We examined the data from all 41 items that were rated on a Likert scale using principal component factor analysis and varimax rotation with Kaiser normalization.12 The 4 factors of highest reliability (a >0.650) and highest eigenvalue were chosen post hoc as dependent variables (ie, attitudes about managed care, satisfaction with career, workload stress, and satisfaction with personal life) and analyzed by stepwise regression using all remaining factors and personal and practice variables as independent variables.
Results
A total of 361 completed surveys were returned; 16 surveys were returned as undeliverable (response rate=46%). The mean physician age was 46 years (range=27-77 years); 74% were men, 26% were women. Most were white/non-Hispanic; only 1.1% were Hispanic, 1.7%, African-American, and 4.8%, Asian-American. Practice characteristics are shown in Table 1. The characteristics of these respondents were very similar to those reported for the AAFP membership in December 2000.13 The exceptions were that minority family physicians were underrepresented among respondents to our survey and that respondents averaged nearly 5 more years in practice than the AAFP membership mean.
Among this sample of family physicians, 51% received all of their income by salary. Only 10% reported that more than half their income was capitated; 72% still received no income through capitation. The respondents reported working a mean of 51 hours per week; however, 33% reported averaging more than 60 hours, and 7% averaged more than 70 hours. They had spent a mean of 15.3 years in practice (range = 1 to 51 years).
Only 55% of respondents felt they were appropriately compensated financially. Family physicians who were satisfied with their financial compensation reported more favorable views of managed care (F=10.55; df=1; P <.001), greater career satisfaction (F=27.07; df=1; P <.0001) and lower workload stress (F=10.42; df=1; P <.001).
Regarding their personal lives, 91% of these family physicians reported they were currently involved in a relationship, and 65% had children in their home. Politically, 30% identified themselves as democrats; 46%, republicans; and 24%, independents.
The responses to the questionnaire are shown in Table 2,Table 2b,Table 2c,. The results of stepwise regression models are presented in Table 3*Table w2.
Attitudes About Managed Care
The responses to items composing this factor show that this sample of family physicians was sharply critical of corporate managed care. For example, only 7% agreed or strongly agreed that corporate managed care is the best way to provide the health care America needs at a cost that society can afford.
The regression analyses summarized in Table 3 suggest that overall attitudes about managed care were predicted primarily by a cluster of 3 factors that tap into other concerns about managed care, reform, and accountability. Also, positive attitudes about managed care were best predicted by greater career satisfaction, a willingness to let others worry about the business of medicine, support of hospitalists, having children at home, and democratic political inclinations.
Satisfaction with Career
The response to items composing this factor suggests evidence of discontent among a significant minority of these family physicians. For example, knowing what they know now, if they could start over 63% would go to medical school again, and 66% would choose family practice again. Overall, 59% said they were satisfied with their professional lives.
In regression analyses, family physicians who were retrospectively satisfied with residency training, felt that they were appropriately compensated for their current work, and were satisfied with their personal lives were most likely to be satisfied with their careers. Both a positive attitude about managed care and reform-mindedness each independently predicted career satisfaction.
A decreased workload stress factor predicted increased career satisfaction; however, longer work hours were reported by those more satisfied with their careers. Women reported less satisfaction with their careers. Given their covariance, it is reasonable to view these variables as a cluster that together predicts 55% of the variance in career-satisfaction ratings.
Workload Stress
The response to items composing this factor suggests that a significant number of respondents felt their practice was very stressful. For example, only 9% reported that they are not overwhelmed by paperwork and administrative requirements, and 48% said that they had personally experienced more stress-related symptoms within the past year. Regression analyses suggested that greater workload stress was significantly predicted by dissatisfaction with either career or personal life, longer work hours, being female, and greater reform-mindedness.
Satisfaction with Personal Life
In their personal lives, 85% of these family physicians felt supported by a primary relationship, their family, or a social network. Healthy lifestyle habits that might help to buffer stress are reported by 52%. Overall, 71% said they were satisfied with their personal lives. As provided in Table 3, regression analyses showed that greater workload stress and longer work hours each predicted less satisfaction with personal life. Overall career satisfaction and being in a primary relationship predicted greater satisfaction with personal life. Having children in the home did not predict greater satisfaction with personal life.