Physician Satisfaction with Medicaid Managed Care

,

Original Research

Physician Satisfaction with Medicaid Managed Care

J Fam Pract. 2000 January;49(1):20-26

References

1. Iglehart JK. The American health care system: Medicaid. N Engl J Med 1999;340:403-8.

2. Jenkins ER. Managed care plus (MC+): the wave of the future for Missouri Medicaid? Mo Med 1995;92:222-3.

3. Coughlin TA, Ku L, Holahan J, Heslam D, Winterbottom C. State responses to the Medicaid spending crisis: 1988 to 1992. J Health Polit Policy Law 1994;19:837-64.

4. Mirvis DM, Chang CF, Hall CJ, Zaar GT, Applegate WB. TennCare: health system reform for Tennessee. JAMA 1995;274:1235-41.

5. Dallek G. A consumer advocate on Medicaid managed care. Health Aff 1996;15:174-7.

6. Halvorson GC. An HMO chief executive officer on Medicaid managed care. Health Aff 1996;15:170-1.

7. Gold M, Sparer M, Chu K. Medicaid managed care: lessons from five states. Health Aff 1996;15:153-66.

8. Chang CF, Kiser LJ, Bailey JE, et al. Tennessee’s failed managed care program for mental health and substance abuse services. JAMA 1998;279:864-9.

9. Freund DA, Hurley RE. Medicaid managed care: contribution to issues of health reform. Ann Rev Public Health 1995;16:473-95.

10. Linn LS, Brook RH, Clark VA, Davies AR, Fink A, Kosecoff J. Physician and patient satisfaction as factors related to the organization of internal medicine group practices. Med Care 1985;23:1171-8.

11. Melville A. Job satisfaction in general practice: implications for prescribing. Soc Sci Med 1980;14A:495-9.

12. Lichtenstein R. Measuring the job satisfaction of physicians in organized settings. Med Care 1984;22:56-68.

13. Kravitz RL, Linn LS, Shapiro MF. Physician satisfaction under the Ontario Health Insurance Plan. Med Care 1990;28:502-12.

14. Stamps PL, Piedmont EB, Slavitt DB, Haase AM. Measurement of work satisfaction among health professionals. Med Care 1978;16:337-52.

15. Schulz R, Girard C, Scheckler WE. Physician satisfaction in a managed care environment. J Fam Pract 1992;34:298-304.

16. Schulz R, Schulz C. Management practices, physician autonomy, and satisfaction: evidence from mental health institutions in the Federal Republic of Germany. Med Care 1988;26:750-63.

17. Stamps PL, Cruz NT. Issues in physician satisfaction: new perspectives. Annu Arbor, Mich: Health Administration Press; 1994;31.-

18. Hughes EC. Men and their work. New York, NY: The Free Press of Glencoe; 1958.

19. Liberman. Analysis of the placebo phenomenon. J Chron Dis 1963;15:761-83.

20. Frankel RM. The laying on of hands: aspects of the organization of gaze, touch, and talk in a medical encounter. In: Todd A, Fisher S, eds. The social organization of doctor-patient communication. Norwood, NJ: Ablex Publishing Corporation; 1993;71-106.

21. Bruhn JG. The doctor’s touch: tactile communication in the doctor-patient relationship. South Med J 1978;71:1469-73.

22. Shortell SM, Waters TM, Clarke KW, Budetti PP. Physicians as double agents: maintaining trust in an era of multiple accountabilities. JAMA 1998;280:1102-8.

23. Mechanic D, Schlesinger M. The impact of managed care on patients’ trust in medical care and their physicians. JAMA 1996;275:1693-7.

24. Balint J, Shelton W. Regaining the initiative: forging a new model of the patient-physician relationship. JAMA 1996;275:887-91.

25. Mawardi BH. Physician career satisfaction: another look. Annu Conf Res Med Educ 1980;19:52-6.

26. Linn LS, Yager J, Cope D, Leake B. Health status, job satisfaction, job stress, and life satisfaction among academic and clinical faculty. JAMA 1985;254:2775-82.

27. Baker LC, Cantor JC. Physician satisfaction under managed care. Health Aff 1993;12:258-70.

28. Murray JP. Physician satisfaction with capitation patients in an academic family medicine clinic. J Fam Pract 1988;27:108-13.

29. Mechanic D. The organization of medical practice and practice orientations among physicians in prepaid and nonprepaid primary care settings. Med Care 1975;13:189-204.

30. Skolnik NS, Smith DR, Diamond J. Professional satisfaction and dissatisfaction of family physicians. J Fam Pract 1993;37:257-63.

