Frequency of satisfaction and dissatisfaction with practice among rural-based, group-employed physicians and non-physician practitionersReport as inadecuate

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BMC Health Services Research

, 16:613

Health systems and services in low and middle income settings


BackgroundWidespread dissatisfaction among United States U.S. clinicians could endanger ongoing reforms. Practitioners in rural-underserved areas withstand stressors that are unique to or accentuated in those settings. Medical professionals employed by integrating delivery systems are often distressed by the cacophony of organizational changes that such consolidation portends. We investigated the factors associated with dis-satisfaction with rural practice among doctors-non-physician practitioners employed by an integrated healthcare delivery network serving 9 counties of upstate New York, during a time of organizational transition.

MethodsWe linked administrative data about practice units with cross-sectional data from a self-administered multi-dimensional questionnaire that contained practitioner demographics plus valid scales assessing autonomy-relatedness needs, risk aversion, tolerance for uncertainty-ambiguity, meaningfulness of patient care, and workload. We targeted medical professionals on the institutional payroll for inclusion. We excluded those who retired, resigned or were fired during the study launch, plus members of the advisory board and research team. Fixed-effects beta regressions were performed to test univariate associations between each factor and the percent of time a provider was dis-satisfied. Factors that manifested significant fixed effects were entered into multivariate, inflated beta regression models of the proportion of time that practitioners were dis-satisfied, incorporating clustering by practice unit as a random effect.

ResultsOf the 473 eligible participants. 308 65.1 % completed the questionnaire. 59.1 % of respondents were doctoral-level; 40.9 % mid-level practitioners. Practitioners with heavier workloads and-or greater uncertainty intolerance were less likely to enjoy top-quintile satisfaction; those deriving greater meaning from practice were more likely. Higher meaningfulness and gratified relational needs increased one’s likelihood of being in the lowest quintile of dissatisfaction; heavier workload and greater intolerance of uncertainty reduced that likelihood. Practitioner demographics and most practice unit characteristics did not manifest any independent effect.

ConclusionsMutable factors, such as workload, work meaningfulness, relational needs, uncertainty-ambiguity tolerance, and risk-taking attitudes displayed the strongest association with practitioner satisfaction-dissatisfaction, independent of demographics and practice unit characteristics. Organizational efforts should be dedicated to a redesign of group-employment models, including more equitable division of clinical labor, building supportive peer networks, and uncertainty-risk tolerance coaching, to improve the quality of work life among rural practitioners.

KeywordsJob satisfaction Quality of work life Rural healthcare Health workforce Physicians Nurse practitioners Physician assistants Inflated beta regression AbbreviationsACOsAccountable-Care Organizations

AICAkaike Information Criterion

APCAdvanced-practice clinician

BICBayesian Information Criterion

CIConfidence interval

CNAsCertified nurse assistants

FTEsFull-time equivalents

GAMLSSGeneralized additive model for location, scale and shape

IRBInstitutional Review Board

LPNsLicensed practical nurses

NCNorth Carolina

NLMIXEDNon-linear mixed regression procedure

NPNurse practitioner

PAPhysician assistant

PCAsPersonal care assistants

PRAWSPractitioner Resilience, Adaptability and Well-being Study

Q1 or q1first quartile

Q3 or q3third quartile

RNsRegistered nurses

SAS™Statistical Analysis Software

SDTSelf-determination theory

U.S.United States

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Author: Anthony C. Waddimba - Melissa Scribani - Nicole Krupa - John J. May - Paul Jenkins


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