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Worklife and Satisfaction of General Internists
Tosha B. Wetterneck, MD;
Mark Linzer, MD;
Julia E. McMurray, MD;
Jeffrey Douglas, PhD;
Mark D. Schwartz, MD;
JudyAnn Bigby, MD;
Martha S. Gerrity, MD;
Donald E. Pathman, MD, MPH;
David Karlson, PhD;
Elnora Rhodes;
for the Society of General Internal Medicine Career Satisfaction Study
Group
Arch Intern Med. 2002;162:649-656.
Background Prior studies have reported relatively low job satisfaction for general
internists. We used data from a large US physician survey to assess correlates
of satisfaction of general internists.
Methods The Physician Worklife Survey was mailed to a national random stratified
sample of 5704 US physicians. General internists were assessed for their satisfaction,
training, patient mix, work hours, the likelihood of recommending their specialty
to medical students, and job stability. We then compared them with a specialist
sample (internal medicine subspecialists [IMSSs]) and a primary care sample
(family physicians [FPs]). Logistic regression was used to model predictors
of satisfaction, stress, and medical student recruitment.
Results There were 2326 respondents (adjusted response rate, 52%): 450 (19%)
were general internists; 502 (22%), FPs; and 438 (19%), IMSSs. General internists
were less satisfied than were IMSSs with their relationships with colleagues
and with patient care issues (P<.01 for both)
and less satisfied than were FPs with community ties (P = .001). Global job, career, and specialty satisfaction were significantly
lower for general internists vs FPs and IMSSs (P<.05).
General internists spent proportionately more of their work week in the hospital
than did FPs (20% vs 13%; P<.001) and more time
providing outpatient care than did IMSSs (56% vs 42%; P<.001). General internists had more patients with complex medical
and psychosocial problems than did FPs (P<.01)
but fewer patients with complex medical problems than did IMSSs (P<.001). Higher satisfaction for general internists was associated
with older physician age, less time pressure during office visits, fewer work
hours, and fewer patients with complex psychosocial problems (P<.05 for all). General internists were less likely than were FPs
to recommend their specialty to medical students (P<.001).
Specialty satisfaction, female gender, and control of hassles predicted medical
student recruitment by general internists.
Conclusions General internists' role of caring for patients with complex problems
is associated with lower levels of satisfaction than for IMSSs and FPs. Adjusting
caseload for patient complexity, expanding time for office visits, and additional
training in the care of patients with psychosocially complex problems may
improve the job satisfaction of general internists and medical student recruitment
into the specialty.
From the Departments of Medicine (Drs Wetterneck, Linzer, and McMurray)
and Biostatistics and Epidemiology (Dr Douglas), University of Wisconsin,
Madison; the Department of Primary Care and Internal Medicine, New York University,
New York (Dr Schwartz); the Department of Medicine, Brigham and Women's Hospital
and Harvard Medical School, Boston, Mass (Dr Bigby); the Department of Internal
Medicine, Oregon Health Sciences University, Portland (Dr Gerrity); the Department
of Family Medicine, University of North Carolina at Chapel Hill (Dr Pathman);
and the Society of General Internal Medicine, Washington, DC (Dr Karlson and
Ms Rhodes).
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