Caring For Patients In A Malpractice Crisis: Physician Satisfaction And Quality Of Care

Columbia University, New York, New York, United States
Health Affairs (Impact Factor: 4.97). 07/2004; 23(4):42-53. DOI: 10.1377/hlthaff.23.4.42
Source: PubMed


The rhetoric of malpractice reform is at fever pitch, but political advocacy does not necessarily reflect grassroots opinion. To determine whether the ongoing liability crisis has greatly reduced physicians' professional satisfaction, we surveyed specialist physicians in Pennsylvania. We found widespread discontent among physicians practicing in high-liability environments, which seems to be compounded by other financial and administrative pressures. Opinion alone should not determine public policy, but physicians' perceptions matter for two reasons. First, perceptions influence behavior with respect to practice environment and clinical decision making. Second, perceptions influence the physician-patient relationship and the interpersonal quality of care.

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Available from: Catherine M Desroches
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    • "There is currently growing interest in using a positive approach in institutions, promoting health at the workplace and other relevant factors (Ariza, Quevedo-Blasco, Ramiro, & Bermúdez, 2013; Bakker, Rodríguez-Muñoz, & Derks, 2012; Fuente, et al., 2013). A good example of this is work satisfaction, given that high satisfaction indices among healthcare professionals influences the quality of the service provided and the satisfaction of the patient him/herself (DeVoe, Fryer, Hargraves, Phillips, & Green, 2002; Mello et al., 2004; Paquet & Gagnon, 2010; Pratt, 2010), whereas workers with high indices of dissatisfaction are more prone to suffering from burnout (Escriba-Agüir, Artazcoz, & Pérez-Hoyos, 2008; Lu, Barriball, Zhang, & While, 2011), physical and mental deterioration (Faragher, Cass, & Cooper, 2005) and an increase in absenteeism, change of post, with all the damage that this entails at the personal and institutional spheres (Buchbinder, Wilson, Melick, & Powe, 1999). Job satisfaction can be defined as the affective orientation an individual has toward his/her work (Price, 2001). "
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    ABSTRACT: The main goal of this research is to explore the organizational climate perceived by administrative and healthcare personnel working in Spanish healthcare services, analyzing the differences according to their health specialization, sex, age and professional status. The sample was made up of 3,787 individuals working in the administrative and healthcare services of the Public Health System of the Principality of Asturias, 88.7% were working in specialist care and 11.3% in primary care. Mean age was 51.88 (standard deviation of 6.28); 79.9% were women and 20.1% men. The organizational climate was assessed with the CLIOR scale. The organizational climate perceived is moderately positive, with a global mean of 3.03 on a scale of 1 to 5 points. The differences are statistically significant (p < .01) according to specialty, age and profession. A better working climate is perceived in primary care than in specialist care, and among older as compared to younger workers. The results indicate that the working climate perceived by administration and services staff employees in the Spanish healthcare context is moderately positive, with a better perceived climate in primary care than in specialist care. Resumen El objetivo de este trabajo es conocer el clima organizacional percibido por los tra-bajadores de administración y servicios del sistema español de salud pública, analizando su es-pecialidad sanitaria, género, edad y categoría profesional. La muestra estuvo compuesta por 3.787 trabajadores de administración y servicios del Servicio de Salud Pública de Asturias, 88,7% procedían de atención especializada y 11,3% de atención primaria. La media de edad es de 51,88 años (desviación típica 6,28); 79,9% fueron mujeres y 20,1% hombres. El clima organi-zacional se evaluó mediante la escala CLIOR, obteniéndose una media de 3,03 en una escala de... PALABRAS CLAVE Satisfacción laboral; Personal sanitario; Salud pública; Estudio descriptivo mediante encuesta
    Full-text · Article · Apr 2014 · International Journal of Clinical and Health Psychology
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    • "Perceived autonomy or work control, on the other hand, has been found to contribute to higher levels of satisfaction in medical work (Bell et al., 2006; Cydulka & Korte, 2008; Katerndahl et al., 2009; Kinzl, Knotzer, Traweger, Lederer, Heidegger, & Benzer, 2005; McGlone, & Chenoweth, 2001; McNearney et al., 2008). Patient-related factors have been shown to be related to lower satisfaction with medical work, including in relation to the complexity of care needs (Katerndahl et al., 2009), perceived degree of emotional burden (Garfinkel, Bagby, Schuller, Dickens, & Schulte, 2005), the threat of legal action for malpractice (Mello et al., 2004), and community underinsurance (Pagán, Balasubramanian, & Pauly, 2007). Overall, it appears that job satisfaction reflects a range of personal, work, and patient-related factors that may ultimately affect the availability of medical services and the quality and safety of medical care. "
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    ABSTRACT: Job satisfaction has become an increasingly important topic of focus for the medical profession over the last 20 years. This report details the application of factor analysis to validate a widely used 10-item job satisfaction scale that has not previously been validated in a medical practitioner population. The study drew on data from 9,900 participants enrolled in the first wave of a longitudinal survey of Australian doctors. The instrument was found to possess a dominant single factor explaining 75% of the variance and internal reliability was high (r = .86), enabling the determination of a composite job satisfaction score. Australian doctors experienced high levels of job satisfaction overall, but this varied with doctor subpopulation, age, geographic location, and hours worked per week. The validation of this brief scale in a large cohort of Australian doctors provides opportunities for undertaking further exploratory and comparative job satisfaction research in medical practitioner populations.
