Physicians, particularly those in primary
care, contend that these aspects of managed care are adversely influencing
the physician-patient relationship and the quality of care. If managed
care is to fulfill its promise as an integrated, cost-effective means of
delivering high quality care, the industry must be more attentive to the
satisfaction of patients and physicians alike.
This on-line publication serves as a guide for managed care executives and physicians on capitation, contracting, compensation, ethics, and other health insurance and delivery issues. The site displays links to current articles in the magazine plus an archive search for full-text articles, all free of charge. Links are provided to Special Focus Areas, which are secondary pages addressing capitation, compensation, disease management, and NCQA/HEDIS. These managed care components either directly or indirectly influence physician satisfaction.
*** Health Forum
Visit the Health Forum site to find an integrated portfolio of communications, information, education, and research products and services that advance leadership for health. It is the publishing and information subsidiary of the American Hospital Association. Although many resources such as the Duet Database require a subscription, health care providers can access the AHA Annual Survey and on-line journals Hospitalsand Health Networks and Health Forum. These journals frequently cover managed care topics and a recent article on physician satisfaction entitled "Recapturing the joy in health care" is reviewed below.
*** The Health Pages: The Voice of the Health Care Consumer
This site is primarily designed for health care consumers. However, it includes a secondary page in which physicians rate managed care plans in 22 U.S. markets. Physicians rate plans in their area based on treatment of doctors, clinical autonomy, timely and accurate payments, administrative ease, and policies impacting quality of care. All these categories gauge physician satisfaction with the plans in their area. The physicians' ratings are used to score the plans, which are then ranked on a summary page for each market. The surveys identify the most important drivers of physician satisfaction and provide a valuable tool for consumers in choosing a health plan.
*** American College of Physicians - American Society of Internal Medicine
The ACP-ASIM web site is a valuable resource for articles and position papers on managed care practices and their influence on physician satisfaction. Secondary pages include the Effective Medical Practice and Managed Care page. Its Managed Care Highlights Section provides regularly updated excerpts on strategies for physician success in a managed care environment. Another useful secondary page is the ACP-ASIM Position Papers. Here the reader finds an index of public policy papers advocating the positions of various internal medicine disciplines. Many of these statements deal with managed care practices which have a direct or indirect impact on physician satisfaction, such as the right to engage in joint negotiations with health insurance plans. The site also includes access to current and archived articles in two major journals, ACP Observer and the Annals of InternalMedicine. Managed care issues are frequently covered in the ACPObserver, including one entitled "A look at physician satisfaction in a time of change," which is reviewed below. Although many features on the site are available to subscribers only, the features listed here are free.
*** American Medical Association
The American Medical Association web site reflects the organization's concern with managed care's impact on healthcare delivery, including physician autonomy and satisfaction. Most pages on the site are accessible to non-members, including full-text articles in JAMA and American Medical News. Two recent articles pertaining to physician satisfaction, "Primary care physicians should be coordinators, not gatekeepers" (JAMA June 2, 1999) and "Driving toward the ideal clinical practice" (American Medical News November 8, 1999) are reviewed below. Secondary Policy and Advocacy pages address the organization's numerous concerns with managed care, including its effects on physician satisfaction.
Primary care physicians should be coordinators, not gatekeepers
This article was originally published in JAMA 1999, Volume 281. The article addresses primary care physician satisfaction in terms of their role as gatekeepers in managed care networks. Primary care physicians have grudgingly accepted this role, but are generally dissatisfied with it. Specialty care physicians and plan members are also frustrated with the gatekeeper system. In fact, specialty care physicians increasingly perceive their primary care colleagues as direct competitors under this system. The Author proposes the concept of primary care physician as a "care coordinator" rather than a "gatekeeper" who restricts access.
Driving toward the ideal clinical practice
Written by American Medical News reporter Linda O. Prager in November 1999, this article suggests that physicians current frustrations with the health care system are primarily the result of inefficiencies within their own practices, not external forces, such as managed care. The article discusses a pilot program by the Institute for Health Care Improvement that seeks to test and rapidly deploy new approaches to delivering care. The concepts being evaluated in the pilot include "open access" scheduling, electronic patient registers, and alternatives to traditional office visits.
Recapturing the joy in health care
This article, originally published in HealthForum Journal November 1999, suggests that changes in the way medicine is practiced have left many physicians unhappy with their choices in careers. Managed care has led to many of the changes that affect physician morale. Physicians in the United States are now expected to assume risk for treating patients while rationing medical resources. The authors contend that rather than merely defending their turf, physicians must embrace change and accept a leadership role in guiding and managing it. Such a pro-active approach will lead to improved job satisfaction.
A look at physician satisfaction in a time of change
This article, which appeared in the March 1998 ACPObserver, discusses internists' overall career satisfaction and their satisfaction with managed care organizations. Although 90% of internists surveyed in Fall 1997 indicated they were "somewhat satisfied" or "very satisfied" with their careers, only 54% were "somewhat satisfied" or "very satisfied" with managed care organizations. The survey also indicated that "patient care or the doctor-patient relationship" is the single most important factor influencing their satisfaction. Managed care poses three challenges to this relationship: time, discontinuity, and the effects of capitated payment.
HMO growth leads to less physician work and less satisfaction
Scroll down to view this article. It
provides a synopsis of research performed by Handley, J and Mitchell, JM
and funded by the Robert Wood Johnson Foundation. The authors compared
the penetration of HMOs in several major healthcare markets to both physician
satisfaction and workload using the 1991 Robert Wood Johnson Foundation
Young Physicians Survey. The study found that doubling HMO market
penetration resulted in significantly lower "very satisfied" responses
by the physicians surveyed. The complete study was published in the
November/December 1997 issue of Health Affairs.
| Note: The information below may contain additional relevant materials and documents. Some of the information may be duplicate. The evaluations depend on both the student doing the review and the information contained at the time of the review. Sites are subject to change! |