MDs in Areas With More Resources Have Lower Satisfaction
Primary care doctors who work in areas with the most medical resources -- including specialists, hospital beds and diagnostic equipment -- say they are less satisfied with the quality of care they provide than doctors in areas with fewer resources, according to a study published in the May issue of Annals of Internal Medicine, the Chicago Tribune reports.
Dartmouth Medical School researchers conducted a nationwide survey of 6,000 physicians who treat Medicare patients. Medicare spending was 58% higher in areas with the most resources compared with areas with the fewest. The study finds that 50% of physicians in high-intensity health care areas said they were able to obtain elective hospital admissions for their patients, compared with 64% of physicians in low-intensity areas.
Doctors in high-intensity areas were less likely to say they obtained adequate hospital stays for patients, strong specialist referrals or high-quality diagnostic imaging services. The study also finds that physicians in high-intensity areas are less likely to report satisfaction with their careers.
Elliott Fischer, the study's senior author, said, "To the surprise of many, (these) doctors ... perceive the quality of care to be worse on almost every dimension that we looked at. Doctors are less satisfied, and they perceive the resources to be scarcer, even when they have more."
Brenda Sirovich, the study's lead author, said the increased demand for resources in high-intensity health care areas creates a situation "where demand feeds supply, feeds demand, feeds supply in sort of a never-ending cycle."
Lawrence Casalino, professor of health studies at the University of Chicago, said, "The implications (of the study) are important; it's not that we need to pour more money into the system, and it's not that we need more hospital beds and more specialists."
Earlier Dartmouth studies found that more expensive health care and more services do not improve patient outcomes, and researchers estimated that 30% of Medicare spending is used for unnecessary care (Kotulak, Chicago Tribune, 5/30).