Switching Doctors: Predictors of Voluntary Disenrollment from a Primary Physician’s Practice

The recent IOM report on the future of primary care called attention to the importance of the physician-patient relationship in primary care, asserting that primary care is predicated on sustained clinician-patient partnerships and on a whole-person orientation.1 In our study, longitudinal data demonstrate that the strength of connection between a patient and his or her primary care physician significantly predicts the likelihood of that patient remaining in that physician’s practice (vs voluntarily leaving) over the next several years. In an era marked by increasing pressure on clinicians and health care organizations to attend to such factors as market share, productivity, and efficiency, these findings point to a set of attributes that might otherwise be overlooked. They suggest that medical practices and health plans cannot afford to ignore that the essence of medical care delivery involves the interaction of one human being with another.

Acknowledgments

This research was supported by grant number R01 HS08841 from the Agency for Healthcare Research and Quality (formerly the Agency for Health Care Policy and Research) and by grant number 035321 from the Robert Wood Johnson Foundation. We are indebted to Dolores Mitchell, executive director of the Massachusetts Group Insurance Commission, whose commitment and participation have made this study possible. We also gratefully acknowledge Brian Clarridge, PhD, and his colleagues at The Center for Survey Research, University of Massachusetts, for their technical expertise and commitment to excellence in obtaining the data for our study. Finally, we acknowledge each of the health plans involved in the study, and particularly the health plan executives who served on our Advisory Committee and those who provided interviews, for generously giving their time, insights, and information that was critical to our research.