Sind amerikanische Ärzte zufriedener? – Ergebnisse einer internationalen Studie unter Ärzten an Universitätskliniken

 

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Zusammenfassung

Ein besseres Verständnis der Faktoren, die die ärztliche Arbeitszufriedenheit beeinflussen, ist nicht nur für Ärzte, sondern auch für Patienten, Manager und Politiker von Relevanz. Ärzte stellen die zentrale Ressource im Gesundheitswesen dar. Wenn eine effizientere und qualitätsorientierte Gesundheitsversorgung erreicht werden soll, ist es unerlässlich, die Motivatoren von Ärzten zu untersuchen und stärker zu berücksichtigen. Untersuchungen haben gezeigt, dass die Arbeitszufriedenheit von Ärzten bedeutende Effekte auf die Produktivität, die Qualität der Versorgung und die Anzahl ärztlich tätiger Mediziner hat. Diese Studie untersucht den Zusammenhang zwischen arbeitsbezogenen monetären und nicht-monetären Faktoren und deren Einfluss auf die Arbeitszufriedenheit zweier vergleichbarer Stichproben von Ärzten in Universitätskliniken in Deutschland und den USA; zwei Länder, die trotz unterschiedlicher Gesundheitssysteme beide Probleme mit der Rekrutierung und Erhaltung ihrer ärztlichen Arbeitskräfte haben. Die Antworten auf den Fragebogen wurden mittels Faktoren- und Korrelationsanalyse sowie deskriptiver Statistik ausgewertet. Die Ergebnisse zeigen, dass deutsche Ärzte im Allgemeinen weniger zufrieden sind als US-amerikanische. Im Hinblick auf bestimmte arbeitsbezogene Prädiktoren der ärztlichen Zufriedenheit ergaben sich in beiden Ländern ähnliche Faktoren. Um die ärztliche Zufriedenheit zu verbessern, sollten Maßnahmen ergriffen werden, die die zeitliche Belastung der Ärzte verringern und die Möglichkeit zur stärkeren Interaktion mit Patienten und Kollegen fördern. Außerdem sollten auch die monetären Anreize verbessert werden und die Einbindung von Ärzten in die Entwicklung von Versorgungsprozessen und administrative Entscheidungen der Patientenversorgung gefördert werden.

Abstract

Understanding the factors that affect physicians’ job satisfaction is important not only to physicians themselves, but also to patients, health system managers, and policy makers. Physicians represent the crucial resource in health-care delivery. In order to enhance efficiency and quality in health care, it is indispensable to analyse and consider the motivators of physicians. Physician job satisfaction has significant effects on productivity, the quality of care, and the supply of physicians. The purpose of our study was to assess the associations between work-related monetary and non-monetary factors and physicians’ work satisfaction as perceived by similar groups of physicians practicing at academic medical centres in Germany and the U.S.A., two countries that, in spite of differing health-care systems, simultaneously experience problems in maintaining their physician workforce. We used descriptive statistics, factor and correlation analyses to evaluate physicians’ responses to a self-administered questionnaire. Our study revealed that overall German physicians were less satisfied than U.S. physicians. With respect to particular work-related predictors of job satisfaction we found that similar factors contributed to job satisfaction in both countries. To improve physicians’ satisfaction with working conditions, our results call for the implementation of policies that reduce the time burden on physicians to allow more time for interaction with patients and colleagues, increase monetary incentives, and enhance physicians’ participation in the development of care management processes and in managerial decisions that affect patient care.

