Evolving dissatisfaction among primary care physicians.
OBJECTIVE: To examine trends in career satisfaction among physicians working with managed care plans. STUDY DESIGN: Cross-sectional surveys conducted in 1996 and 1999. PARTICIPANTS AND METHODS: We surveyed primary care physicians (PCPs) affiliated with 5 large health plans in Massachusetts and assessed physicians' ratings of overall satisfaction with their current practice situation and with managed care. RESULTS: A total of 1336 PCPs (56%) responded to the 1996 survey and 966 (42%) responded to the 1999 survey. In 1996, 19.8% of physicians were somewhat or very dissatisfied with their current practice situation vs 33.4% in 1999, an increase of more than 50% (P < .001). Overall dissatisfaction with managed care increased from 28.3% to 62.2% (P < .001). In multivariable models, external influences on physicians' practices were important predictors of overall dissatisfaction. Physicians whose choice of hospitals was restricted (odds ratio, 2.23; 95% confidence interval, 1.30-3.78) and those who reported that managed care plans influenced their practice "a lot" (odds ratio, 1.85; 95% confidence interval, 1.10-3.11) were more likely to be dissatisfied. Adequacy of reimbursement was an important predictor of overall satisfaction and satisfaction with managed care, and ways physicians experienced financial incentives were associated with managed care dissatisfaction. CONCLUSIONS: Primary care physicians in Massachusetts are increasingly dissatisfied with their practice and with managed care. Continued erosion of physician satisfaction could have significant implications for quality of care and the quality of the workforce attracted to medicine as a career.