31. Suchman AL, Roter D, Green M, Lipkin M, Jr. Physician satisfaction with primary care office visits: Collaborative Study Group of the American Academy on Physician and Patient. Med Care 1993;31:1083-92.

32. Mainous AGd, Ramsbottom-Lucier M, Rich EC. The role of clinical workload and satisfaction with workload in rural primary care physician. Arch Fam Med 1994;3:787-92.

33. Kerstein J, Pauly MV, Hillman A. Primary care physician turnover in HMOs. Health Serv Res 1994;29:17-37.

34. Sallis JF, Fortmann SP, Solomon DS, Farquhar JW. Increasing returns of physician surveys. Am J Public Health 1984;74:1043.-

35. Maheux B, Legault C, Lambert J. Increasing response rates in physicians’ mail surveys: an experimental study. Am J Public Health 1989;79:638-9.

36. Silverstein G. Physicians’ perceptions of commercial and Medicaid managed care plans: a comparison. J Health Polit Policy Law 1997;22:5-21.

37. Schulz R, Scheckler WE, Moberg DP, Johnson PR. Changing nature of physician satisfaction with health maintenance organization and fee-for-service practices. J Fam Pract 1997;45:321-30.

38. Warren MG, Weitz R, Kulis S. Physician satisfaction in a changing health care environment: the impact of challenges to professional autonomy, authority, and dominance. J Health Soc Behav 1998;39:356-67.

39. Mitchell JB. Physician participation in Medicaid revisited. Med Care 1991;29:645-53.

40. Davidson SM, Perloff JD, Kletke PR, Schiff DW, Connelly JP. Full and limited medicaid participation among pediatricians. Pediatrics 1983;72:552-9.

41. Adams EK. Effect of increased Medicaid fees on physician participation and enrollee service utilization in Tennessee, 1985-1988. Inquiry 1994;31:173-87.

42. Kerr EA, Hays RD, Mittman BS, Siu AL, Leake B, Brook RH. Primary care physicians’ satisfaction with quality of care in California capitated medical groups. JAMA 1997;278:308-12.

43. Baker LC, Cantor JC, Miles EL, Sandy LG. What makes young HMO physicians satisfied? HMO Pract 1994;8:53-7.

44. Barr JK, Steinberg MK. Professional participation in organizational decision making: physicians in HMOs. J Community Health 1983;8:160-73.

Efforts to increase physician satisfaction with clinical autonomy may also increase quality of care.^10,11 Low levels of satisfaction with clinical autonomy in managed care systems has been associated with a perception of lower quality of care.⁴² However, participation in managed care plans does not always result in lower satisfaction with clinical autonomy. Several studies have shown a strong association between participation in managed care plans and high levels of satisfaction with clinical autonomy.^15,37,43 Physician involvement in decision-making processes that affect their daily work is related to increased satisfaction with autonomy.^16,44 Thus, involving physicians and physician organizations in the formulation of guidelines that will affect physician behavior in Medicaid managed care plans could promote satisfaction with clinical autonomy while improving quality and controlling costs.

The strengths of this study include the development of 3 scales that have good face validity and content validity and high internal reliability. Our survey included physicians participating in traditional Medicaid, as well as Medicaid managed care. Most importantly, this is one of the first studies to address physician satisfaction early in the national experiment with Medicaid managed care plans.

Limitations

Our study may be limited by a response rate of 52%. Although we found no difference between late and early responders on measures of satisfaction and intention to continue participation, our results may be biased toward negative responders. This study was also limited to Missouri physicians. It may not be possible to generalize our findings to other states. Furthermore, we measured satisfaction early in the implementation of Medicaid managed care. Physician satisfaction may change as the Medicaid managed care and commercial markets evolve.

Conclusions

There may be a tendency for some to view an exploration of the effect of changes in the health care delivery system on physician autonomy and satisfaction as a case of professional self-interest, especially in the current climate where physicians are increasingly and publicly critical of the impact of managed care on quality of care. However, the larger sociological perspective—drawn from decades of empirical and theoretical research that links autonomy to physician satisfaction, the therapeutic relationship, and quality of care—shows the importance of autonomy and satisfaction.^{10,11,18,20,21} Finding ways to promote physician autonomy and satisfaction in Medicaid managed care settings is necessary to maintain the therapeutic relationship that forms the basis of high-quality care. The quality indicators of Medicaid managed care plan performance should include a measurement of physician satisfaction and autonomy.

Acknowledgments

Dr Gazewood was partially funded by the National Research Service Award 5-T32-P#17001-08 and by a Harrison Teaching Professorship of Generalist Medicine. The Missouri Division of Medical Services and the University of Missouri-Columbia Department of Family and Community Medicine small grant program also provided funding.

The authors acknowledge Paula McDonald for research assistance and secretarial support.