Literatur

• 1 Firth-Cozens J, Greenhalgh J. Doctor's perceptions of the links between stress and lowered clinical care.  Social Science Medicine. 1997;  44 ((7)) 1017-1022
  CrossrefPubMedGoogle Scholar
• 2 Williams ES, Konrad TR, Linzer M. et al . Physician, practice, and patient characteristics related to primary care physician physical and mental health: Results from the Physician Worklife Study.  Health Services Research. 2002;  37 ((1)) 121-143
  PubMedGoogle Scholar
• 3 Mechanic D. Physician discontent.  Journal of the American Medical Association. 2003;  290 ((7)) 941-946
  CrossrefPubMedGoogle Scholar
• 4 Simoens S, Hurst J. The supply of physician services in OECD countries.  OECD Health Working Papers. 2006;  no 21
  PubMedGoogle Scholar
• 5 Federal Physicians Chamber . Results of physicians’ statistics 2005.  , Special Issue February 24, 2005. Available at http://www.bundesaerztekammer.de/30/aerztestatistik/03statistik2005/index.html , Juli 20, 2007: Tabelle 8
  PubMedGoogle Scholar
• 6 Federal Physicians Chamber . Results of physicians’ statistics 2005. Special Issue February 24, 2005.  , Available at http://www.bundesaerztekammer.de/30/aerztestatistik/03statistik2005/index.html , Juli 20, 2007: Tabelle 9
  PubMedGoogle Scholar
• 7 Federal Physicians Chamber . Results of physicians’ statistics 2005.  , Special Issue February 24, 2005. Available at http://www.bundesaerztekammer.de/30/aerztestatistik/03statistik2005/index.html , Juli 20, 2007: Tabelle 6
  PubMedGoogle Scholar
• 8 Ramboll Management .Gutachten im Auftrag des Bundesministeriums für Gesundheit und Soziale Sicherung zum Ausstieg aus der kurativen ärztlichen Beruftsätigkeit in Deutschland. BMGS-Publikation 2005
• 9 Janus K, Amelung VE, Gaitanides M. et al . German physicians „on strike” – Shedding light on the roots of physician dissatisfaction.  Health Policy. 2007;  82 357-365
  CrossrefPubMedGoogle Scholar
• 10 Cooper RA, Getzen TE, McKee HJ. et al . Economic and demographic trends signal an impending physician shortage.  Health Affairs. 2002;  21 ((1)) 140-154
  CrossrefPubMedGoogle Scholar
• 11 Grumbach K. The ramifications of specialty dominated medicine.  Health Affairs. 2002;  21 ((1)) 155-159
  PubMedGoogle Scholar
• 12 Weiner JP. A shortage of physicians or a surplus of assumptions?.  Health Affairs. 2002;  21 ((1)) 160-162
  PubMedGoogle Scholar
• 13 Snyderman R, Sheldon GF, Bischoff TA. Gauging supply and demand: The challenging quest to predict the future physician workforce.  Health Affairs. 2002;  21 ((1)) 167-168
  CrossrefPubMedGoogle Scholar
• 14 Landon BE, Reschovsky JD, Pham HH. et al . Leaving medicine: The consequences of physician dissatisfaction.  Medical Care. 2006;  44 ((3)) 234-242
  CrossrefPubMedGoogle Scholar
• 15 Grumbach K, Vranizan K, Bindman AB. Physician supply and access to care in urban communities.  Health Affairs. 1997;  16 ((1)) 71-86
  CrossrefPubMedGoogle Scholar
• 16 Council on Graduate Medical Education .Physician distribution and health care challenges on rural and inner city areas: Tenth report to congress and the Department of Health and Human Services. Secretary. Rockville, MD: Health Resources and Services Administration, U.S. Department of Health and Human Services 1998
• 17 Ricketts TC. The changing nature of rural health care.  Annual Review of Public Health. 2000;  21 639-657
  CrossrefPubMedGoogle Scholar
• 18 Grumbach KD. Primary care in the United States – The best of times, the worst of times.  New England Journal of Medicine. 1999;  341 ((26)) 2008-2010
  CrossrefPubMedGoogle Scholar
• 19 Grumbach K. The ramifications of specialty dominated medicine.  Health Affairs. 2002;  21 ((1)) 155-159
  PubMedGoogle Scholar
• 20 Mechanic D. Physician discontent.  Journal of the American Medical Association. 2003;  290 ((7)) 941-946
  CrossrefPubMedGoogle Scholar
• 21 Kassirer JP. Doctor discontent.  New England Journal of Medicine. 1998;  339 1543-1545
