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

13 Jan
2010

Most respondents to the PWS identified themselves as white (73%). Asian or Pacific Islander physicians represented 18% of respondents, Hispanic physicians 6%, and black physicians 3%. Black physicians were more likely to be female. Although the distribution of income was fairly similar for white, black, and Asian or Pacific Islander physicians, Hispanic physicians tended to report higher incomes (Table 1). However, this finding may be the result of differential reporting rates. The fraction of respondents without information on income was greater for Hispanic (17.9%) and Asian or Pacific Islander (19.8%) than for white (12.1%) and black (8.8%) physicians.

Among black and white physicians, family practice was the most commonly reported specialty. In contrast, Asian or Pacific Islander and Hispanic physicians were more likely to report practicing internal medicine.
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Table 1. Demographic Characteristics of Participants in the Physician Worklife Study

WhiteBlackAsian or Pacific IslanderHispanic

Total

Respondents, n (%)1,626 (73%)57 (3%)400(18%)134 (6%)2,217
Gender & Marital Status
Female *

24%

49%

39%

13%

26%

Married

86%

73%

83%

85%

85%

Average Age*

46.8

46.3

47.4

46.2

46.9

Income*
Less than $100,000

22%

17%

24%

12%

22%

$100,000-$149,999

35%

58%

32%

25%

35%

$150,000-$249,999

26%

12%

17%

28%

25%

$250,000 or more

7%

10%

5%

15%

7%

Specialty*
Family Practice

40%

43%

23%

26%

38%

Internal Medicine

30%

23%

47%

36%

32%

Internal Medicine Specialty

9%

5%

5%

16%

9%

Pediatrics

17%

29%

21%

15%

18%

Pediatric Specialty

2%

1%

4%

7%

2%

Practice Type*
Solo Practjce

17%

20%

29%

15%

19%

Small GrouV

42%

26%

29%

42%

40%

Large Single Specialty Group

5%

0%

2%

9%

5%

Large Multi-Specialty Group

13%

7%

8%

7%

12%

Group/Staff Model HMO

6%

18%

9%

6%

6%

Academic Group

8%

15%

8%

12%

8%

Other

9%

12%

13%

2%

9%

* pO.Ol for test of no difference between racial/ethnic categories

There were also some notable differences in practice type along racial and ethnic lines. White and Hispanic physicians were more likely than black or Asian or Pacific Islander physicians to work in a small group setting. Asian or Pacific Islander physicians were more likely than others to work in a solo practice.

Patient Panel Characteristics

There were significant differences across physician race and ethnicity in the percent of patient panels described as: speaking little or no English (pO.Ol), and on Medicaid (p=0.01) (Figure 1). Differences in percent of uninsured patients or of patients with complex psychosocial problems were not significant (p<0.10). In general, minority physicians appeared to serve a more demanding patient base than did white physicians. For example, black physicians reported the greatest percentage of Medicaid patients and patients with complex psychosocial problems, Asian or Pacific Islander physicians reported the greatest percentage of uninsured patients, and Hispanic physicians reported the largest proportion of patients with limited English. Additionally, there was a significant difference in the sex distribution of patient panels, with Asian or Pacific Islander physicians reporting lower proportions of female patients than other physicians (p=0.03).

Table 2. Professional Satisfaction Domain Scores*, By Physician Race/Ethnicity

Global MeasuresWhiteBlack       Asian or      Hispanic Pacific IslanderTotal
Career Satisfaction*3.71(0.03)3.92(0.12)3.57(0.07)3.97

(0.13)

3.71

(0.03)
Job Satisfaction*3.72(0.03)3.79(0.15)3.41(0.06)3.93

(0.11)

3.70

(0.03)
Stress*2.33(0.03)2.33(0.10)2.54(0.05)2.30

(0.09)

2.35

(0.02)
Satisfaction Domains
Autonomy*3.39(0..03)3.39(0.11)3.09(0.06)3.73

(0.07)

3.35

(0.02)
Relationships with patients3.84(0..03)3.95(0.18)3.88(0.06)3.93

(0.07)

3.85

(0.03)
Relationships with colleagues3.66(0,.02)3.66(0.11)3.61(0.05)3.53

(0.08)

3.65

(0.02)
Patient care issues*3.13(0..03)3.51(0.14)2.96(0.06)3.39

(0.10)

3.13

(0.03)
Relationships with staff*3.80(0,,02)3.65(0.11)3.54(0.05)3.60

(0.11)

./3.76

(0.02)
Personal time2.86(0,.03)2.86(0.12)2.94(0.06)3.06

(0.08)

2.87

(0.03)
Relationships with community*3.76(0,.03)3.82(0.12)3.43(0.06)3.54

(0.13)

3.72

(0.03)
Pay*3.09(0..03)2.85(0.18)2.67(0.07)3.09

(0.20)

3.03

(0.03)
Administrative issues2.60(0..03)2.68(0.16)2.62(0.07)2.74

(0.10)

2.61

(0.03)
Resources (supplies, exam rooms, staff)*3.64(0,.03)3.20(0.15)3.44(0.05)3.77

(0.09)

3.61

(0.02)
# Reported as means (standard error); * p<0.05 for test of no difference between racial/ethnic categories

Physicians of each racial or ethnic group reported higher proportions of their patient base as being from their own racial or ethnic group than did physicians of other racial or ethnic groups; e.g., black patients constituted a larger proportion of the patient panels of black physicians than the patient panels of nonblack physicians (Figure 2). In every case, this difference was highly significant (p<0.01). Although the differences are not as striking, nonwhite physicians also tended to care for more nonwhite patients not of their own racial or ethnic category than did white physicians. For example, Asian or Pacific Islander physicians cared for a greater percentage of black and Hispanic patients than did white physicians. canadian antibiotics

Professional Satisfaction

Most respondents to the PWS reported high levels of professional satisfaction. For example, 78% of respondents either agreed or strongly agreed with the statement, “Overall, I am pleased with my work” (a component of the career satisfaction scale). Similarly, 69% agreed or strongly agreed with the statement, “Overall, I am satisfied in my current practice” (a component of the job satisfaction scale).

