Kikano G E, Goodwin M A, Stange K C
Department of Family Medicine, Case Western Reserve University, Cleveland, OH, USA.
J Fam Pract. 1998 Jun;46(6):499-505.
Many physicians today are employed by another physician, group, hospital, HMO, or other organization. However, the differences in the characteristics, practice patterns, and patient outcomes of self-employed and employed physicians are not well understood.
The practices of 108 community family physicians in northeast Ohio were assessed using a multimethod cross-sectional design. Physician characteristics were assessed by questionnaire. Direct observation of 3536 consecutive patient visits was used to measure time use and the delivery of preventive services recommended by the US Preventive Services Task Force. Patient satisfaction was assessed with the Medical Outcomes Study (MOS) 9-item Visit Rating Form.
Employed physicians were more likely to be female, in group practice, work fewer hours, and see fewer patients. Job satisfaction was similar between the two groups, but employed physicians reported greater satisfaction with leisure and family time. Employed physicians spent more time per patient visit, scheduled a larger percentage of well-care visits, and were more likely to refer to specialists. Employed physicians also spent a greater proportion of their patients' visit time performing history-taking and eliciting family information, and a lesser proportion of time on physical examination, planning treatment, providing health education, and chatting. Recommended screening and health habits counseling preventive services were more likely to be delivered by employed physicians. Patient satisfaction was similar for the two groups.
Primary care physician characteristics and practice patterns differ by employment status. The consequences of the trend toward a largely employed physician workforce as reported in this study should be carefully considered.
如今许多医生受雇于其他医生、医疗团队、医院、健康维护组织（HMO）或其他机构。然而，个体执业医生与受雇医生在特征、执业模式和患者治疗结果方面的差异尚未得到充分了解。
采用多方法横断面设计对俄亥俄州东北部108名社区家庭医生的执业情况进行评估。通过问卷调查评估医生特征。对连续3536次患者就诊进行直接观察，以测量时间利用情况以及美国预防服务工作组推荐的预防服务提供情况。使用医疗结果研究（MOS）9项就诊评分表评估患者满意度。
受雇医生更有可能为女性，在团队执业，工作时间较短，看诊患者较少。两组的工作满意度相似，但受雇医生对休闲和家庭时间的满意度更高。受雇医生每次患者就诊花费的时间更多，安排的健康检查就诊比例更大，更有可能转诊至专科医生。受雇医生在患者就诊时也花费更大比例的时间进行病史采集和了解家庭信息，而在体格检查、制定治疗计划、提供健康教育和聊天方面花费的时间比例较小。受雇医生更有可能提供推荐的筛查和健康习惯咨询等预防服务。两组的患者满意度相似。
初级保健医生的特征和执业模式因就业状况而异。本研究报告的医生劳动力大量受雇化趋势的后果应予以仔细考虑。
