New wine in an old bottle: does alienation provide an explanation of the origins of physician discontent?

We have witnessed transformational changes to the U.S. health care system over several decades. Alongside these changes is an increasing number of research reports and commentaries on physician workplace dissatisfaction and discontent. Primary care physicians, in particular, report dissatisfaction with conditions on the ground. Is there solid evidence concerning the magnitude of doctors' discontent, and how is it changing over time? Is it confined to the United States, or is it also occurring in other countries with different health care systems? Does physician discontent affect the processes, quality, and outcomes of medical care? This article addresses these questions. It considers the dimensions of physician dissatisfaction, whether there is a problem, and competing contributions to physician discontent. The authors suggest that the classic concept of alienation may build upon valuable earlier work and provide a new, coherent explanation of the workplace origins of physician discontent. Alienation theory combines both structural and psychological components associated with workplace discontent and has the potential to explain the changing position of knowledge workers (such as physicians) in the new economy.