Staff Model HMO Doctors Happier than Independent Practice Counterparts, Study Finds
San Mateo County physicians who work in a "traditional staff group model HMO" were more satisfied with the "quality of practice and patient care" and reported less income decline than physicians who work in an "office-based independent practice," according to a new study published in this week's Archives of Internal Medicine. To study the "managed care environment" -- which has "evolved from traditional staff group model HMOs into increasingly decentralized and complex networks of providers" -- researchers at Stanford University evaluated 1998 survey responses from 250 independent physicians and 113 physicians working for Kaiser Permanente, the county's sole remaining group model HMO. The authors write that San Mateo was an "excellent setting" for the study because it "has experienced managed care from its inception and in its various forms." Here are some of the results of the study:
- Physicians from the two groups "reported similar hours worked per week, time spent with patients during office visits and total patient encounters per week";
- 61% of independent physicians, however, said their income had declined since 1993, compared to 47% of group model physicians. The rate of "substantial" income decline -- defined as greater than 25% in revenue -- was 27% to 4%, respectively.
- Controlling for "income changes, practice setting, years in practice" and gender, group model physicians were "significantly more satisfied with a variety of professional and quality of care issues, viewed more favorably the utility of treatment guidelines and drug formularies and held more positive general perceptions of managed care than" independent physicians (Chehab et al., Archives of Internal Medicine, 1/22).
- 4% of independent doctors said that "working with managed care insurance guidelines improved patient care," compared to 56% of group doctors (Whitney, San Mateo County Times, 1/25).
Study authors conclude that their findings "suggest that the structure of managed care plans for physicians not in a traditional [group model] HMO is suboptimal and negatively affects physician perceptions of the quality of their professional practice and the quality of care offered to patients" (Archives of Internal Medicine, 1/22). Philip Alper, a private practice internist and lead author of the study, attributed the varying attitudes to the fact that Kaiser Permanente doctors "participate in making the rules" regarding patient treatment. He blamed HMOS for what he called a "wasteful and stupid way to practice medicine" in which private practice physicians are having to spend "more and more time and money" on administrative work (San Mateo County Times, 1/25). And Dr. Thomas Raffin, study co-author and co-director of the Stanford Center for Biomedical Ethics, said, "The take-home message [of the study] is that physicians feel more satisfied if they find consistency in the ways the financial, prescription and other controls are administered" (AScribe News, 1/23). To view the entire study, go to http://archinte.ama-assn.org/issues/current/rfull/ioi00284.html.This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.