Dermatologists in Kaiser Permanente-northern California. Satisfaction, perceived constrains, and policy options

A survey was conducted in a large closed-panel health maintainance organization to identify and understand influences on dermatologists' job satisfaction and preferences for policies affecting management of routine dermatologic care. Of the population of 98 dermatologists, 91 (93%) responded. The main variables of interest were current and ideal practice characteristics (time allocations and case mix) and (dis) agreement with 4 statements: (1) I am satisfied with my job; (2) I favour a direct access model over a gatekeeper model for patients seeking dermatologic care; (3) I favour training primary care physicians to evaluate and treat routine dermatologic problems; and (4) I welcome incorporating nurse practitioners and physician extenders into my practice.

The dermatologists currently spend 86% of their work time providing patient care. On average, 70% of their caseload involves routine problems; 56% would ideally increase the complexity mix of their patients. The survey reveals gender differences in perceptions of time constraints and opportunities for professional development. Most dermatologists (88%) report they are satisfied with their jobs. Satisfaction correlates strongly with their perceived ability to deliver excellent care, use their skills, and develop new skills (correlations, 0.53-0.59). Although 78% favor retaining direct patient access, at least 60% endorse more cooperative work with primary care physicians and nurse practitioners. These views are related to their satisfaction, interest in challenging cases, development and use of new skills, and perceived relationships with colleagues and support staff.

Understanding the factors that affect physician preferences can help to identify policies that potentially improve efficiency without compromising quality of care or physician satisfaction. If routine problems can be effectively managed in cooperation with other health care providers, this may also lead to the more complex case mix these dermatologists ideally want. Further study might focus on the scheduling and referral processes that influence both cost-effectiveness and continuity in coverage for dermatologic problems.