Hospice Satisfaction Among Patients, Family, and Caregivers: A Systematic Review of the Literature.

Background: Hospice care is an underused form of intervention at the end of life. The experiences of patients, families, and other caregivers are important to consider in thinking about how to encourage greater use of hospice care, through policies and advocacy that promote its benefits. Specifically, patient, family, and other caregiver satisfaction with hospice care is important to understand better. Methods: A PRISMA-guided review of the research on hospice care satisfaction and its correlates among patients, families, and other caregivers. Included in the review is research published over the time period 2000-2023 identifying a hospice care satisfaction finding. Results: Thirty-eight studies were included in the review. Key findings were: (a) higher levels of hospice care satisfaction among patients, families, and other caregivers; and (b) correlates of hospice care satisfaction falling into the categories of communication, comfort, and support. The published literature had fewer findings related to demographic correlates of satisfaction such as age or race/ethnicity and was lacking in comparative research examining satisfaction across different types of hospice care settings. Discussion: Extant research demonstrates a consistently higher level of hospice care satisfaction among patients, families, and other caregivers. This satisfaction appears related to specific aspects of care delivery that involve effective care coordination and communication; pain and symptom management; and emotional support. Strengthening future research involves testing additional interventions aimed at enhancing satisfaction; including more comparative research across hospice care settings; and more studies that include patients as the key respondents.

Burnout Among Family Physicians in the United States: A Review of the Literature.

BACKGROUND AND OBJECTIVES: Burnout among physicians who work in primary care is an important problem that impacts health care quality, local communities, and the public's health. It can degrade the quality of primary care services in an area and exacerbate workforce shortages. This study conducted a review of the published research on burnout among family physicians working in the United States. METHODS: We used a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided approach and several article databases to identify, filter, and analyze published research on US family physician burnout that uses data collected from 2015 onward. RESULTS: Thirty-three empirical studies were identified with findings that included US family physician burnout prevalence and/or associations between burnout and specific personal and contextual drivers. Mean family physician burnout prevalence across studies that measured it was 35%. Almost half of the studies classified one-third or more of their family physician samples as burned out. Physician gender (being female), age (being younger), and job/work-related factors (workload, time pressures) were the most commonly identified correlates of family physician burnout. The vast majority of studies were cross-sectional and used secondary data. CONCLUSIONS: The extant research literature on family physician burnout in the United States shows that burnout is currently a meaningful problem. Several important correlates of the problem can be identified, some of which managers and health care organizations can proactively address. Other correlates require managers and health care organizations also viewing family physicians in differentiated ways. The collective literature can be improved through a more consistent focus on similar burnout correlates across studies; inclusion of interventions aimed at lessening the effects of key burnout correlates; employment of more robust longitudinal and quasi-experimental research designs; and additional pandemic-era data collection on burnout.

Resiliency-based adaptations used by primary care physicians during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic is a profound change event for U.S. primary care physicians and their medical practices. PURPOSE: We examined how a group of U.S. primary care physicians and their medical practices used resiliency-based strategies, tactics, and mindsets to navigate pandemic-related change over the time period early 2020 through mid-2021. METHODOLOGY: A 15-month longitudinal qualitative study of the same 10 physicians interviewed a total of 42 times at four time intervals during the 2020-2021 COVID-19 pandemic. Data were analyzed using a systematic coding approach consisting of first- and second-order code categories feeding into an overall interpretive framework of resiliency-based adaptations. RESULTS: Primary care physicians and their practices engaged in two main resiliency-based strategic adaptations during the pandemic. These adaptations were labeled "keeping the business afloat" and "keeping primary care relevant for patients." Each consisted of different strategies and tactics that shared common features including proactiveness, innovativeness, and pragmatism. Specific resiliency-based mindsets were identified that helped physicians both initially engage in needed strategies and tactics while continuing to engage in them over time. CONCLUSIONS: The results demonstrate how physicians use resiliency-based adaptation in response to profound change in their environments, defined by behavioral variety and motivated by self-interested and patient-centered imperatives. PRACTICE IMPLICATIONS: Physicians are proactive and possess multiple adaptive capabilities. Seen in this more positive light, health care organizations should focus on greater engagement of their physician-employees in implementing innovation in care delivery and managing change, that is, as responsible partners rather than resistors to meeting organizational imperatives.

Making do by getting real: Psychological contract violations and proactive career agency among medical professionals.