  CrossrefPubMedGoogle Scholar
• 22 Campion EW. A symptom of discontent.  New England Journal of Medicine. 2001;  344 ((3)) 223-225
  CrossrefPubMedGoogle Scholar
• 23 Rittenhouse DR, Mertz E, Keane D. et al . No exit: An evaluation of measures of physician attrition.  Health Services Research. 2004;  39 ((5)) 1571-1588
  CrossrefPubMedGoogle Scholar
• 24 Landon BE, Rechovsky JD, Blumenthal D. Changes in career satisfaction among primary care and specialist physicians, 1997–2001.  Journal of the American Medical Association. 2003;  289 ((4)) 442-449
  CrossrefPubMedGoogle Scholar
• 25 Ramboll Management .Gutachten im Auftrag des Bundesministeriums für Gesundheit und Soziale Sicherung zum Ausstieg aus der kurativen ärztlichen Beruftsätigkeit in Deutschland. BMGS-Publikation 2005
• 26 Herzberg F, Mausner B, Snyderman BB. The motivation to work (2. Ausgabe). New York: John Wiley & Sons, Inc. 1959
• 27 Bovier PA, Perneger TV. Predictors of work satisfaction among physicians.  European Journal of Public Health. 2003;  13 299-305
  CrossrefPubMedGoogle Scholar
• 28 Williams ES, Konrad TR, Linzer M. et al . Refining the measurement of physician job satisfaction: Results from the Physician Worklife Survey. SGIM Career Satisfaction Study Group. Society of General Internal Medicine.  Medical Care. 1999;  37 ((11)) 1140-1154
  CrossrefPubMedGoogle Scholar
• 29 Konrad TR, Williams ES, Linzer M. et al . Measuring physician job satisfaction in a changing workplace and a challenging environment. SGIM Career Satisfaction Study Group. Society of General Internal Medicine.  Medical Care. 1999;  37 ((11)) 1174-1182
  CrossrefPubMedGoogle Scholar
• 30 OECD .OECD Health Data. OECD: Paris 2004
• 31 Fottler MD, Shewchuk RM, O’Connor SJ. What matters to health care executives? Assessing the job attributes associated with their staying or leaving.  International Journal of Organization Theory and Behavior. 1998;  1 ((2)) 223-247
  PubMedGoogle Scholar
• 32 Grumbach K, Osmond D, Vranizan K. et al . Primary care physicians’ experience of financial incentives in managed-care systems.  New England Journal of Medicine. 1998;  339 1516-1521
  CrossrefPubMedGoogle Scholar
• 33 Hemenway D, Killen A, Cashman SB. et al . Physicians’ responses to financial incentives.  New England Journal of Medicine. 1990;  322 1059-1063
  PubMedGoogle Scholar
• 34 Hillman AL. Financial incentives for physicians in HMOs: Is there a conflict of interest?.  New England Journal of Medicine. 1987;  317 1743-1748
  PubMedGoogle Scholar
• 35 Hillman AL. Managing the physician: Rules versus incentives.  Health Affairs Winter. 1991;  138-146
  PubMedGoogle Scholar
• 36 Hillman AL, Pauly MV, Kerstein JJ. How do financial incentives affect physicians clinical decisions and the financial performance of health maintenance organizations?.  New England Journal of Medicine. 1998;  321 86-92
  PubMedGoogle Scholar
• 37 Hadley J, Mitchell JM. Effects of HMO market penetration on physicians’ work effort and satisfaction.  Health Affairs. 1997;  16 ((6)) 99-111
  PubMedGoogle Scholar
• 38 Baker GP, Jensen MC, Murphy KJ. Compensation and incentives: Practice versus theory.  The Journal of Finance. 1988;  43 ((3)) 593-616
  CrossrefPubMedGoogle Scholar
• 39 Karasek  Jr  RA. Job demands, job decision latitude and mental strain: implications for job redesign.  Administrative Science Quarterly. 1979;  24 285-307
  CrossrefPubMedGoogle Scholar
• 40 Janus K, Amelung VE, Baker LC. et al . Monetary and non-monetary drivers of physician job satisfaction – Insights from a cross-national comparative study.  Journal of Health Politics, Policy and Law. 2008;  33 ((6)) 1133-1167
  CrossrefPubMedGoogle Scholar

Korrespondenzadresse

Prof. Dr. K. Janus

Department of Health Policy and Management

Columbia University

600 West 168th Street

6th floor

New York

NY 10032

Email: kj2186@columbia.edu