How strategies for managing patient visit time affect physician job satisfaction: a qualitative analysis.

BACKGROUND: There is much physician discontent regarding policies that limit time for patient visits and contribute to physician dissatisfaction with the medical profession as a whole. Yet little is known about how physician strategies for managing time limits correspond to job satisfaction.
OBJECTIVE: The goal of this study was to identify strategies physicians use for managing time with patients and the effects these strategies have on job satisfaction.
DESIGN: In-depth interviews with primary care providers in various clinical settings (academic medical centers, community-based centers, solo practices, nonacademic group practices) were audiorecorded. PARTICIPANTS: Primary care physicians (n = 25). APPROACH: Transcribed audiorecordings of physician interviews were coded using a modified grounded theory approach. An open coding process was used to identify major themes, subthemes, and the interrelationships among them.
RESULTS: Three main themes emerged. (1) Study physicians disregarded time limits despite the known financial consequences of doing so and justified their actions according to various ethical- and values-based frameworks. (2) Disregarding time limits had a positive impact on job satisfaction in the realm of direct patient care. (3) The existence of time limits had a negative impact on overall job satisfaction.
CONCLUSION: For the study physicians, disregarding time limits on patient visits is an adaptive short-term strategy that enhances satisfaction with direct patient care. It is unlikely that such a strategy alone will help physicians cope with their broader- and growing-dissatisfaction with the profession.