If Massachusetts reflects the nation, physicians' satisfaction with their professional lives has declined substantially in the last 15 years, according to a study sponsored by the Agency for Healthcare Research and Quality (AHRQ) in conjunction with the Robert Wood Johnson Foundation.

The study compared findings from surveys of Massachusetts primary care physicians in 1986 and 1997. By 1997, fewer than two-thirds of physicians were satisfied with most areas of practice, and fewer than half were content with the time they spent with patients, the amount of leisure time they had, and incentives for providing high-quality care, as compared with physicians in 1986. However, respondents in both 1986 and 1997 said they were satisfied with the quality of care they were able to provide.

"This important research shows that changes in the way health care is delivered affect those who are dedicated to providing care to their patients," said John M. Eisenberg, M.D., director of AHRQ. "Both the public and private sectors need to work together to help health professionals adapt to the changes in the structure and organization of the American health care system."

The study also examined differences in the experiences of physicians working in different types of medical practices. Nearly half of physicians in practices that contract with multiple insurers reported one or more insurance company denials of patient care in the prior year. Physicians in these practice arrangements were highly dissatisfied with the procedures required for obtaining health plan authorization for patient care, as opposed to physicians who work exclusively with one health plan. In addition, fewer than half indicated that they would recommend the health plans with which they were associated to family members or friends.

"Many of these physicians began practicing decades ago in a system with virtually no oversight or restraint on spending," said Dana Gelb Safran, Sc.D., of the New England Medical Center, who is the principal investigator on the project. "From their perspective, the changes in their professional life have been profound, and for the most part, unwelcome. If we had tracked physician satisfaction in other parts of the country with health care markets similar to Massachusetts, we would have expected similar findings."

According to the researchers, there are many reasons why physician satisfaction is important. Numerous studies have reported that dissatisfaction leads to increased physician turnover, which in turn leads to decreased continuity of care for patients, and increased costs to the medical system. Other research has shown a positive relationship between physician satisfaction and patient satisfaction. In addition, physician satisfaction affects the morale of the health care workers and staff who work closely with the physicians.

"The changes that have come to the medical profession over the past 10-15 years have put enormous pressure on physicians with regard to their productivity and performance," concluded Dr. Safran. "As the American health care system continues to evolve, the satisfaction of patients and health care professionals alike will need to be monitored to assure the future quality of health care services."

For details, see, "Doctor Discontent: A Comparison of Physician Satisfaction in Different Delivery System Settings, 1986 and 1997," by Alison Murray, M.D., M.P.H., et al, published in Journal of General Internal Medicine 2001;16:451-459.