BACKGROUND: Health care professionals face greater uncertainty in their careers as traditional jobs wither and new, organizationally controlled jobs proliferate, reducing economic security and professional autonomy. PURPOSE: We apply psychological contract and self-efficacy theory to examine the career agency of early-career physicians. We ask the following: (a) What are the unfulfilled expectations and emotions experienced by young physicians at the training and early career stages? (b) What are the forms of career agency exhibited by young physicians in response to unfulfillment? METHODOLOGY: We conducted a study on 48 U.K. early-career primary care physicians, known as general practitioners. The sample comprised both trainees as well as newly qualified physicians. Data were collected through in-depth interviews and focus group discussions. RESULTS: Physicians interpreted their early-career experiences based on predominantly ideological expectations around what it means to be a successful professional. However, the realities of practice resulted in highly emotional experiences of violation that were associated with a "reactive" agency and job behaviors that were more transactional and less relational. CONCLUSION: This study identifies the expectations of early career professionals, which helps understand how and why psychological contract violations occur. It also expands the conceptualization of career agency from a positively framed aspect of professional behavior to one that includes haphazard and self-serving elements. PRACTICE IMPLICATIONS: Our study highlights several implications of the shifts in physician career agency for primary care practice. It discusses the potential effects of the purposeful self-interest among doctors on professional identity and power, as well as patient care.

Changes in Career Thinking and Work Intentions Among Family Medicine Educators in Response to the COVID-19 Pandemic.

INTRODUCTION: This study examined the attitudes and perceptions of family medicine educators with regards to COVID-19's impact on both career thinking and work intentions. METHODS: We surveyed 949 Family Medicine educators and practicing physicians as part of the 2021 Council of Academic Family Medicine's (CAFM) Educational Research Alliance (CERA) survey. RESULTS: Changes in thinking about their nonwork lives (P < .001, OR = 2.82), changes in life priorities (P < .001, OR = 2.07), along with recent changes to the educator job that are perceived as less enjoyable (P < .001, OR = 1.31), are associated with career thinking changes. Perception of being treated fairly (P = .002, OR = 0.83), changes in thinking about nonwork lives (P = .003, OR = 1.29), changes in life priorities (P < .001, OR = 1.65), and recent less enjoyable changes to the educator job (P < .001, OR = 1.26), are associated with an intent to reduce work hours. Perception of being treated fairly (P < .001, OR = 0.81), changes in life priorities (P < .001, OR = 1.31), recent work changes that are less enjoyable (P < .001, OR = 1.38), and workload increases (P = .02, OR = 0.87), are associated with increased thoughts of doing something different in 5 years. Older participants were more likely to intent to reduce hours (P < .001, OR = 1.05) and have increased thoughts of doing something different in 5 years (P < .001, OR = 1.04). Meanwhile, women were more likely to experience career thinking changes (P = .02, OR = 1.42). DISCUSSION: Our findings suggest that the career thinking and work intentions of family medicine educators have been greatly impacted by the pandemic. There may be consequences for how they think about and approach their careers and jobs in the future. Additional research is needed to determine what these actual consequences mean. In addition, employers should carefully assess these types of changes, identify which educator subgroups they may affect the most, and act accordingly, particularly in areas like recruitment and retention.

Physician Satisfaction With Telehealth: A Systematic Review and Agenda for Future Research.

BACKGROUND AND OBJECTIVES: The use of telehealth has risen dramatically due to the Covid-19 pandemic and is expected to be a regular part of patient care moving forward. We know little currently about how satisfied physicians are with this type of patient care. The present systematic review examines physician satisfaction with telehealth, as physician acceptance remains vital to telehealth gaining wider and more permanent adoption. METHODS: A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-guided systematic review of empirical articles published between 2010 and 2020 that contain a finding examining physician satisfaction with using telehealth, using 4 article databases (PubMed, Web of Science, COCHRANE, and CINAHL), to identify relevant studies. A standardized data abstraction Excel sheet was used to extract relevant information from each of the included studies. Relevant study findings related to physician satisfaction with telehealth were reviewed for each of the 37 studies by the coauthors. RESULTS: A total of 37 published studies were included in the review. Thirty-three of the 37 (89%) studies reviewed were classified as having findings showing moderate to high levels of physician satisfaction with telehealth. Just under 60% of the studies focused on physician satisfaction with providing telemedicine to patients (21/37). Twelve other studies focused on physician satisfaction with teleconsultations with other providers. Four studies examined physician satisfaction with both. The type of patient telemedicine or provider teleconsultation performed varied greatly across the 37 studies, with several different diagnoses or care situations included. Research designs used in the studies were less robust, with all studies using primary data for assessing physician satisfaction but only one study providing any type of multivariate analysis of physician satisfaction with telehealth. CONCLUSION: The results of this review support the observation that physicians across different specialties, geographic locations, practice locations, and care situations appear satisfied with engaging in telehealth for both patient care and consultations with other physicians. The research on telehealth should be enhanced, given how ubiquitous telehealth has become due to the Covid-19 pandemic. This enhancement should include larger physician sample sizes in studies of telehealth satisfaction; more research focused on telehealth in the primary care setting; and the types of virtual modalities that have become more commonplace for physicians to use due to the Covid-19 pandemic.