    Preview · Article · Mar 2011 · Evaluation & the Health Professions
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    • "For one, health worker satisfaction influences retention, as has been shown in several studies [96-98], including in studies of financial-incentive programs for return of service [12,41,63]. Moreover, health worker satisfaction is associated with patient satisfaction [99] and quality of care [100,101]. Health workers are also likely to share their experiences with colleagues and may thus influence the supply of health workers to underserved areas as well as participation in financial-incentive programs. The reviewed studies offer some insight into the mechanism through which individual programs affect participant satisfaction. "
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    ABSTRACT: In many geographic regions, both in developing and in developed countries, the number of health workers is insufficient to achieve population health goals. Financial incentives for return of service are intended to alleviate health worker shortages: A (future) health worker enters into a contract to work for a number of years in an underserved area in exchange for a financial pay-off. We carried out systematic literature searches of PubMed, the Excerpta Medica database, the Cumulative Index to Nursing and Allied Health Literature, and the National Health Services Economic Evaluation Database for studies evaluating outcomes of financial-incentive programs published up to February 2009. To identify articles for review, we combined three search themes (health workers or students, underserved areas, and financial incentives). In the initial search, we identified 10,495 unique articles, 10,302 of which were excluded based on their titles or abstracts. We conducted full-text reviews of the remaining 193 articles and of 26 additional articles identified in reference lists or by colleagues. Forty-three articles were included in the final review. We extracted from these articles information on the financial-incentive programs (name, location, period of operation, objectives, target groups, definition of underserved area, financial incentives and obligation) and information on the individual studies (authors, publication dates, types of study outcomes, study design, sample criteria and sample size, data sources, outcome measures and study findings, conclusions, and methodological limitations). We reviewed program results (descriptions of recruitment, retention, and participant satisfaction), program effects (effectiveness in influencing health workers to provide care, to remain, and to be satisfied with work and personal life in underserved areas), and program impacts (effectiveness in influencing health systems and health outcomes). Of the 43 reviewed studies 34 investigated financial-incentive programs in the US. The remaining studies evaluated programs in Japan (five studies), Canada (two), New Zealand (one) and South Africa (one). The programs started between 1930 and 1998. We identified five different types of programs (service-requiring scholarships, educational loans with service requirements, service-option educational loans, loan repayment programs, and direct financial incentives). Financial incentives to serve for one year in an underserved area ranged from year-2000 United States dollars 1,358 to 28,470. All reviewed studies were observational. The random-effects estimate of the pooled proportion of all eligible program participants who had either fulfilled their obligation or were fulfilling it at the time of the study was 71% (95% confidence interval 60-80%). Seven studies compared retention in the same (underserved) area between program participants and non-participants. Six studies found that participants were less likely than non-participants to remain in the same area (five studies reported the difference to be statistically significant, while one study did not report a significance level); one study did not find a significant difference in retention in the same area. Thirteen studies compared provision of care or retention in any underserved area between participants and non-participants. Eleven studies found that participants were more likely to (continue to) practice in any underserved area (nine studies reported the difference to be statistically significant, while two studies did not provide the results of a significance test); two studies found that program participants were significantly less likely than non-participants to remain in any underserved area. Seven studies investigated the satisfaction of participants with their work and personal lives in underserved areas. Financial-incentive programs for return of service are one of the few health policy interventions intended to improve the distribution of human resources for health on which substantial evidence exists. However, the majority of studies are from the US, and only one study reports findings from a developing country, limiting generalizability. The existing studies show that financial-incentive programs have placed substantial numbers of health workers in underserved areas and that program participants are more likely than non-participants to work in underserved areas in the long run, even though they are less likely to remain at the site of original placement. As none of the existing studies can fully rule out that the observed differences between participants and non-participants are due to selection effects, the evidence to date does not allow the inference that the programs have caused increases in the supply of health workers to underserved areas.
    Full-text · Article · Jun 2009 · BMC Health Services Research
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