RESidENcy PROGRAM Scholarly and Community Medicine Projects

Does Micropractice Lead to Macrosatisfaction?
Meaghan Combs, MD, MPH; Elizabeth Paddock, MD; Melissa Stiles, MD, Ron Prince, MS
University of Wisconsin, Department of Family Medicine, Madison, WI
ABSTRACT RESULTS RESULTS OUTCOMES: SATISFACTION
Physician quality of work life is a well recognized
key factor in career choice and retention. No
comparison exists between traditional practices and
p y p y p y
by the University of Wisconsin Department of
Family Medicine in community and residency
clinics and physicians working in micropractice
clinics across the USA. Micropractice clinics are
defined as those which are independent, with low
overhead, and extended visit time with patients.
•Micropractice physicians reported:
• greater satisfaction with opportunities to fully
utilize skills in practice, (mean score of 4.38 compared to
Community and Residency clinic mean scores of 3.55 and 3.58, respectively,
(Krusal-Wallis = 13.779, p=0.001).)
• more satisfaction with amount of time spent with
family, (mean score of 4.09 compared to Residency and Community
clinic mean scores of 2.97 and 2.30, respectively, (K-W = 25.794, p=0.000).)
• working under time pressure only occasionally, (mean
score of 2.50, compared to often by Community and Residency clinics, mean
scores of 4.07 and 4.08, respectively (K-W = 4.839, p=0.00).)
• more likely to agree: able to match time spent with
patients to the level of complexity of the patient’s
care, (mean score of 4.63 compared to Community and Residency
physicians, mean scores of 3.29 and 3.00, respectively (K-W test of 39.277,
p=0.00).)
• they were not planning to leave the work group in
the h near ffuture,
(K-W test of 10.94, p=0.004.)
•Residency clinic physicians reported:
• greater satisfaction with current income, (mean score
of 3.25, compared to Community and Micropractice clinic mean
scores of 2.76 and 2.32, respectively. (K-W = 6.549, p=0.38).)
micropractices. We surveyed physicians employed ( ,p ))
Methods Community Clinic:
• “The dissatisfaction with income arises because of the lack of valuing
• Validated survey assessed physician satisfaction with current
employment
• Survey invitation emailed to University of Wisconsin, Department of
Family Medicine residency clinic and community clinic physicians and
a national sample of self-identified micropractice physicians
• Surveys were completed through online survey tool
(http.//survey.wisc.edu)
• Responses were all anonymous
• Data was analyzed y using gSPSS and the online survey y tool
• Krusal-Wallis or chi-square tests were used to assess data for
statistically significant differences to questions in regards to
Satisfaction, Practice Issues, Outcomes, and Scope of Practice amongst
the three identified employment models: community clinic,
micropractice, and residency clinic.
• 92 total respondents
GENDER
AGE
CLINIC TYPE
RESEARCH POSTER PRESENTATION DESIGN © 2011
www.PosterPresentations.com
Demographics g p
51% male
N=46
47% 25-45 yrs
N=43
32% Community
N=29
49% female
N=44
52% 45-65 yrs
N=47
24% Microclinic
N=22
1% >65 yrs
N=1
44% Residency
N=40
primary care relative to specialist medicine.”
• “I get discouraged with all the uncompensated time--phone calls, dictations,
Mychart, and I am often working from home or on my days off to complete
these things.”
Microclinic:
• “I would not trade this model for anything short of bankruptcy”
• “My hospital recredentialling is coming up and I will have to give up
privileges. In the last 2 years I have only had 2 patients hospitalized”
Residency Clinic:
• “We'd W nearly yall enjoy j y more time with our families!”
Community Clinic:
• “I don't enjoy jymy ywork
as much as I could if I were to have more time to
learn and to teach patients...this is the difficulty of trying to be 'efficient' while
being 'thorough'”
Microclinic:
• “I am not able to perform some of the procedures that I previously was able
to perform...I cannot afford this equipment, would not have the number to
support their purchase, do not have staff for it, do not have room for it.”
Community Clinic:
• “you left out the effects of ancillary support staff. In small group practice
models the MD's have much more control over who they work with in clinic
setting. Now that seems controlled more by the "big organization" , unless
you have a very dedicated clinic manager committed to the continuity of
patient care”
Microclinic:
• “30-40 hours is PATIENT time, another 10 hours on paper work drivel”
Residency:
• “Patient care is 40-55 hours, with 12 additional hours of
administrative/teaching time, which is often encroached by the patient care
time”
Community Clinic:
• “My My happiness/satisfaction is integrally tied to the quality of my
support staff. I didn't see any questions about these individuals. When
they support my practice and are efficient, we act as a team and can
provide good care. If I don't have that support,then my satisfaction really
plummets.”
Microclinic:
• “I would NEVER go back to being employed or on the hamster wheel
again”
OUTCOMES:
SCOPE OF PRACTICE
•84% Community & 90% Residency clinic physicians
DO practice inpatient medicine
• 86% Microclinic physicians
DO NOT practice inpatient medicine
• 44% Community & 65% Residency physicians
DO practice OB
• 91% Microclinic physicians
DO NOT practice ti OB
• Microclinic physicians have been in their current model of
practice
for no more than 10 years
• Community Clinic physicians reported most hours of patient care
per week
REFERENCES
Beasley et. al. Quality of Work life of Independent vs Employed Family
Physicians in Wisconsin: A WReN study. Annals of Family Medicine. Vol
3,No 6. Nov/Dec 2005
Linzer, M, et. al. Physician stress: results from the physician work life study.
Stress health. 2002; 8:37-42
Moore LG. Going solo: one doc, one room, one year later. Fam Pract
Manag. March2002:25–29.
Moore LG. The Ideal Medical Practice Model: Improving Efficiency, Quality
and the Doctor-Patient Relationship. Fam Pract Manag. 2007 Sep;14(8):20-
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