Physician Race and Ethnicity, Professional Satisfaction, and Work-Related Stress: DISCUSSION

14 Jan
2010

physician satisfaction

In a national survey of physicians, we found that professional satisfaction differed by physician race and ethnicity. Asian or Pacific Islander physicians reported lower job satisfaction and higher stress than white physicians, while Hispanic physicians were significantly more satisfied with their jobs and careers than white physicians. Black physicians did not exhibit a significant difference in job or career satisfaction or stress. Although the differences in mean satisfaction scores across groups appeared small, previously published results from the PWS indicate that these differences in satisfaction may be an indication of significant underlying discontent, as measured by intent to leave a job or low perceived health. For example, a decrease of 0.3 points in job satisfaction (the unadjusted difference observed between white and Asian or Pacific Islander physicians) was associated with a 16% increase in the odds of planning to leave direct patient care within the next five years. These findings are consistent with prior research showing that dissatisfied primary care physicians were much more likely than others to leave a practice over a four-year follow-up period.

Consistent with previous research, we found that minority physicians were more likely to serve high-demand or underserved populations, and we found expected associations between patient panel characteristics and physician satisfaction. Surprisingly, however, panel characteristics did not appear to explain racial or ethnic differences in physicians’job or career satisfaction. Nor were these differences in professional satisfaction explained by physicians’ demographic characteristics or practice characteristics. Exploration of specific facets of professional satisfaction suggests that satisfaction with patient care issues is important in explaining the pattern of global satisfaction measures observed. This facet of satisfaction was measured with four questions, addressing: adversarial relationships with patients; feeling overwhelmed by patient needs; patients demanding unnecessary treatments; and time pressures impairing relationships with patient. Black and Hispanic physicians reported higher satisfaction with patient care issues compared to white physicians, while Asian or Pacific Islander physicians reported lower satisfaction. Both black and Asian or Pacific Islander physicians reported significantly lower satisfaction with resources, as might be expected if patient panels are disproportionately low-income. Low professional satisfaction among Asian or Pacific Islander physicians appeared to extend to several additional facets of work life, including autonomy, relations with staff, relations with community, pay, and resources. canadian pharmacy viagra

Our study was limited in several important respects. The data were cross-sectional and therefore cannot provide insight into the temporal sequence of workplace conditions and professional satisfaction. Small sample size, especially for under-represented minority physicians, may have impaired our ability to identify important aspects of worklife experiences. Despite efforts to draw a nationally representative sample, the small number of minority respondents limits the external validity of the findings reported here. As with any survey, our results are subject to potential nonresponse bias. Nonrespon­dents may have systematically differed from respondents in their work lives and professional satisfaction, and to the extent that such differences varied by race or ethnicity, our findings may not accurately reflect true racial or ethnic differences in physician satisfaction. Finally, we consolidated specific ethnic categories into broader groups, thus possibly obscuring differences within major categories.

These limitations notwithstanding, we believe our results have important implications regarding minority physicians in the United States. Physicians’ professional satisfaction is linked to patient satisfaction and to patient adherence to medical recommendations. Previous studies have investigated professional satisfaction of physicians across genders or specialties, but there is limited information on satisfaction among minority physicians except in academic settings. Physicians from racial and ethnic minority groups might be expected to have low satisfaction due to demanding patient panels, overt or covert workplace discrimination, and  associated with professional isolation. In this study, black and Hispanic physicians indicated that, despite these concerns, they had high levels of overall professional satisfaction. The finding of greater satisfaction among Hispanic physicians is consistent with results from the Women Physicians’ Health Study (WPHS), in which female Hispanic physicians reported higher work control and career satisfaction compared to white, black, or Asian or Pacific Islander physicians. In contrast, results from the WPHS suggested black female physicians were more likely to be dissatisfied that with their career than white female physicians, while Asian or Pacific Islander female physicians had greater career satisfaction. The differences between the WPHS results and the PWS reported here may be due to sex differences in satisfaction. Our sample is too small to adequately explore this possibility, but the association of career satisfaction and race may vary by sex.
These results have relevance to understanding the consequences of affirmative action programs for potential beneficiaries. One possible concern about affirmative action is whether the selection process ultimately places under-represented minority physicians at risk of higher work stress or professional dissatisfaction. In this study, neither black nor Hispanic physicians report systematically lower professional satisfaction or higher stress than white and Asian or Pacific Islander physicians. In fact, Hispanic physicians have higher satisfaction. The facets of professional satisfaction in which minority physicians report lower satisfaction, such as resources, highlight the care many minority physicians provide to underserved populations.

Factors that undermine the professional satisfaction of minority physicians, if they translate into pro­fessional burnout or retirement from clinical work, may thus lead to lesser access to care for underserved communities. Our findings suggest that Asian or Pacific Islander physicians are at greater risk of experiencing low job satisfaction and that this experience may be in part a consequence of dissatisfaction with patient care issues. These factors, while a source of frustration for many physicians, are likely to especially impact physicians caring for underserved populations. In this data set, for example, low satisfaction on patient care issues was significantly predicted by percent of patients on Medicaid. pharmacy united kingdom

Black physicians, who care for a greater percentage of Medicaid patients than white or Asian or Pacific Islander physicians, reported greater levels of satisfaction with patient care issues. It is not clear what aspect of black physicians’ work experiences could be offsetting the potential stressors of underserved patient panels and low satisfaction with resources. Some of the difference may be explained by expectations and orientation of physicians. In the PWS, physician satisfaction with patient care issues was significantly predicted by the extent to which psychosocial aspects of practice were emphasized during clinical training. Another source of indirect evidence arises from the American Association of Medical Colleges 2001 survey of medical school graduates. In this survey, under-represented minority graduates were substantially more likely than others to endorse the statement, “everyone is entitled to receive adequate medical care;” to believe that healthcare access is a major problem; and to believe that physicians can influence health and disease prevention. Such beliefs could increase the satisfaction gained from providing medical care in demanding contexts.

In summary, racial/ethnic variations in physician satisfaction exist but are not entirely explained by demographic characteristics, practice setting, or patient panel characteristics. Future research should further explore differences in physician satisfaction for different racial and ethnic groups. Researchers should investigate how patient characteristics influence satisfaction for different physicians and how the racial and ethnic diversity of the patient panel influences satisfaction. Policymakers should consider the potential impact of low reimbursement rates and inadequate resources for care of the underserved on the willingness of physicians, including specifically minority physicians, to remain in practice. Apcalis Oral Jelly

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