Juan Nicolas Pena Sanchez Rein Lepnurm Silvia Bermedo

Transcription

Juan‐Nicolas Pena‐Sanchez
Juan Nicolas Pena Sanchez
[email protected]
Rein Lepnurm
Rein Lepnurm
[email protected]
Silvia Bermedo‐Carrasco
Silvia Bermedo Carrasco
[email protected]
2013 CAHSPR Conference
Vancouver BC Canada
Vancouver, BC, Canada
May 28th, 2013
Latent gender inequalities in the well‐being of physicians according to payment methods
1.
Background
• Well‐being of physicians
• Payment methods for physicians
2.
Research objectives
3.
Methods
• Objectives
• Design and sample
• Measures
• Statistical method
i i l
h d
4.
Results
5.
Research limitations and implications
6.
6
Conclusions
“That physician will hardly be thought very careful
of the health of his patients if he neglects his own”
Galen 130–200 A.D.
Latent ggender inequalities in th
he well‐beingg of physicians
Outline
1. Background: well‐being of physicians
practicing medicine1, 2.
3 Emotionally‐charged environment 2‐3 : •
•
•
•
Suffering
Fear
Death
Sexuality
3 Time pressure and erosion of autonomy have been associated with dissatisfaction of physicians33‐55.
associated with dissatisfaction of physicians
3 This is an issue relevant for physicians AND for quality of care
l
f
.
1.
2.
3.
4.
5.
McCue JD. The effects of stress on physicians and their medical practice. N Engl J Med. 1982;306(8):458‐63.
Wallace JE et al. Physician wellness: a missing quality indicator. Lancet. 2009;374(9702):1714‐21
Williams E, Skinner A. Outcomes of physician job satisfaction. Health Care Manage Rev. 2003;28(2):119‐40.
Keeton K et al. of physician career satisfaction, work‐life balance, and burnout. Obstet Gynecol. 2007;109:949‐55.
Stoddard J, et al. Managed care, professional autonomy, and income: effects on physician career satisfaction. J Gen Intern Med. 2001 Oct;16(10):675‐84.
3 Physicians face intrinsic and unalterable tensions of 1. Background: well‐being of physicians
A poor well‐being among physicians could lead to:
•
•
•
•
•
9
Dissatisfaction of physicians influences quality of health services and the relationships with patients6‐8
•
•
1.
2.
3.
4.
5.
6.
7.
8.
Distress1
Inequity of efforts and rewards2
3
Leave direct patient care
p
Burn‐out4
Leaving the medicine5
Related to patient dissatisfaction
Associated with lower compliance with treatments
9
Lepnurm R et al.. A measure of daily distress in practising medicine. Can J Psychiatry 2009;54:170‐80.
Dobson R et al. Developing a scale for measuring professional equity among Canadian physicians. Soc Sci Med 2005;61:263‐6.
Hann M et al. Relationships between job satisfaction, intentions to leave family practice and actually leaving among family physicians in England. Eur J Public Health 2011;21:499‐503.
Escribà‐Agüir V, et al. [Effect of psychosocial work environment and job satisfaction on burnout syndrome among specialist physicians]. Gac Sanit 2008;22:300‐8.
Lanndon B et al. Leaving medicine: the consequences of physician dissatisfaction. Med Care 2006;44:234‐42.
Williams E, Skinner A. Outcomes of physician job satisfaction. Health Care Manage Rev. 2003;28(2):119‐40.
Keeton K et al. Predictors of physician career satisfaction, work‐life balance, and burnout. Obstet Gynecol. 2007;109:949‐55.
Carlsen F, Bringedal B. [Population satisfaction with health care and physician job satisfaction]. Tidsskr Nor Laegeforen. 2009 Feb;129(5):405‐7.
1. Background: well‐being of physicians
increased considerably
increased
considerably1.
3 Conflicts between work and home play significant roles in burnout, and the significant roles in burnout and the
predictors of burnout differ by gender2.
3 A considerable percentage of physicians who are mothers report A
id bl
f h i i
h
h
high levels of work‐to‐family conflicts3.
3 There is evidence that female specialists are paid slightly less in comparison to male physicians 4. 3 New cohorts of female physicians tend to choose alternative payment Latent ggender inequalities in th
3 The proportion of female physicians has methods rather than the traditional schemes5.
1.
2.
3.
4.
5.
Canadian Institute for Health Information (CIHI). Supply, Distribution and Migration of Canadian Physicians, 2010 [Internet]. CIHI 2011
Langballe EM, et al. The predictive value of individual factors, work‐related factors, and work‐home interaction on burnout in female and male physicians. Stress and Health. 2011; 27: 73‐87.
Wallace JE, Lemaire J. On physician wellbeing‐you'll get by with a little help from your friends. Soc Sci Med. 2007; 64: 2565‐77.
Leigh JP, et al. Physician wages across specialties: informing the physician reimbursement debate. Arch Intern Med. 2010; 170: 1728‐34.
Canadian Institute for Health Information (CIHI). Profiling Physicians by Payment Program: A Closer Look at Three Provinces [Internet]. CIHI 2010.
