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The results of two surveys of primary
care physicians, conducted 10 years apart, suggest that the
level of dissatisfaction with the practice of medicine has
markedly risen.
The reality of medical practice has changed
over the last 10 years and the disparity
between expectations and reality has driven
this downward movement in satisfaction.
Researchers evaluated the results of
two surveys of primary care physicians: the Medical Outcomes
Study, conducted between 1986 and 1990 in Boston, Chicago
and Los Angeles, included 583 physicians; and the Study of
Primary Care Performance in Massachusetts, conducted between
1996 and 1999, included 992 physicians.
Over the period of the two surveys, the
investigators found a sharp decline in multiple aspects of
physician satisfaction with their professional life. Many
of the changes in medical practice over the past decade, including
managed care and large medical groups that contract with health
plans, have caught physicians who went into practice decades
ago off guard.
Physicians showed the most dissatisfaction
with their professional autonomy, amount of leisure time available
and with the time available to spend with individual patients.
In addition, physician satisfaction with their total earnings
also sharply declined.
In 1986 about 75% of the physicians said that they were satisfied
or very satisfied with their total earnings, and in 1997 that
number dropped to 55%.
These feelings of professional dissatisfaction
have resulted in higher rates of older physicians taking early
retirement. Physicians who have
trained more recently are less surprised by what medicine
looks like today, whereas physicians who have been in practice
longer find the pressures of productivity and competitiveness
an unwelcome surprise, which they regard as questioning their
professional judgment and their technical expertness.
Journal of
General Internal Medicine July, 2001;16:451-459
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