Managed Care, Professional Autonomy, and Income:

Effects on Physician Career Satisfaction

October 2001
Journal of General Internal Medicine , 16 (10), 675-684
Marie C. Reed, Alison K. Vratil, Jeffrey Stoddard, J. Lee Hargraves

anaged care appears to exert its effect on physicians’ career satisfaction through impact on professional autonomy, rather than through income reduction. The level of career satisfaction derived by physicians from their work is a basic—yet—essential element in the functioning of the health care system. This study, using data from 1996-97 Community Tracking Study Physician Survey, examines the degree to which professional autonomy, compensation and managed care are associated with career satisfaction among physicians. It is the first study to comprehensively assess the relative importance of predictors of physician career satisfaction.

Among a wide range of physician personal and practice measures, the authors of this study found that traditional core professional values and autonomy were the most important determinants of career satisfaction after controlling for all other factors. Income, relative to physicians in similar specialties, was also positively associated with satisfaction. Greater professional autonomy was strongly associated with more satisfaction with career, while the effect of managed care does not. As managed care evolves, policy makers may need to focus efforts on retaining physicians’ sense of autonomy while encouraging use of evidence-based medical care.

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