title: The impact of practice setting on physician perceptions of the quality of practice and patient care in the managed care era.
abstract: BACKGROUND
  Managed care is practiced in both traditional institutional health maintenance organization (HMO) settings and in a variety of complex and decentralized office-based arrangements. This study examines how practice setting affects physician perceptions of the quality of professional practice and patient care in a managed care environment.
  
  
  METHODS
  A survey was conducted in 1998 of 1081 physicians in San Mateo County, California, who practice in either a traditional staff group model HMO (SGM-HMO) (n = 113) or office-based independent practice (OBIP) (n = 250). Respondents were surveyed about current and past practice characteristics, income changes, current satisfaction with professional and patient care matters, utility of treatment guidelines and formularies, and general perceptions of managed care. Responses were compared between practice settings using bivariate comparisons and logistic regression analyses.
  
  
  RESULTS
  Physicians in the SGM-HMO and those in OBIP reported similar hours worked per week, time spent with patients during office visits, and total patient encounters per week. Declining income was more frequent in OBIP (61% vs 47%) and relatively more substantial (27% with income declines >25% vs 4% in SGM-HMO). Adjusting for income changes, practice setting, years in practice, and sex, SGM-HMO physicians were significantly more satisfied with a variety of professional and quality of care issues (P<.001), viewed more favorably the utility of treatment guidelines and drug formularies (P<.001), and held more positive general perceptions of managed care (P<.001) than OBIP physicians.
  
  
  CONCLUSIONS
  In a managed care environment, SGM-HMO physicians are significantly more satisfied with the quality of practice and patient care than physicians in OBIP. This study suggests that the myriad managed care contracts, formularies, and guidelines received by physicians in OBIPs may lead to more negative perceptions of the quality of professional practice and patient care.
authors.affiliation: Department of Medicine, Center for Biomedical Ethics, Room H3151, Stanford University School of Medicine, Stanford, Calif 94305-5236, USA.
authors.forename: E L
authors.initials: EL
authors.lastname: Chehab
authors.forename: N
authors.initials: N
authors.lastname: Panicker
authors.forename: P R
authors.initials: PR
authors.lastname: Alper
authors.forename: L C
authors.initials: LC
authors.lastname: Baker
authors.forename: S R
authors.initials: SR
authors.lastname: Wilson
authors.forename: T A
authors.initials: TA
authors.lastname: Raffin
mesh_terms: D001291:Attitude of Health Personnel; D002140:California; D003625:Data Collection; D005260:Female; D006801:Humans; D007182:Income; D007588:Job Satisfaction; D008297:Male; D008329:Managed Care Programs; D010820:Physicians / Q000523:psychology*; D017410:Practice Guidelines as Topic; D011331:Private Practice; D011787:Quality of Health Care