Physician satisfaction in a changing health care environment: the impact of challenges to professional autonomy, authority, and dominance.

For some time, sociologists have debated whether physicians still retain dominance in the health care world, public faith in their moral and scientific authority, and the autonomy to set work conditions and make clinical decisions. Using ideas derived from this debate, we analyze the impact of changes in the health care environment on physician satisfaction. Our data come from a mailed survey of 510 Arizona physicians. Our results show that background physician attributes did not predict satisfaction, nor did most organizational attributes. However, participation in IPAs (Individual Practice Associations) predicted higher satisfaction, while payment according to a third party payer's fee-for-service schedule predicted lower satisfaction. In addition, physicians were more likely to be satisfied if they wrote the orders that non-physicians had to follow, were paid what they wanted, did not need to subordinate their clinical judgment to that of non-physicians, and believed that their patients had confidence in physicians. Our conclusions discuss both theoretical and policy implications of our findings.