Physician perceptions of health care reform: national versus state knowledge, input and support.

Health care reform directly impacts physicians and the practice of medicine. A questionnaire was sent to a random sample of 2,000 physicians in the state of Florida to obtain physician perceptions of health care reform. Physician knowledge, input, and support of both state and national health care reform were reported in the lowest categorizations. Issues deemed most important for support were tort reform and physician autonomy. The approach of the Florida plan, managed competition, was viewed as ineffective in addressing the issues of cost and access. Experience with the managed competition model and objective evaluations may alter perceptions and increase physician support.

Pharmacy involvement in patient-focused care in Florida hospitals.

Hospital pharmacy directors in Florida were surveyed to determine the effects of patient-focused care on pharmacy practice. In a statewide mail survey in 1994, directors were asked whether their hospital had implemented patient-focused care or was planning to, what factors influenced this, whether and how the pharmacy was involved, what changes in structure and services resulted, and how they perceived the impact of patient-focused care on the practice of hospital pharmacy. They were asked to identify specific programs, interdisciplinary teams, and opportunities associated with patient-focused care programs. Usable surveys were returned by 148 respondents (48.8% response rate). Fifty-three (35.8%) of the respondents had implemented patient-focused care and 50 (34%) were planning to ; 82.5% of these respondents (85 of 103) said pharmacists were involved in the planning efforts. Respondents said hospital administration was most often responsible for initiating patient-focused care, and cost was the top-ranked reason. For pharmacy, patient-focused care brought more interdisciplinary activities and new services. Florida hospital pharmacy directors thought patient-focused care would change the practice of pharmacy and that the change would be positive.

Physician issues and Florida health care reform.

Data are presented from a mail survey of Florida physicians one year after passage of the Florida Health Care Insurance and Reform Act. Respondents rated the importance of various issues and reported their perceptions of physician input, knowledge and support for health-care reform legislation. Issues considered important included tort reform, physician autonomy, consumer choice of providers, and freedom from insurance hassles along with reduced paperwork. Ratings were low for input and health-care reform support. Issues of importance to physicians were not addressed by previous legislation; therefore, they must take the lead in focusing new legislation in conjunction with their professional organizations.

Physician responses to a managed environment: a perceptual paradox.

Increased management of physicians is inevitable in today's economically competitive environment. Health maintenance organizations (HMOs) and other managed care settings are challenged by and often confronted with negative perceptions of physicians relating to management and organized practice. Paradoxically, reported experiences of physicians show these negative perceptions to be misconceptions. Managers need to eliminate this perceptual bias through physician education and dialogue.

A comparison of concurrent general and HMO-affiliated medical practice experience.

This study was designed to differentiate the general practice perceptions of physicians who affiliate with an HMO and those not affiliated with an HMO as well as the "within physician" comparison of HMO practice experience relative to one's own general practice. A written survey was mailed to 1,000 members of the Florida Medical Association (FMA). A total of 372 physicians responded to the survey; 114 (31%) reported affiliation with an HMO. Based on a 5-point Likert-type scale, the rating of overall satisfaction with the general practice of medicine was good (mean=3.19). Perceptions of general practice did not differ substantially based on HMO-affiliation status. However, physicians reporting concurrent general and HMO-affiliated practice clearly distinguished these experiences. All aspects of medical practice, except paperwork, were rated consistently lower for HMO practice in comparison to general practice.

The occurrence and distribution of burnout among infectious diseases physicians.

The occurrence and distribution of the three dimensions of the burnout syndrome (emotional exhaustion, depersonalization, and lowered feelings of personal accomplishment) were studied among infectious diseases physicians. A written survey was mailed to the entire identified US population of infectious diseases physicians (n = 4328); a 46.3% response rate provided 1840 usable surveys. Statistical analyses of the data demonstrated that 43.5% of the physician sample reported high scores on emotional exhaustion, and 40.3% scored high on depersonalization. Personal accomplishment scores remained high, despite burnout levels, with 91.8% reporting high personal accomplishment. The highest percentage of burnout occurred among physicians in private practice settings (55%), followed by government settings (39%), and academia (37%). The high percentage of infectious diseases physicians experiencing burnout suggests the need for further research to establish trends, to determine if other types of physicians experience similar levels of burnout, to identify casual factors, and to develop avenues to reduce stress and facilitate coping.

Impact of role stress on physical therapists' emotional and physical well-being.

This study examined the relationship between role stress and the physical and emotional well-being of 187 physical therapists practicing in the state of Missouri. Data collected via survey research established a significant relationship between role conflict (conflict between organizational demands and personal and professional values) and emotional exhaustion (r = .50) and between role conflict and somatic and job-induced tension (r = .43 and r = .44, respectively). Role ambiguity created by an uncertain organizational climate was related significantly to emotional exhaustion (r = .26) and to somatic and job-induced tension (r = .21 and r = .29, respectively). Perceived improper allocation of time, inadequate staff or resources, and receipt of incompatible demands were identified as significant role stressors and predictors of diminished emotional and physical well-being. Physical therapy directors and individual therapists should work within their organizations to reduce role stress and its detrimental effects, to align professional and organizational values, and to maintain personal and professional standards.

Nursing in long-term care: dispelling a myth.

Contrary to the myth that describes nursing in nursing homes as debasing and undesirable, our research affirms that LTC nursing offers opportunities for a rich, rewarding, and satisfying work experience. Indeed, LTC nursing practice has the potential to fulfill both personal and professional needs for growth and development. Survey data coupled with interviews of LTC nursing staff establish that, if well managed, the content and context of LTC nursing can provide a challenging and stimulating career option.