DOES MICROPRACTICE LEAD TO MACROSATISFACTION?Meaghan Combs MD MPH, Elizabeth Paddock MD, Melissa Stiles MD, Ron Price MSUniversity of Wisconsin, Department of Family Medicine, Madison WI
WHY THIS STUDY:Fall 2010. Independently wondering about the micropractice model.
Questions:How do they work?Are physicians practicing in this model happier when compared to more traditional practices?What has to give to make this work? Could applying some of these tricks make primary care more palatable to medical students?
MICROCLINICIndependentLow overheadExtended time with patientsGuru: Gordan Moore MD
Ideal Medical PracticeGoals:Best careLess time documentingAppropriate referrals Decreased costs to the systemAppropriate compensation for good careIncreased happiness with career choice
NO COMPARISONSReview of literature showed no studies comparing physician satisfaction between the micropractice model and traditional medical practices.
We know that physician quality of work life is a key component in physician career choice and retention
Study conducted late winter 2011. Comparison of physicians employed by the UW-DFM and physicians working in micropractice clinics across the USA (self-identified)
METHODSValidated survey assessed physician satisfaction with current employment5 point Likert response scale (scored 1-5, where 5 was the most positive response)Survey invitation emailed to UW-DFM residency clinic and community clinic physicians and a national sample of self-identified micropractice physiciansSurveys were completed through online survey tool (http.//survey.wisc.edu)Responses were all anonymous92 total respondentsUniversity of Wisconsin IRB approval
- ANALYSISIndividual items assessed via non-parametric tests: Chi square for nominal items, Kruskal Wallis for oridinal scale itemsAlpha criterion of p
RESULTSComparisons between residency clinic based family physicians, family medicine community clinic based family physicians and micropractice clinicians.
N=92Residency clinic: 44%Community clinic: 32%Micropractice clinic: 32%
Micropractice providers reported:The least satisfaction with incomeThe greatest satisfaction with family timeThe greatest satisfaction with the ability to provide continuity of care
RESULTS: OUTCOMESGiven the total work situation, micropractice clinicians rate the overall quality of the medical care they provide higher than residency or community clinicians. Practitioners in the microclinic model rate their ablility to achieve professional goals the highestMicroclinic practitioners were the least likely to be planning to leave their practice.
RESULTS: PRACTICEMicroclinic:Least likely to work under time pressuresHave the most influence over management decisions affecting their practiceAre more often able to match the degree of complexity of a patient to the amount of time spent. Most satisfied with opportunities to fully utilize skills.
SCOPE OF PRACTICEOnly 16% of those in a micropractice do inpatient medicine (vs 91% residency and community)Only 9% do OB. (vs 44% community and 65% residency)
RESULTS: COMPOSITE SATISFACTION
Composite Satisfaction scale based on 8 items that asked directly about satisfactionOne item deleted (plan to leave workgroup in near future) because substantially lowered overall reliability of scaleFinal scale had reliability of alpha = 0.77 (acceptable/good)
COMPOSITE SATISFACTIONPractice models differ in Composite Satisfaction (P < 0.001)
Community Clinic24.8Microclinic29.1Residency Clinic25.6
DIFFERENT CHARACTERISTICS CONFOUNDERS?Age, gender, years since residency, and number of hours spent on patient care each week do not differ significantly among practice models
Years in Current Practice and Practice Setting (urban-suburban-rural) do differ
PRACTICE SETTINGAlthough the setting differs among the 3 practice models, Microclinic practices have the most balanced distribution of the 3 models, so not likely the cause of greater satisfactionPractice setting compared for Community, Microclinic, and Residency clinic models
YEARS IN THE SAME PLACEThose with less than 5 and more than 20 years in the same clinic are most satisfied (top)And those in Microclinic practices definitely fall into the fewer than 5 category (bottom)Satisfaction and years in clinic all 3 practice modelsYears in current clinic by practice model
YEARS IN THE SAME PLACEHowever, if we look at only the Residency and Community clinic physicians, it is clear that those with fewer than 5 years in the same clinic are more satisfied within those settings as well.Satisfaction and years in clinic Residency and Community Clinics only
DISCUSSION-Community clinics:Sense of organization being too big, that physicians are not a part of the decision making team. Not enough support for primary care. Sense that one size does not fit all
DISCUSSIONResidency clinics:Not enough support/positive reinforcement. Seems like organization only cares about RVUs. Feel pressure to produce, to reach protocol standards, to have patients be very satisfiedno time left to think deeply about anythingDifficulty in continuity of care in residency clinicsBattle between clinic productivity, teaching, researching, leadership rolesTeaching/educating role seems to mitigate some of the negatives- other studies support this finding.
DISCUSSIONMicropractice:Low incomeStill working other jobsTrying to work outside insurance systemHappy to be off hamster wheelGreat to be own bossLoss of procedures/hospital credentialingProbably going to need an assistant
COMMON THEMESRole of support staffFrustrations with the roles of specialist- taking over patients after a consultCommunicationPrimary care as undervaluedStretched too thinInsuranceUnpaid work
CONCLUSIONSOverall physician satisfaction is greater for those working in a micropractice clinic. Micropractice clinicians have an overwhelmingly narrower scope of practice.
FUTUREAre micropractice clinics financially viable? Can the features of a practice that make microclinic providers happier be applied to more traditional models of practice?
REFERENCES: Beasley et. al. Quality of Work life of Independent vs Employed Family Physicians in Wisconsin: A WReN study. Annals of Family Medicine. Vol 3,No 6. Nov/Dec 2005
Linzer, M, et. al. Physician stress: results from the physician work life study. Stress health. 2002; 8:37-42
Moore LG. Going solo: one doc, one room, one year later. Fam Pract Manag. March2002:2529.
Moore LG. The Ideal Medical Practice Model: Improving Efficiency, Quality and the Doctor-Patient Relationship. Fam Pract Manag.2007Sep;14(8):20-24