1. Background: payment methods for physicians
t t l h lth
total health expenditures:
dit
*
3 Payment of physicians is the third‐largest category of Figure based on CIHI data: National Health Expenditure Trends, 1975 to 2011. Ottawa: 2011. Available on: https://secure.cihi.ca/estore/productFamily.htm?locale=en&pf=PFC1671
Cost driver contributions to physician expenditure
Canada, from 1998 to 2008
• 6.8% was the average annual growth in physician spending
• Key drivers were
Key drivers were
3 Traditionally physicians have been paid for services provided through Fee‐For p
g
2, 3
Service(FFS)
3 All provinces and territories have p
implemented Alternative Payment Plans (APP)3,4:
•
•
•
•
1.
2.
3.
4.
Salaries
Capitation
Sessional contracts
Blended plans
Source: CIHI. Health Care Cost Drivers: The Facts (2011) ,Pg 20.
CIHI. Health Care Cost Drivers: The Facts. Ottawa: 2011. Available on: https://secure.cihi.ca/estore/productFamily.htm?locale=en&pf=PFC1672
CHSRF. Myth: Most physicians prefer fee‐for‐service payments. Mythbusters Teaching Resource . 2010
CIHI. Canadian Institute for Health Information. Physicians in Canada: The Status of Alternative Payment Programs, 2005–2006. Ottawa: 2008.
Wranik DW, Durier‐Copp M. Physician remuneration methods for family physicians in Canada. Health Care Anal. 2010;18(1):35‐59.
3 Health care cost drivers (1998 to 2008)1:
3 Diverse forms of APPs have been implemented across ,
Canada.
Canada 1, 2
3 APPs have been increasing from 10.6% in 2000 to 26.8% in APPs have been increasing from 10.6% in 2000 to 26.8% in
2010.1
3 Concerns regarding declining physician productivity1
3 Shift to APP may have variable effects on physician Shift to APP may have variable effects on physician
behaviours and clinical practice patterns3
1.
2.
3.
CIHI. Canadian Institute for Health Information. Physicians National Database, Payments and Utilization, Wranik DW, Durier‐Copp M. Physician remuneration methods for family physicians in Canada. Health Care Anal. 2010;18(1):35‐59.
Elit L, Cosby J. Does shifting a physician payment system shift physician priorities? Eur J Gynaecol Oncol. 2006;27(4):375‐8.
Alternative Payment Plans (APPs)
2. Research objectives
To identify differences in the levels of career satisfaction, fulfilment‐recognition d
d d il di
f h i i
b
rewards, and daily distress of physicians by gender and payment method
To assess interactions between gender and payment method on the three measures of physicians’ well‐being.
h i i ’ ll b i
Objectives
3. Methods: design and sample
from July to December 2011
from July to December 2011
3 Inclusion criterion:
• Physicians practicing in the SHR
3 Exclusion criteria:
E l i
i i
• MDs in a residence program
• On leave of absence or retired
3 A survey sent by mail and with an on‐line option offered by e‐mail
li
i
ff d b
il
3 Ethics and Operational Approval
Ethics and Operational Approval
3 Cross‐sectional study conducted 794 physicians were eligible
3. Methods: measures (professional equity)
Balance between contributions and rewards2,3:
–
–
3
3
Tangible rewards
Intangible rewards
A 15‐item scale developed and validated
in 2004, cross‐national study in Canada3
My Outcomes (Salary, promotions, bonuses, etc.)
Others’ Inputs (education, experience, etc.)
Others’ Outcomes (Salary, promotions, bonuses, etc.)
Dimensions3:
•
•
•
1.
2.
3.
My Inputs (education, experience, etc.)
Fulfilment
Financial
Recognition
Adams’ Equity Theory2
Effort‐reward imbalance at work: Theory, measurement and evidence” by Department of Medical Sociology, Duesseldorf University, Pg 3
Borkowsky N. Process theories of Motivation. In: Organizational behavior, theory, and design in health care, Pg 132
Dobson R, Lepnurm R, Struening E. Developing a scale for measuring professional equity among Canadian physicians. Soc Sci Med. 2005 Jul;61(2):263‐6.
3
3. Methods: measures (career satisfaction)
Professional equity and career satisfaction are complementary
3
Integrates four dimensions of career satisfaction1‐2
3
Assesses the higher order needs of physicians2
3
The 16‐item scale developed and validated in a cross‐national study1
Inherent and performance
high‐order needs
Personal and Professional
low‐order needs
3
1. Lepnurm R, Danielson D, Dobson R, Keegan D. Cornerstones of career satisfaction in medicine. Can J Psychiatry. 2006 Jul;51(8):512‐22.
2. Gerrity M, et al. Career satisfaction and clinician‐educators. The Society of General Internal Medicine Career Satisfaction Study Group. J Gen Intern Med. 1997 Apr;12 Suppl 2:S90‐7.
3. Methods: measures (daily distress)
9 Measures distress of physicians identifying1‐2:
Job strain at lower levels of distress
1
2
Never A few times yearly 3
4
Once 2‐3 times monthly monthly 5
