OBJECTIVE: Our goal was to characterize how family physicians perceive recent changes in the health care system and how content they are with various factors.
STUDY DESIGN: We performed a cross-sectional mailed survey.
POPULATION: The survey was completed by a random sample of 361 family physicians practicing in the United States.
OUTCOMES MEASURED: The survey evaluated attitudes about corporate managed care, health care reform, career satisfaction, compensation, personal life satisfaction, workload stress, personal well-being, and residency training.
RESULTS: Relative to survey data gathered in 1996, fewer family physicians in our survey reported that they were satisfied with their careers (59% vs 82%); fewer were satisfied with their compensation (55% vs 65%); and fewer would again choose family practice as their specialty (66% vs 75%). Thirty-one percent worried that they were “burning out,” as physicians, and 48% reported that they had experienced more stress-related symptoms in the past year. Only 7% agreed that corporate managed care is the best way to provide the health care America needs at a cost society can afford, but only 36% unequivocally endorsed the concept of a national health plan. Forty-two percent of the respondents reported that they had witnessed bad patient outcomes they perceived to be attributable to managed care business processes.
CONCLUSIONS: The morale and career satisfaction of family physicians seems to have eroded in recent years, and discontent is common. As a group, family physicians are unhappy with the current health care system and quite unified about certain specific reforms, yet they are far from such consensus about more sweeping reform.
The 1990s were a time of remarkable upheaval in US health care. The input of physicians and consumers was marginalized in a market-driven system guided by insurers, employers, and government. Well-intentioned managed care concepts that many physicians would endorse were less evident than managed care business practices that sparked rancor and frustration, as well as creating time and income pressures.
Although 80% of physicians believe that the current health care system requires fundamental change,1,2 there is little agreement about what form that change should take. For example, 25%3 to 40%4 of physicians in statewide surveys and 66% of students entering one medical school system5 endorse a single-payer national health plan. Despite the lack of consensus about what direction reform should take, there is growing skepticism about the current model. For example, only 21% of surveyed internal medicine residents believe that corporate managed care is the best model for our health care system.6 Among students, residents, faculty members, and deans of medical schools, 52% favor a single-payer system, while 22% favor a corporate managed care system.7
Coincident with marked changes in American health care, the popular press have reported deteriorating morale and career satisfaction among physicians.8,9 For family physicians there are mixed but generally positive data about career satisfaction. Survey data report that only 52% of young family physicians would definitely again choose to become a physician,10 yet from 70%10 to 74%11 would again choose family practice as a specialty. In a 1996 survey4 (at a time when both family practice residency applicants and salaries for new graduates peaked), 82% of family physicians reported satisfaction with their careers; 75% stated that they would again select family practice as a specialty; and 65% reported satisfaction with their compensation.4
Since 1996, annual surveys of the family practice residents in our own training program have shown a steady decline in the number who would go to medical school again (from 73% to 50% between 1996 and 1999). We suspected that our residents were reacting to changes and uncertainties similar to those faced by all family physicians. This prompted us to survey practicing family physicians about their experiences with and attitudes toward their practice and the US health care system.
Methods
We designed a 41-item questionnaire that focused on family physicians’ observations related to corporate managed health care and personal perception of their own well-being and career. Family physicians were asked to rate each item on a 5-point scale (where 1=strongly disagree, and 5=strongly agree). Additional items focused on demographic information, nature of practice, presence of a primary relationship, presence of children in the home, political inclination, extent of managed care participation, and both the nature and perceived adequacy of compensation. The final questionnaire was the product of pretesting and feedback by 6 of the family practice faculty members from our residency training program and consultation with researchers.
We selected a random national sample of 800 practicing members of the American Academy of Family Physicians (AAFP) in June 1999. A 6-page survey was mailed to each family physician, accompanied by a cover letter requesting participation and a postcard by which a summary of the final survey results could be requested. We sent a second mailing 5 weeks later to those who had not yet responded.