Physician employment status and practice patterns.
BACKGROUND
Many physicians today are employed by another physician, group, hospital, HMO, or other organization. However, the differences in the characteristics, practice patterns, and patient outcomes of self-employed and employed physicians are not well understood.


METHODS
The practices of 108 community family physicians in northeast Ohio were assessed using a multimethod cross-sectional design. Physician characteristics were assessed by questionnaire. Direct observation of 3536 consecutive patient visits was used to measure time use and the delivery of preventive services recommended by the US Preventive Services Task Force. Patient satisfaction was assessed with the Medical Outcomes Study (MOS) 9-item Visit Rating Form.


RESULTS
Employed physicians were more likely to be female, in group practice, work fewer hours, and see fewer patients. Job satisfaction was similar between the two groups, but employed physicians reported greater satisfaction with leisure and family time. Employed physicians spent more time per patient visit, scheduled a larger percentage of well-care visits, and were more likely to refer to specialists. Employed physicians also spent a greater proportion of their patients' visit time performing history-taking and eliciting family information, and a lesser proportion of time on physical examination, planning treatment, providing health education, and chatting. Recommended screening and health habits counseling preventive services were more likely to be delivered by employed physicians. Patient satisfaction was similar for the two groups.


CONCLUSIONS
Primary care physician characteristics and practice patterns differ by employment status. The consequences of the trend toward a largely employed physician workforce as reported in this study should be carefully considered.
Kikano
G E
GE
Department of Family Medicine, Case Western Reserve University, Cleveland, OH, USA. gek@po.cwru.edu
Goodwin
M A
MA
Stange
K C
KC
D000328:Adult; D003430:Cross-Sectional Studies; D003625:Data Collection; D004651:Employment / Q000706:statistics & numerical data*; D005194:Family Practice / Q000458:organization & administration / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008329:Managed Care Programs; D009819:Office Visits / Q000706:statistics & numerical data; D009820:Ohio; D010067:Ownership / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D010821:Physicians, Family / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data*; D011364:Professional Practice / Q000706:statistics & numerical data*; D013996:Time and Motion Studies; D000078329:Workforce