The Health Care Manager Volume 33, Number 3, pp. 220–226 Copyright # 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Dimensions of Quality Care Affecting Career Satisfaction of Pediatricians Alex M. Schmidt, MBA; Satish P. Deshpande, PhD This study investigated factors impacting career satisfaction among pediatricians. The study used data from the 2008 Health Tracking Physician Survey, conducted by the Center for Studying Health System Change. The 2008 Health Tracking Physician Survey data set consisted of 4720 physicians who were members of the American Medical Association. Among the respondents, 427 identified themselves as pediatricians. Results indicated more than 52% of pediatricians were very satisfied with their careers in medicine. Nearly 35% of pediatricians were older than 48 years. Approximately 48% were male, and 67% were of white race. The average respondent worked 45 hours per week in medically related activities. Regression analysis indicated the following had a significant impact on pediatrician career satisfaction: inadequate time with patients, patient noncompliance, and delayed reports from other physicians and facilities. Number of hours worked per week and worry over potential malpractice suits also had a significant impact on career satisfaction of pediatricians. Key words: career satisfaction, health care, pediatricians, quality care
I
N 2008, THE US Department of Health and Human Services predicted the total number of active physicians nationwide would increase to 952 000 by the year 2020. The analysis examined 35 different medical specialties. Three of the 4 largest percentage increases were expected in pediatrics and pediatric subspecialties.1 Ahead of schedule, the United States crossed the million-physician threshold in 2011, and the number of pediatricians has more than doubled since the 1990s.2 According to a literature review conducted by the American Academy of Pediatrics, new ranks of pediatricians will face many challenges. Projected trends for the field include problems such as a greater number of children living in poverty, rampant childhood
Author Affiliations: Department of Management, Haworth College of Business, Western Michigan University, Kalamazoo, Michigan. The authors have no conflict of interest. Correspondence: Satish P. Deshpande, PhD, Department of Management, Haworth College of Business, Western Michigan University, Kalamazoo, MI 49008-5797 ([email protected]). DOI: 10.1097/HCM.0000000000000022
obesity, increased exposure to violence and drugs, and financial barriers to children’s health.3 Despite these challenges, pediatricians continue to report the lowest income among medical specialties.4-7 As a corollary, many medical students view pediatrics as a less prestigious specialty and could be pursuing other fields because of concerns over indebtedness.8 Despite less perceived prestige and income, pediatricians report some of the highest levels of career satisfaction in medicine. Whether compared with surgical specialists or general internists, pediatricians are more likely to be satisfied with their careers and demonstrate markedly low levels of job stress and burnout.9-13 Their high satisfaction has been attributed to everything from the pleasantness of working with children to their relatively lighter clinical workload.10,14 As numerous studies have shown, physician career satisfaction can be predicted by the perceived quality of care provided to patients.12,15-17 The same phenomenon has been documented among pediatricians,18 but little attention—if any—has been given to the specific dimensions of quality care impacting career satisfaction. That is to say, a pediatrician may have concerns about malpractice or uninsured patients that predict
220
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Quality Care Affecting Career Satisfaction satisfaction, but this study investigates the degree to which physicians view those factors as problematic in providing quality care to patients. With the historic and sustained growth of pediatricians, it is important to understand what determines their career satisfaction so that policy makers and managers can plan for the recruitment, retention, and long-term competence of these physicians. METHODS Data The Center for Studying Health System Change (HSC) periodically conducts surveys among nationally representative samples of households and physicians. Data used in this study came from the HSC 2008 Health Tracking Physician Survey, which was funded by Robert Wood Johnson Foundation. This is the most current Health Tracking Physician Survey as of date. The survey covered a variety of topics including physician, specialty, compensation, information technology, malpractice threats, and practice-related factors. Detailed documentation on the survey can be found at http://www.icpsr.umich.edu/ icpsrweb/HMCA/studies/27202. The HSC used a list of American Medical Association physicians to arrive at a stratified sample of 10 250 physicians who were mailed the survey. Of the 4750 completed survey, 427 respondents identified themselves as general pediatricians, which comprised the data set for this study. Listwise deletion of missing values left a final sample of 401 pediatricians. The HSC’s report on the methodology used in the survey is available for interested readers at http://www.hschange.com/ CONTENT/1085/1085.pdf.
