domains influencing physician decision-making in resource allocation.

Main Methods:

• A 19-item survey was developed based on literature review and physician interviews.
• The survey was administered to 428 physicians (internal medicine, pediatrics, family medicine, surgery) at an academic medical center.
• Exploratory factor analysis was used to identify underlying attitude domains.

Main Results:

• Four prominent domains emerged: cost-consciousness, discomfort with uncertainty, fear of malpractice, and annoyance with utilization review.
• Reliability analysis (Cronbach's alpha) ranged from 0.66 to 0.88 for the four scales.
• Cost-consciousness was the only attitude associated with lower self-reported resource use; fear of malpractice and annoyance with utilization review increased with patient care time.

Conclusions:

• A reliable 19-item survey instrument was successfully developed to measure physician attitudes related to resource utilization.
• The four identified scales (cost-consciousness, discomfort with uncertainty, fear of malpractice, annoyance with utilization review) can help identify key determinants of physician decision-making.
• This instrument can foster a better understanding of physician responses to different practice environments and resource management strategies.