title: Managed care and primary physician satisfaction.
abstract: BACKGROUND
  We examined whether physician compensation, financial incentives, and care management tools were associated with primary physician job and referral satisfaction. Our study was guided by a conceptual model of physician satisfaction derived from published evidence.
  
  
  METHODS
  A cross-sectional survey was performed of 495 primary physicians (family practitioners, general practitioners, general internists) in the Seattle metropolitan area in 1997.
  
  
  RESULTS
  Bivariate analyses revealed that salary compensation, productivity bonuses, and withholds for referrals were associated with job and referral dissatisfaction. However, after controlling for physician, practice, and office characteristics, only the association between salary payment and job dissatisfaction remained significant. Practice in offices with more physicians had the strongest association with physician job dissatisfaction.
  
  
  CONCLUSIONS
  Although managed care features are correlated with physician job and referral dissatisfaction, the source of dissatisfaction may originate from being an employed physician in a large medical group with more physicians, which may be more likely to impose bureaucratic controls that limit physician autonomy.
authors.affiliation: Center for Cost and Outcomes Research, University of Washington, Seattle 98195, USA. grem@u.washington.edu
authors.forename: David
authors.initials: D
authors.lastname: Grembowski
authors.forename: Cornelia M
authors.initials: CM
authors.lastname: Ulrich
authors.forename: David
authors.initials: D
authors.lastname: Paschane
authors.forename: Paula
authors.initials: P
authors.lastname: Diehr
authors.forename: Wayne
authors.initials: W
authors.lastname: Katon
authors.forename: Diane
authors.initials: D
authors.lastname: Martin
authors.forename: Donald L
authors.initials: DL
authors.lastname: Patrick
authors.forename: Christine
authors.initials: C
authors.lastname: Velicer
mesh_terms: D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D006123:Group Practice; D006801:Humans; D007389:Internal-External Control; D007588:Job Satisfaction; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration*; D015999:Multivariate Analysis; D010820:Physicians / Q000523:psychology* / Q000706:statistics & numerical data; D011216:Practice Management, Medical / Q000458:organization & administration; D011320:Primary Health Care / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000458:organization & administration; D012456:Salaries and Fringe Benefits / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014861:Washington; D016526:Workload