A survey of physicians in a large group practice.

Job satisfaction surveys among physicians, a recent phenomenon, are a very important managerial tool to determine the work motivation needs of physician-employees. The first MD Job Survey was done in 1984 by Lichtenstein(1) on physicians employed by prisons. The largest survey of salaried physicians to date has been the 1987 Health Services Research Center of Chapel Hill survey of physicians employed in group practices. Currently, individual group practices are surveying their staffs with job satisfaction questions in order to enhance the work environment.

The data reported in this article were obtained from several satisfaction surveys and are presented to emphasize the needs of physician-employees that health care organization managers should consider. Satisfied employees, even physicians, respond to organizational goals with good productivity and achievement of high-quality medical care. Using Herzberg's(2) motivation-hygiene theory of intrinsic and extrinsic motivators, questions were divided into the following categories:

Job Satisfiers: Direct Patient Clinical Work Professional Career Goals

Job Dissatisfiers: Financial Compensation Administrative/Management Policy Colleague Interaction Clinical Resources, Facilities

Support Staff Personal Time

The 1987 Health Services Research Center survey(3) of physicians employed in large medical practice organizations was representative of the 20,000 physicians working in this sector of the medical labor force. Non-government group practices that employed at least 40 full-time physicians who identified themselves as practitioners of primary medical care participated. Because the practices were large, there was some degree of administrative hierarchy. The physicians and management have many similar, though not identical, goals. Many practice satisfaction questions were asked, and stratification was possible.

The results reported here are from survey data of the individual profile of Fallon Clinic, a large multispecialty group practice with 105 physicians and a predominance of prepaid patients. Comparisons are made with similar groups having 100-250 physicians and greater than 70 percent prepayment type of care and with the National Health Research Center sample. The results are very similar to those of a survey of physician groups with 75-99 members. Another survey was conducted in late 1988 and late 1990 on this same large multispecialty group practice using a survey instrument developed by a Physician Satisfaction Committee and Amicus, a consulting firm.(4) This joint physician and administrative effort was an attempt to identify areas for improvement in job dissatisfaction.

Results

The overall 80.3 percent satisfaction rate for Fallon Clinic physicians (figure 1, right) is commendable when compared with 61.6 percent for similar groups and 74.1 percent nationally. Tables 2-9 present a summary of the results only for physicians who were satisfied, comparing the Fallon Clinic sample with physicians in similar sized groups (100-250 physicians) with similar percentages (greater than 70 percent) of prepaid patients and with the national sample. [TABULAR DATA OMITTED] The national average of all groups surveyed tende d to be smaller in size (30-50 physicians) and have fewer (10-25 percent) prepaid patients.

Direct Clinical Work

The national group of salaried physicians, which had fewer prepaid patients, seemed happier with the time they spent with patients, practiced more as they wanted, and were more satisfied with patient volume. They seemed more involved in patients' protocols and were personally more satisfied with the quality of care they gave patients. The physicians of the largely prepaid groups were especially unhappy with their paperwork, very dissatisfied in not practicing the way they wanted, felt little involved in patient protocols, and definitely felt rushed with their patients. The Fallon group was closer to their type of group size, except that they were more pleased with the quality of care they provided.

Career Goals

The largely prepaid group physicians felt they lacked autonomy, were not pleased with their organization's recognition of them, and didn't seem to anticipate much advancement. The Fallon group seemed satisfied with their opportunities for advancement and for achieving their own professional goals. Fallon physicians also felt their contribution was recognized by the organization. The national group with smaller numbers of physicians did not see much chance of advancement in the organization. Financial Rewards The Fallon group seemed very satisfied with salaries and potential earnings, while other prepaid groups were less so.

Administrative Relations

Large prepaid groups are not at all satisfied with the methods of choosing their administrative leaders and also are not involved enough in deciding their productivity. They saw their organizations as not at all interested in their satisfaction. The Fallon group seemed satisfied with the organization's effort to restrain costs, while national groups did not think their groups were interested enough.

Colleague Interaction

Nationally, group physicians were satisfied with their ease of referrals. The other two groups of more physicians and more prepaid patients felt they were being restrained by their administrations' restricting referrals to preferred providers or to the group practice.

National groups overall had more input into selecting their support staffs and equipment purchases than did prepaid groups and seemed to like to be responsible for their office facilities.

Personal Time

As noted in other studies, most physicians never feel they have enough personal time, but most think that the time they put into their work is reasonable.

Years in Service to the Organization

There also appears to be a correlation between job satisfaction and years in practice. In the Amicus survey, the answers to several questions showed a notable difference when categorized by years of service in the group practice. For example, in the first 6 months, recruited physicians show 100 percent loyalty, dropping in the 1-2 year employment category to 83 percent. After this time, it appears that dissatisfied or disloyal physicians either quit, so that the 2-5 year group returned to 97 percent loyalty, or that those dissatisfied changed their minds and stayed but improved their attitudes.

Conclusions

Although time-consuming, a survey of physician's attitudes toward their work and facilities, their feelings toward administration and their coworkers, and their satisfaction with their salary can be a valuable tool for an organization. Standards can be established if enough surveys are conducted and the results are stratified according to size of group practice, time of service of each physician, and method of patient payment or reimbursement.

References

1. Lichtenstein, R. "Measuring the Job Satisfaction of Physicians in Organized Settings." Medical Care 22(1):56-57, Jan. 1984.

2. Herzberg, F. "One More Time How Do You Motivate Employees?" Harvard Business Review 65(5):109-20, Sept.-Oct. 1987.

3. Konrad, T. "The Salaried Physician: Medical Practice in Transition." Unpublished paper. Chapel Hill, N.C.: Health Services Research Center, University of North Carolina, 1989.

4. Jack Silversin, AMICUS, personal communication, 1992.