6
7
Once weekly 2‐3 times weekly Daily Risk of burnout at higher levels g
of distress
9 16‐item scale with sub‐scales of fatigue and negative affect1
9 Instrument validated across Canada in 20041
1.
2.
Dobson R, Lepnurm R, Struening E. Developing a scale for measuring professional equity among Canadian physicians. Soc Sci Med. 2005;61(2):263‐6.
Dobson R, Lepnurm R. Wellness activities address inequities. Social Science & Medicine. 2000;50(1):107‐21.
9 Related to everyday issues faced by physicians1
4. Results
37.2% 48.1%
794
Eligible physicians
382
Participated
9 Bias was checked and found negligible.
9 Broad specialty categories:
• Family Practitioners/GPs
• Medical specialists
• Surgical specialties
• Laboratory /Medical images
35.6%
31.4%
25.9%
7.1%
62.6% Latent ggender inequalities in th
Response rate
espo se ate
4. Results
The MANOVA test (Wilks’ Lambda criterion) identified that the Lambda criterion) identified that the
3 The MANOVA test (Wilks
dependent variables:
• Affected by gender, p=0.04
Affected by gender p=0 04
• Not by the payment method, p=0.41
• There was no evidence of an interaction effect, p=0.3
3 The three dependent variables were correlated (p<0.001):
4. Results
3 Female physicians reported:
• Lower levels of career satisfaction,
Lower levels of career satisfaction, p
p=0.01
0.01
• Lower levels of fulfilment‐recognition rewards, p=0.01
• Higher levels of daily distress, p=0.03
3 The three dependent variables were correlated (p<0.001):
4. Results
recognition equity:
• An interaction effect was identified between gender and payment method
and payment method F(2,375)=3.51, p=0.03.
3 In the levels of fulfilment‐
5. Research limitations
• Relationships are associations
• Sequence of events cannot be determined
3 Results can be extrapolated to:
• All the physicians in the SHR
p y
• Practitioners in similar health regions (Regina Qu'Appelle Health Region), with caution
3 Response rate is adequate in comparison to other surveys among physicians.
3 Response bias was checked.
3 Inherent limitations of cross‐sectional studies
5. Research implications
3 Gender inequalities need to be considered when designing payment methods for physicians.
3 The findings suggest that APP do not threaten physicians’ clinical y
autonomy.
3 Female physicians report:
• Higher percentage of complex patients1
• Less control on daily aspects of practice2
Extra challenges to achieve work‐life balance3‐4
• Extra challenges to achieve work‐life balance
and professional development4‐5
1.
2.
3.
4.
5.
McMurray JE, et al. The work lives of women physicians. J Gen Intern Med.2000; 15: 372‐80.
Brown S, Gunderman RB. Viewpoint: enhancing the professional fulfillment of physicians. Acad Med. 2006; 81: 577‐82
Verlander G. Female physicians: balancing career and family. Acad Psychiatry. 2004; 28: 331‐6. Shollen SL, et al. Organizational climate and family life: how these factors affect the status of women faculty at one medical school. Acad Med. 2009; 84: 87‐94
Leigh JP, et al. Physician wages across specialties: informing the physician reimbursement debate. Arch Intern Med. 2010; 170: 1728‐34
3 Strategies to eliminate gender inequalities are still required.
6. Conclusions
and professional equity, and higher levels of daily distress.
3 Latent gender inequalities in the well‐being of physicians need to L t t
d i
liti i th
ll b i
f h i i
dt
be addressed.
3 APP and blended payment methods did not show differences in the well‐being indicators.
3 Potential interaction effects of payment method and gender need to be explored in national studies.
3 Female physicians reported poorer levels of career satisfaction Acknowledgements
9 MERCURi Research Group
•
9 Medical Affairs Office , SHR
•
•
•
9 Advisory Committee:
•
•
•
•
•
Dr. Allen Backman
Dr. Rein Lepnurm
Dr. Roy T. Dobson
Dr. David Keegan
Dr. David Keegan
Dr. Joseph Garcea
Debora Voigts
M
Margaret Lissel
t Li l
Stan Yu
John Dickinson
9 WRTC Training Program
9 George & Arlene Loewen
George & Arlene Loewen Family Bursary
Family Bursary
9 University of Saskatchewan Travel Award
9 Professors School of Public Health, U of S
9 2013 CASHPR Travel Student Bursary
MERCURi
Research Group
9 Physicians of the Saskatoon Health Region
Publication available
Publication available
By Juan Nicolás Peña Sánchez

Juan Nicolas Pena Sanchez Rein Lepnurm Silvia Bermedo

Transcription

Similar documents

High Technology

ProArgi-9+ and the Physicians` Desk Reference

roup

Family Physician

Health Match BC - Divisions of Family Practice

Poster - Macklin Symposium - Autism and the Military Child

The Alluvian Hotel

Physician Beware: `The Dog Ate My Checkbook`

Human Resources: Love in the Afternoon

Jennifer Moody AmeriMed Consulting Concierge Medicine Health