Related Experiment Videos
Primary care physician turnover in HMOs
J Kerstein1, M V Pauly, A Hillman
1Baruch College, City University of New York.
Health Services Research
|April 1, 1994
Summary
Physician turnover in health maintenance organizations (HMOs) is influenced by financial incentives and practice environment constraints. Physicians accurately anticipate their response to financial risk but dislike HMO restrictions.
Area of Science:
- Health Services Research
- Physician Workforce Studies
- Organizational Behavior
Background:
- Physician turnover is a significant concern in managed care.
- Understanding the drivers of physician departure from Health Maintenance Organizations (HMOs) is crucial for workforce stability.
Purpose of the Study:
- To determine if physician turnover in HMOs is driven by inaccurate expectations or by actual practice environment factors.
- To analyze the impact of financial incentives and market characteristics on physician retention.
Main Methods:
- Utilized data from a nationwide survey of HMOs (1987-1988) and the Area Resource File (ARF).
- Analyzed individual HMOs' primary care physician incentive mechanisms and general HMO characteristics.
- Incorporated countywide data on physician and population characteristics, and market dynamics.
Main Results:
- Physician turnover increased when HMO enrollment constituted a larger portion of their practice.
- Compensation structures influenced turnover: group-dependent compensation led to higher departure rates than direct risk-bearing.
- Bonuses based on individual productivity and lack of surplus sharing also increased turnover.
- Market characteristics were significant predictors of physician turnover.
Conclusions:
- Physicians appear to accurately predict their reactions to financial risks within HMOs.
- Physicians express dissatisfaction with restrictions imposed by HMOs, contributing to turnover.