Figure 1. Characteristics of Patient Panels

Figure 1. Characteristics of Patient Panels, by Physician Racial/Ethnic Identity

Mean scores on global satisfaction measures, and the 10 specific satisfaction domains are shown in Table 2. Small but significant differences across racial/ethnic groups were evident in both the global job (pO.Ol) and career (p=0.01) satisfaction measures and in work-related stress (p<0.01). Overall, Asian or Pacific Islander physicians tended to experience lower job satisfaction (pO.Ol) and higher stress (pO.Ol) than white physicians. Asian or Pacific Islander physicians also averaged lower career satisfaction, although this difference was not statistically significant (p=0.11). Hispanic physicians, in contrast, reported higher job (p=0.05) and career (p=0.03) satisfaction than white physicians and minimal differences in stress (p=0.82). Black physicians showed a trend towards higher career satisfaction (p=0.09) than white physicians (p=0.64) or stress (p=0.71). tadalis sx

Figure 2. Racial-Ethnic Composition

Figure 2. Racial/Ethnic Composition of Patient Panels, by Physician Racial/Ethnic Identity

Racial and ethnic variations in mean scores on the specific job satisfaction domains were significant for autonomy, patient care issues, relations with staff, relations with the community, pay, and resources. The patterns generally corresponded to those found for the global professional satisfaction measures. For each of these six domains in which there were significant differences across physician race/ethnic group, Asian or Pacific Islander physicians reported significantly lower satisfaction compared to white physicians (p<0.01 for all). Black physicians reported significantly higher satisfaction with patient care issues (p=0.01) and significantly lower satisfaction with resources (p<0.01). For example, while 43% of white physicians agreed with the statement, “Many patients demand potentially unnecessary treatments,” only 20% of black physicians agreed. Although the relationship was only significant for Asian or Pacific Islander physicians, black and Hispanic physicians also reported lower satisfaction with relations with staff (p=0.17 for black physicians and p=0.07 for Hispanic physicians). Hispanic physicians differed significantly from white physicians only with respect to patient care issues (p=0.01) and satisfaction with personal time (p=0.04). In both of these domains, Hispanic physicians reported greater levels of satisfaction than white physicians.
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After controlling for age, sex, marital status, and income, significant differences remained in mean levels of job satisfaction, career satisfaction, and stress across physician race and ethnicity (Table 3).

Table 3. Regression Models of Physician Race/Ethnic and Professional Satisfaction

Career Satisfaction p      95% aJob Satisfaction p        95% CI<PStress 95% CI
Adjusted for MD Demographics’*
Black MDs

0.20

(-0.03, 0.43)0.07(-0.22, 0.36)

-0.04

(-.24, 0.16)

Asian or Pacific Islander MD’s

-0.11

(-0.26, 0.03)-0.29(-0.43,-0.15)

0.21

(0.09, 0.33)

Hispanic MDs

0.29

(0.04, 0.54)0.23(0.01,0.45)

-0.02

(-0.22, 0.17)

Adjusted for MD Demographicsand Practice Characteristics*
Black MDs

0.20

(-0.06, 0.47)0.10(-0.22, 0.43)

-0.06

(-0.26, 0.15)

Asian or Pacific Islander MD’s

-0.03

(-0.17, 0.12)-0.22(-0.36, -0.07)

0.18

(0.05, 0.30)

Hispanic MDs

0.29

(0.05, 0.53)0.27(0.07, 0.47)

-0.01

(-2.1,0.18)

Adjusted for MD Demographicsand Patient Characteristicstt
Black MDs

0.19

(-0.06, 0.44)0.09(-0.21,0.39)

-0.09

(-0.28, 0.11)

Asian or Pacific Islander MD’s

-0.15

(-0.29,-0.01)-0.30(-0.44,-0.15)

0.20

(0.09, 0.32)

Hispanic MDs

0.30

(0.04, 0.56)0.25(0.01,0.49)

-0.04

(-0.23, 0.16)

* All models are relative to white physicians. Adjusted for sex, marital status, age, and income category; л Practice characteristics include specialty and practice type; # Patient characteristics include percent of patients: female, elderly, speaking little or no English, with complex/numerous medical problems, with complex/numerous psychosocial problems, with substance abuse problems, on Medicaid, uninsured.

Hispanic physicians reported significantly higher levels of career and job satisfaction compared to whites. Asian or Pacific Islander physicians reported significantly higher stress levels and significantly lower job satisfaction than white physicians. Black physicians reported higher career satisfaction than white physicians, but the difference was not statistically significant. Differences between black and white physicians with respect to job satisfaction and stress were small and nonsignificant. Additional adjustment for specialty and practice type did not substantively change these findings. viagra soft

As expected, patient panel characteristics were significantly associated with professional satisfaction. For example, stress was positively correlated with percent of patients with complex psychosocial problems (p=0.01), substance abuse problems (p=0.01), and on Medicaid (p=0.01). However, despite the finding that minority physicians had generally more-demanding patient panels, inclusion of patient panel characteristics in a regression model did not substantively change the associations between physician race and ethnicity and professional satisfaction.

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