American College of Physicians: Internal Medicine — Doctors for Adults ®

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In new ACP survey, internists say they're satisfied

From the September 1996 ACP Observer, copyright 1996 by the American College of Physicians.

Managed care may be changing the practice of internal medicine, but not necessarily for the worse. That's the conclusion of a first-ever ACP survey that examines how College members' experiences with managed care have affected their attitude about being an internist.

The survey, conducted this spring, found that nine out of 10 ACP members describe themselves as "satisfied" with their medical career, and the majority of them say they are "very satisfied." Remarkably, they feel this way even though a significant number—40%—say they are "not too satisfied or not at all satisfied" with their managed care organizations.

"The survey was interesting and surprising," said John Tooker, FACP, the College's Deputy Executive Vice President, who heads ACP's Managed Care Work Group. "You see a lot of headlines and hear a lot of individual stories about doctors saying they hate managed care and are changing their practices. But when we took a scientific survey of our members, we didn't find that. We found they do like their practice, even though they do have concerns about managed care."

The snapshot of internal medicine produced by the survey shows that the typical ACP member has seven managed care contracts and has been working with them for a little more than four years. About one-third of their patients are enrolled in these managed care plans.

The survey also showed that internists with longer managed care affiliations seem to be more satisfied working in medicine, and that satisfaction is highest among internists involved in their managed care organization's utilization management processes. Interestingly, however, fewer than half of the respondents said that quality improvement processes were having much of an effect on improving patient care or on reducing unnecessary procedures. This is the one of the issues the College hopes to explore in greater detail through a series of focus groups planned for this fall, Dr. Tooker said.

Three-quarters of all the respondents said they felt that affiliating with managed care had led to some decrease in their clinical autonomy; two-thirds said they thought their opportunities for referral and consulting had decreased; and half said their income had gone down since they started with managed care.

More than half of the internists questioned said that at one time or another, they experienced what they believed to be "inappropriate constraints" on their options for patient care, but only one-fifth said that happens "a lot."

The College plans to use the results of the survey to help plan programs and products for members, Dr. Tooker said. For instance, about 40% of the respondents said they feel they will need to develop new clinical skills within the next few years.

Of the more than 400 internists who responded to the survey, nearly 90% reported working at least three-quarters time in patient care. Slightly more than half were specialists; 47% identified themselves as generalists. A third were in solo practice; a quarter worked in a single-specialty group and another 29% were part of a multi-specialty group. Only about 7% were employed by a staff- or group-model HMO.

Nearly all the respondents (89%) had some arrangement with managed care, and in 80% of those cases, that affiliation was a non-exclusive contract. About 15% were either employed by a managed care organization or under an exclusive contract.

The margin of sampling error for the survey was plus or minus five percentage points.

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