Physicians' Career Satisfaction Linked to Patients' Satisfaction With Care

Scratch a satisfied physician, and you just might find satisfied patients in the same area of the country. So says "Congruent Satisfaction: Is There Geographic Correlation Between Patient and Physician Satisfaction?" in the January issue of Medical Care, a journal of the American Public Health Association. The study used data from telephone surveys of 179,127 patients and 37,238 physicians, according to the abstract.

Principal investigator Jennifer DeVoe, M.D., D.Phil., assistant professor in the family medicine department at Oregon Health and Science University, Portland, began the study during an internship at AAFP's Robert Graham Center in Washington. "We knew anecdotally that when patients were unhappy, it was likely physicians were unhappy as well," said DeVoe in an interview. "That motivated us to look at the national data" to confirm the satisfaction correlation and see whether it held true from region to region.

The study did not match physicians with their own patients; instead, it analyzed responses to general questions about satisfaction by patients and physicians within their geographic areas. The authors discovered high correlation between physicians' satisfaction with their overall careers and patients' satisfaction with their overall health care.

Physicians' satisfaction with their overall careers also highly correlated both with patients' trust that their primary care physicians would put patients' medical needs above all other considerations in treatment decisions and with patients' satisfaction with their choice of a primary care physician. In addition, patients' satisfaction with their overall health care highly correlated with primary care physicians' ability to obtain referrals to other specialists who provide high-quality care.

In general, patients' satisfaction levels somewhat exceeded those of physicians. On a scale from 1 to 5, with 1 being equivalent to very satisfied and 5 being equivalent to very dissatisfied, the mean levels of physicians' career satisfaction ranged from 1.7 to 2.4, and the mean levels of patients' satisfaction with their overall health care ranged from 1.4 to 1.8.

The study plotted satisfaction levels in 60 areas of the country, with high patient and physician satisfaction scores, for example, in Lansing, Mich.; Milwaukee; Minneapolis; and northeast Illinois. Areas with low satisfaction rankings include Miami; Orange County, Calif.; Los Angeles; and Newark, N.J. A table with the satisfaction rankings in the 60 areas is available on request from DeVoe at devoej@ohsu.edu.

"We may not know whether physician forces directly cause patient satisfaction, if patient forces contribute to physician satisfaction, or if it is other external environmental factors that strongly influence them both," said the authors in the article. "Regardless of how the cascade begins, satisfaction among both patients and physicians is a key element in health care delivery, and triggering a cycle of dissatisfaction can lead to a worsening of many aspects in the health care system."

The authors call for further studies to identify, for example, what causes higher rates of satisfaction in some sites compared with others and how satisfaction levels relate to malpractice insurance costs and tort reform laws in some states.

DeVoe noted the lawsuit potential among less satisfied patients and added, "If patients are unhappy, they're less likely to follow the physician's advice, so they're less likely to take medications, to get testing done or to change their lifestyle in the way the physician recommends."

The satisfaction data came from the 1996-2001 cycles of the Community Tracking Study Household and Physician Surveys. Among the physicians whose responses were part of this new analysis, said DeVoe, 60 percent were in primary care specialties and 40 percent were in subspecialties; about 25 percent of all the physicians were family physicians or general practitioners. The article notes, "Primary care physicians were oversampled" by design.

Earlier satisfaction studies, said DeVoe, have looked at one area of the country; one specialty; one diagnosis; or one practice environment, such as a certain managed care organization or hospital system. "I believe this is the first study in which people have looked at patients' and physicians' satisfaction levels across the country, using nationally representative data and doing rigorous research," said DeVoe.