Management practices, physician autonomy, and satisfaction. Evidence from mental health institutions in the Federal Republic of Germany.

Physicians are moving into organized settings where their autonomy is more constrained and where management has more responsibility for physician satisfaction. The relationship of management practices to physician autonomy and satisfaction was explored in a survey of 185 psychiatrists in the State of Hessen in the Federal Republic of Germany (FRG). Analysis revealed that controlling for physician and institutional characteristics, management practices in relationship to participative activities, supportive communication, and peer review activities were the most important predictors both of perceived clinical autonomy and of work satisfaction. Gender was also a factor in that male physicians experienced greater perceived autonomy. Perceived clinical autonomy was an important factor in explaining satisfaction, whereas a few other physician and institutional characteristics were significant in predicting satisfaction. Unexpectedly, there was more perceived clinical autonomy among psychiatrists in larger, less well funded, more managerially constrained, state institutions than in smaller, community general hospitals and private organizations. Implications for further research are discussed.