Both patient and physician satisfaction are complex responses to an individual's values, attitudes, expectations of the encounter, and experiences. Our work suggests that there is an association between the professional satisfaction of general internists and the satisfaction of their patients. There are several potential explanations for this finding.
A patient's satisfaction with a medical encounter results from the patient's perception that his or her expectations have been met and requests fulfilled.18
Physicians who are themselves more satisfied may be better able to address a patient's questions and concerns.19
A physician's affect toward their patients is correlated with patient satisfaction.20,21
Providers who are more satisfied with their professional life may communicate better or be more empathetic.22
An alternative explanation of the observed relation between physician and patient satisfaction is that both patient and provider satisfaction are determined by some other aspect of the delivery of care that we did not measure. Physicians with greater professional competence may have greater professional satisfaction, and patients may be able to detect better competence, which results in better satisfaction.18
Patients and physicians in large managed care organizations have independently been shown to be less satisfied; physicians are dissatisfied with their clinical autonomy and patients are dissatisfied because they are concerned about their access to their physician.3
Physicians who take care of more capitated patients report lower satisfaction with the quality of care that they can provide for these patients23
; these patients may also be less satisfied with their care.2
Practice sites with more satisfied patients have been shown to have more satisfied physicians.11
It is also possible that patients who are more satisfied with their care prompt their physician to feel more satisfied with his or her work life.
Studies have examined the relation between several patient and physician characteristics and patient satisfaction. Older patients consistently appear to be more satisfied than younger patients.3,19,24
Gender, ethnicity, income, and education have all shown inconsistent effects on satisfaction.3,19,24–27
Paralleling prior work,2
we found that patients with managed care insurance had lower overall satisfaction with medical care, but their satisfaction with the most recent physician visit was similar to that of patients with other types of insurance coverage. Lower satisfaction among patients with managed care has been shown to be in part due to limitations in choosing a primary care physician.16
The conclusions of many studies of patient satisfaction have been limited by sample size. Our sample is large by comparison, and we are able to look more definitively at the independent effects of these factors.
Prior work has suggested that the physician's age,3
may affect patient satisfaction, but we did not find a significant relation between these physician characteristics and patient satisfaction. It is intriguing that the patients of physicians who work part-time were more satisfied than those of physicians who work full-time. Perhaps physicians who work part-time feel less time pressure and are therefore able to listen and respond to patients' concerns more thoroughly.
Our study has several limitations. We did not examine the concordance of patient and physician satisfaction with a specific interaction. Rather we chose to examine the association between physician satisfaction and the satisfaction of a sample of patients in their practice. The identity of a patient's primary care physician was not obtained directly from the patient, but rather from the patient's medical record. Any differences in assignment should be random and, if anything, would bias our findings away from the described relation between physician and patient satisfaction. We do not have information about the penetrance of managed care in a physician's overall practice. The penetrance of managed care in a practice could affect both patient and physician satisfaction. Depression has been associated with patient satisfaction and may also be associated with physician satisfaction. We did not measure patient or physician depression and therefore cannot control for its effect. Finally, we measured only limited aspects of patient and physician interaction. We do not believe that satisfaction is the only important dimension of this interaction.
Managed care has produced increasing financial and time constraints for general internists. We believe that the interrelation between physician and patient satisfaction is an important issue in our health care system. The consumer movement in health care empowers patients and insists that providers find ways to improve patient satisfaction with care. Conversely, managed care is perceived as disempowering physicians and decreasing their professional satisfaction. Our work suggests that to improve patient satisfaction, one must also consider physician satisfaction.