The growth of managed care and changes in physicians' incomes, autonomy, and satisfaction, 1991-1997.
Using survey data collected in 1991 and 1997 from a panel of almost 1,500 physicians, we analyzed the relationship between changes in physicians' incomes, practice autonomy, and satisfaction, and the growth of HMOs and physicians' perceived financial incentives. Both the growth of HMOs and financial incentives to reduce services were significantly related to lower income growth, reductions in practice autonomy, and decreases in satisfaction. Changes in income and autonomy were both positively and significantly related to changes in satisfaction. Controlling for changes in income and autonomy, HMO growth was no longer significantly related to changes in satisfaction. Having a perceived financial incentive to reduce services remained a negative and significant determinant of the change in career satisfaction.
Hadley
Jack
J
Urban Institute, Center for Studying Health System Change, Washington, DC, USA. jhadley@ui.urban.org
Mitchell
Jean M
JM
D001291:Attitude of Health Personnel; D006279:Health Maintenance Organizations / Q000458:organization & administration* / Q000706:statistics & numerical data; D006302:Health Services Research; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007588:Job Satisfaction; D015233:Models, Statistical; D010816:Physician Incentive Plans / Q000191:economics; D010817:Physician-Patient Relations; D010820:Physicians / Q000191:economics / Q000523:psychology*; D017009:Professional Autonomy; D014481:United States