title: The impact of managed care contracting on physicians.
abstract: BACKGROUND
  Prior literature suggests that the fragmented U.S. health care system places a large administrative burden on physicians. Less is known about how this burden varies with physician contracting practices.
  
  
  OBJECTIVE
  To assess the extent to which physician practice outcomes vary with the number of managed care contracts held or the availability of such contracts.
  We perform secondary data analyses of the first four rounds of the nationally representative Community Tracking Study Physician Survey (1996-2005), which includes 36,340 physicians (21,567 PCPs [primary care physicians] and 14,773 specialists) across the four survey periods. Our measures include reported hours in patient care, share of hours outside patient care, adequacy of time with patients, career satisfaction, and income.
  
  
  RESULTS
  Doctors who contract with more plans report spending more time in patient care (per 11 additional contracts, about 30 min per week for PCPs and 20 min per week for specialists), report spending a modestly larger share of their time outside patient care (per 11 additional contracts, about 10 min per week for PCPs and specialists), are slightly more likely to report inadequate time with patients (odds ratio 1.005 per additional contract for PCPs), and earn higher incomes (per 11 additional contracts, about 3 % more per year for specialists).
  
  
  CONCLUSIONS
  Contracting opportunities confer significant benefits on physicians, although they do add modest costs in terms of time spent outside patient care and lower adequacy of time with patients. Simplifications that reduce the administrative burden of contracting may improve care by optimizing allocation of physician effort.
authors.affiliation: Department of Medicine, Massachusetts General Hospital, 10 Emerson Place, Rm. 10G, Boston, MA, 02114, USA, dply@partners.org.
authors.forename: Dan P
authors.initials: DP
authors.lastname: Ly
authors.forename: Sherry A
authors.initials: SA
authors.lastname: Glied
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003284:Contract Services / Q000458:organization & administration*; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D006302:Health Services Research / Q000379:methods; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007588:Job Satisfaction; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration*; D008875:Middle Aged; D010817:Physician-Patient Relations; D058007:Physicians, Primary Care / Q000523:psychology / Q000706:statistics & numerical data*; D011216:Practice Management, Medical / Q000458:organization & administration*; D011364:Professional Practice / Q000458:organization & administration; D013038:Specialization; D013997:Time Factors; D014481:United States; D016526:Workload / Q000706:statistics & numerical data