Bates A S, Harris L E, Tierney W M, Wolinsky F D
Department of Pediatrics, Indiana University School of Medicine, Regenstrief Institute for Health Care, Indianapolis, USA.
Med Care. 1998 Apr;36(4):610-7. doi: 10.1097/00005650-199804000-00016.
The purpose of this study was to examine the dimensions of physician work satisfaction across a variety of medical specialties and practice settings.
A modified version of the Scheckler et al survey instrument was mailed to all physicians in Marion County, Indiana. Forty-two percent (777) of the eligible physicians responded. Exploratory factor analysis and internal consistency measures were used to assess the instrument's validity and reliability. Multivariable linear regression was used to predict global and summary scale scores.
Four dimensions of physician work satisfaction were identified: relationships with patients (k = 6, alpha = 0.81), autonomy in clinical decision-making (k = 8, alpha = 0.81), office resources (k = 7, alpha = 0.87), and professional relationships (k = 5, alpha = 0.82). Most (73%) of the physicians were satisfied with their overall practice, and the majority were also satisfied with their income. Significant differences were observed in the sources and magnitude of physician work satisfaction across medical specialty, practice setting, and financial arrangement. Physicians in private practice were most satisfied with their overall practice and office resources, whereas physicians in health maintenance organizations (HMOs) were most satisfied with their autonomy in clinical decision-making. Physicians not working in HMOs but having a large percentage of patients with capitated reimbursement were not enthusiastic about the effect of managed care on their medical practice. Among primary care physicians, family practitioners and general internists were generally less satisfied, and general pediatricians were generally more satisfied with most aspects of their medical practices.
The modified version of the Scheckler et al instrument is a reliable and valid measure of physician work satisfaction. Increases in the market share of managed care have differentially affected the work satisfaction of physicians based on their medical specialty, practice setting, and financial arrangements.
本研究旨在探讨不同医学专科和执业环境下医生工作满意度的维度。
将经修改的施克莱尔等人的调查问卷邮寄给印第安纳州马里恩县的所有医生。42%（777名）符合条件的医生进行了回复。采用探索性因素分析和内部一致性测量来评估该问卷的有效性和可靠性。使用多变量线性回归来预测总体和综合量表得分。
确定了医生工作满意度的四个维度：与患者的关系（k = 6，α = 0.81）、临床决策自主权（k = 8，α = 0.81）、办公资源（k = 7，α = 0.87）和职业关系（k = 5，α = 0.82）。大多数（73%）医生对其总体执业情况感到满意，并且大多数人对自己的收入也感到满意。在不同医学专科、执业环境和财务安排方面，医生工作满意度的来源和程度存在显著差异。私人执业医生对其总体执业情况和办公资源最满意，而健康维护组织（HMO）的医生对其临床决策自主权最满意。不在HMO工作但有很大比例患者采用按人头付费报销的医生，对管理式医疗对其医疗执业的影响并不热衷。在初级保健医生中，家庭医生和普通内科医生总体上满意度较低，而普通儿科医生对其医疗执业的大多数方面总体上更满意。
施克莱尔等人问卷的修改版是一种可靠且有效的医生工作满意度测量工具。管理式医疗市场份额的增加，根据医生的医学专科、执业环境和财务安排，对医生的工作满意度产生了不同的影响。
