Cover
Title Page
Copyright
Preface
Contents
Figures
Tables
Executive Summary
Acknowledgments
Abbreviations
Methodology
Organization of This Report
Overview
Domestic Versus Foreign Medical School
Physician Specialty
Geographic Location
Working Environment
Electronic Health Records
Health System Changes
Downstream Effects of Physician Professional Satisfaction
Summary
Justification for Mixed Methods
Practice Sample
Qualitative Data Collection: Semistructured Interviews During Site Visits
Quantitative Data Collection
Qualitative Analyses
Quantitative Analyses
Limitations of Study Methods
Chapter Four: Conceptual Model
Chapter Five: Characteristics of the Survey Sample
Providing High-Quality Care Is Inherently Satisfying
Perceived Barriers to Providing High-Quality Patient Care
Quantitative Findings
Comparison Between Current Findings and Previously Published Research
Qualitative Findings
Improved Professional Satisfaction: EHRs Improve Some Aspects of Quality of Care
Worsened Professional Satisfaction: Time-Consuming Data Entry
Worsened Professional Satisfaction: User Interfaces That Do Not Match Clinical Workflow
Worsened Professional Satisfaction: Interference with Face-to-Face Care
Worsened Professional Satisfaction: Insufficient Health Information Exchange
Worsened Professional Satisfaction: Mismatch Between Meaningful-Use Criteria and Clinical Practice
Worsened Professional Satisfaction: EHRs Threaten Practice Finances
Worsened Professional Satisfaction: Template-Based Notes Degrade the Quality of Clinical Documentation
Future Effects on Professional Satisfaction: Physicians Express Optimism About EHR Development in the Long Term
Quantitative Findings
Comparison Between Current Findings and Previously Published Research
Ability to Choose Colleagues and Coworkers
Control Over Business and Managerial Decisions
Ability to Choose Hours and Schedule
Comparison Between Current Findings and Previously Published Research
Values Alignment with Practice Leadership
Balancing Leadership Initiatives with Physician Autonomy
Comparison Between Current Findings and Previously Published Research
Collegiality, Teamwork, and Respect Among Physicians and Staff Within Practices
Regular Interpersonal Contact Can Foster Collegiality
Relationships with Providers and Delivery Systems Outside the Practice
Respect from Patients
Comparison Between Current Findings and Previously Published Research
Excessive Time Pressure Worsens Physician Professional Satisfaction
Work-Life Balance
Practice Improvement Strategies to Manage Workload
Quantitative Findings
Comparison Between Current Findings and Previously Published Research
Work Content
Specific Components of Work Content
Allied Health Professionals and Support Staff
Quantitative Findings
Comparison Between Current Findings and Previously Published Research
Overview of Findings
Fairness of Income
Payment Reform
Quantitative Findings
Comparison Between Current Findings and Previously Published Research
Cumulative Effect of Many Rules and Regulations: Frustration and Burnout
Meaningful-Use Requirements Are Perceived as Good for Patient Care but Are Time Consuming and Frustrating for Some Physicians
Improvements in the Professional Liability Environment Contributed to Better Professional Satisfaction
Comparison Between Current Findings and Previously Published Research
Uncertainty About the Effects of Health Reform as Leading to Consolidation
Medical Homes
Comparison Between Current Findings and Previously Published Research
Chapter Sixteen: Conclusions
Improvement Targets: Internal to Physician Practices
Improvement Targets: External to Physician Practices
Implications for Health Policy and Systems
Appendixes: A. Advisory Committee Members
References