OBJECTIVE: Because career satisfaction among general internists is relatively low, we sought to understand the impact on satisfaction of general internists managing patients both in and outside of the hospital. Using data from a national survey, we asked, "Among outpatient-oriented general internists (i.e., internists who spend less than 50% of their clinical time caring for inpatients), what effect does time spent in the hospital have on physician satisfaction, stress, and burnout?" DESIGN/PARTICIPANTS: The Physician Worklife Study, in which 5,704 physicians in primary and specialty nonsurgical care selected from the American Medical Association's Masterfile were surveyed (adjusted response rate = 52%), was used. Our analyses focused on clinically active outpatient-oriented general internists (N = 339). MEASUREMENTS AND MAIN RESULTS: We constructed multivariate linear models to test for statistically significant associations between the amount of time spent seeing inpatients and physician satisfaction as measured by several satisfaction scales. Even after controlling for total hours worked and other possible confounding variables, we found that increased time working in the hospital was significantly associated with decreases in satisfaction with administration, specialty, autonomy, and personal time, and significantly associated with an increase in life stress. There was also a significant association between increased time spent in the hospital and burnout. CONCLUSIONS: Our findings imply that there may be a tension between the practice of inpatient and outpatient medicine by general internists, and suggest that fewer hospital duties may increase career satisfaction for outpatient-oriented internists. Although additional studies are warranted in order to better understand why these relationships exist, our data suggest that the hospitalist model of inpatient care might be one approach to alleviate stress and improve satisfaction for many general internists.
Bibliographical noteFunding Information:
Received from the Health Services Research and Development Field Program, Ann Arbor VA Center for Practice Management and Outcomes Research (SS, JKZ, RAH), and the Department of Internal Medicine, University of Michigan Medical School (SS, RAH), Ann Arbor, Mich; the Department of Medicine and Department of Health Behavior and Health Education, University of North Carolina Schools of Medicine and Public Health (CEG), and the Division of Health Professions and Primary Care, Sheps Center, University of North Carolina School of Medicine (TRK), Chapel Hill, NC; and the Department of Medicine, University of Wisconsin–Madison School of Medicine (ML), Madison, Wis.
The Physician Worklife Study was supported by grant #27069 from the Robert Wood Johnson Foundation and analyses for this paper were supported, in part, by VA Health Services Research & Development. Dr. Saint is supported by a Career Development Award from the Health Services Research & Development Service of the Department of Veterans Affairs and a Patient Safety Developmental Center grant from the Agency for Healthcare Research and Quality (P20-HS11540).
- Job satisfaction
- Primary health care
- Professional practice