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care. Physicians rated each variable on a 3-point scale according to whether it was ‘‘not a problem (1),’’ a ‘‘minor problem (2),’’ or a ‘‘major problem (3)’’ affecting their ability to provide highquality care. The variables included inadequate time with patients, patients’ inability to pay for needed care, lack of access to qualified specialists, delays in receiving reports from other physicians and facilities, problems communicating with patients, medical errors in hospitals, and patient noncompliance. Practice-dependent factors Three independent variables described the nature of the physician’s practice. The first, electronic medical record (EMR) use, was dummy coded to indicate whether the physician’s practice uses an entirely electronic system for storing and accessing patient records (0 = not all electronic, 1 = all electronic). The second variable was malpractice worry, measured by agreement with the statement ‘‘I am concerned that I will be involved in a malpractice case sometime in the next 10 years.’’ This variable was rated on a 5-point Likert scale, where 1 corresponds to ‘‘strongly disagree’’ and 5 to ‘‘strongly agree.’’ Finally, number of hours worked per week was rated on a continuous scale, top coded at 80 hours. Physician demographic factors The final 3 independent variables relate to the physician’s personal characteristics. Age in years was measured on an 8-point scale (1 = >67, 2 = 67-63, 3 = 62-58, 4 = 57-53, 5 = 52-48, 6 = 47-43, 7 = 42-38, 8 = 67 67-63 62-58 57-53 52-48 47-43 42-38
Dimensions of Quality Care Affecting Career Satisfaction of Pediatricians Alex M. Schmidt, MBA; Satish P. Deshpande, PhD This study investigated factors impacting career satisfaction among pediatricians. The study used data from the 2008 Health Tracking Physician Survey, conducted by the Center for Studying Health System Change. The 2008 Health Tracking Physician Survey data set consisted of 4720 physicians who were members of the American Medical Association. Among the respondents, 427 identified themselves as pediatricians. Results indicated more than 52% of pediatricians were very satisfied with their careers in medicine. Nearly 35% of pediatricians were older than 48 years. Approximately 48% were male, and 67% were of white race. The average respondent worked 45 hours per week in medically related activities. Regression analysis indicated the following had a significant impact on pediatrician career satisfaction: inadequate time with patients, patient noncompliance, and delayed reports from other physicians and facilities. Number of hours worked per week and worry over potential malpractice suits also had a significant impact on career satisfaction of pediatricians. Key words: career satisfaction, health care, pediatricians, quality care
I
N 2008, THE US Department of Health and Human Services predicted the total number of active physicians nationwide would increase to 952 000 by the year 2020. The analysis examined 35 different medical specialties. Three of the 4 largest percentage increases were expected in pediatrics and pediatric subspecialties.1 Ahead of schedule, the United States crossed the million-physician threshold in 2011, and the number of pediatricians has more than doubled since the 1990s.2 According to a literature review conducted by the American Academy of Pediatrics, new ranks of pediatricians will face many challenges. Projected trends for the field include problems such as a greater number of children living in poverty, rampant childhood
Author Affiliations: Department of Management, Haworth College of Business, Western Michigan University, Kalamazoo, Michigan. The authors have no conflict of interest. Correspondence: Satish P. Deshpande, PhD, Department of Management, Haworth College of Business, Western Michigan University, Kalamazoo, MI 49008-5797 ([email protected]). DOI: 10.1097/HCM.0000000000000022
obesity, increased exposure to violence and drugs, and financial barriers to children’s health.3 Despite these challenges, pediatricians continue to report the lowest income among medical specialties.4-7 As a corollary, many medical students view pediatrics as a less prestigious specialty and could be pursuing other fields because of concerns over indebtedness.8 Despite less perceived prestige and income, pediatricians report some of the highest levels of career satisfaction in medicine. Whether compared with surgical specialists or general internists, pediatricians are more likely to be satisfied with their careers and demonstrate markedly low levels of job stress and burnout.9-13 Their high satisfaction has been attributed to everything from the pleasantness of working with children to their relatively lighter clinical workload.10,14 As numerous studies have shown, physician career satisfaction can be predicted by the perceived quality of care provided to patients.12,15-17 The same phenomenon has been documented among pediatricians,18 but little attention—if any—has been given to the specific dimensions of quality care impacting career satisfaction. That is to say, a pediatrician may have concerns about malpractice or uninsured patients that predict
220
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Quality Care Affecting Career Satisfaction satisfaction, but this study investigates the degree to which physicians view those factors as problematic in providing quality care to patients. With the historic and sustained growth of pediatricians, it is important to understand what determines their career satisfaction so that policy makers and managers can plan for the recruitment, retention, and long-term competence of these physicians. METHODS Data The Center for Studying Health System Change (HSC) periodically conducts surveys among nationally representative samples of households and physicians. Data used in this study came from the HSC 2008 Health Tracking Physician Survey, which was funded by Robert Wood Johnson Foundation. This is the most current Health Tracking Physician Survey as of date. The survey covered a variety of topics including physician, specialty, compensation, information technology, malpractice threats, and practice-related factors. Detailed documentation on the survey can be found at http://www.icpsr.umich.edu/ icpsrweb/HMCA/studies/27202. The HSC used a list of American Medical Association physicians to arrive at a stratified sample of 10 250 physicians who were mailed the survey. Of the 4750 completed survey, 427 respondents identified themselves as general pediatricians, which comprised the data set for this study. Listwise deletion of missing values left a final sample of 401 pediatricians. The HSC’s report on the methodology used in the survey is available for interested readers at http://www.hschange.com/ CONTENT/1085/1085.pdf.
221
care. Physicians rated each variable on a 3-point scale according to whether it was ‘‘not a problem (1),’’ a ‘‘minor problem (2),’’ or a ‘‘major problem (3)’’ affecting their ability to provide highquality care. The variables included inadequate time with patients, patients’ inability to pay for needed care, lack of access to qualified specialists, delays in receiving reports from other physicians and facilities, problems communicating with patients, medical errors in hospitals, and patient noncompliance. Practice-dependent factors Three independent variables described the nature of the physician’s practice. The first, electronic medical record (EMR) use, was dummy coded to indicate whether the physician’s practice uses an entirely electronic system for storing and accessing patient records (0 = not all electronic, 1 = all electronic). The second variable was malpractice worry, measured by agreement with the statement ‘‘I am concerned that I will be involved in a malpractice case sometime in the next 10 years.’’ This variable was rated on a 5-point Likert scale, where 1 corresponds to ‘‘strongly disagree’’ and 5 to ‘‘strongly agree.’’ Finally, number of hours worked per week was rated on a continuous scale, top coded at 80 hours. Physician demographic factors The final 3 independent variables relate to the physician’s personal characteristics. Age in years was measured on an 8-point scale (1 = >67, 2 = 67-63, 3 = 62-58, 4 = 57-53, 5 = 52-48, 6 = 47-43, 7 = 42-38, 8 = 67 67-63 62-58 57-53 52-48 47-43 42-38