Burnout and Physician Gender: What Do We Know?

PURPOSE: Burnout (BO) is a serious phenomenon affecting US physicians. Female physicians, now accounting for a larger share of the workforce, are thought to experience higher levels of BO in some situations compared with their male counterparts. The current review aimed to systematically examine extant literature on physician BO as it relates especially to the female physician. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided search of 4 databases yielding empirical studies with relevant findings regarding female physician BO, published during the time period 2010-2019. RESULTS: A total of 43 studies were included in the current review. Both male and female doctors have higher percentages of burned out doctors, with a third or more of each group indicating BO in each of the studies examined. These higher levels of BO remained regardless of where physicians worked, their clinical specialty, workloads, or age. However, the review supports the notion that for women doctors, there is generally a higher likelihood of experiencing BO compared with male doctors, particular with respect to the emotional exhaustion dimension of BO. CONCLUSIONS: BO is important for both female and male physicians; although women doctors may experience it to a greater degree. Women doctors will benefit from talent management approaches by health care organizations that recognize their greater tendency to BO compared with men. These approaches should be aimed at ameliorating the factors that give rise to feelings of emotional exhaustion in particular. Additional research is needed to better understand the full extent to which physician gender plays a role in BO.

The gender pay gap in medicine: A systematic review.

BACKGROUND: Women are becoming doctors in greater numbers. Despite this, there is evidence of female doctors' continued differential treatment compared to their male counterparts. PURPOSE: The aim of this study was to review systematically the extant literature on the gender-based pay gap in medicine across time, different medical specialties, and different countries of clinical practice. METHODS: Systematic search of three databases using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies needed to be empirical and contain either an unadjusted or adjusted gender-based finding related to pay. RESULTS: A total of 46 articles published since 2000 contained a gender-based finding related to physician pay. Thirty-two of these 46 articles presented either adjusted or unadjusted means comparisons (or both) comparing pay between male and female physicians. Eighteen of the 46 articles controlled for one or more variables in examining pay between the two groups. Across almost all studies, female doctors earn significantly less than men, often tens of thousands of dollars less annually, despite similar demographic and work-related profiles. This earnings gap is persistent across time, medical specialty, and country of practice. PRACTICE IMPLICATIONS: The gender-based pay gap is an ongoing crisis within medicine that must be addressed. From a practice perspective, women physicians may benefit from greater organizational awareness of potential workplace bias and the implementation of more supportive policies aimed at better equalizing compensation through greater support and transparency related to salary negotiations, promotional opportunities, and pay scales across various job titles.

Organizational commitment among physicians: A systematic literature review.

PURPOSE: Physicians work increasingly in larger organizations across different health care delivery systems. This systematic review examines the published empirical literature on organizational commitment among physicians within an international context. DESIGN: A systematic, PRISMA-guided review examining studies of organizational commitment among physicians published over time. Four article databases and a combination of appropriate search terms aided in identifying relevant articles. FINDINGS: Key findings include: (a) physicians, regardless of country, personal characteristics, type of job, or place of employment generally have lower levels of organizational commitment than other health care workers; (b) work- and job-related variables, particular age and job satisfaction, shape physicians' organizational commitment; and (c) organizational commitment and the factors that shape it are similar across physicians working in different health systems.Review implications: Organizational commitment should remain central for researchers to study in most health systems internationally. Larger samples, longitudinal research, and greater use of theory are design improvements that will strengthen the extant research. The findings imply that if healthcare organizations create workplaces that make physicians feel in control, do not overwhelm them with work, provide a supportive culture, enhance their ability to give input, and keep them job satisfied, they may gain enhanced organizational commitment.Originality and value: To our knowledge, this is the first review of research examining organizational commitment among physicians. It is a resource for researchers and managers interested in learning more about aligning physician thinking and behavior with health care organizations.

How teams impact patient satisfaction: A review of the empirical literature.

BACKGROUND: The increased use of health care teams merits further investigation in terms of their impact on patient satisfaction. Patient satisfaction and patient experience generally have come front-and-center given trends within the health care industry around "patient-centered care" and "consumer engagement." PURPOSE: This review examines research published between 2000 and 2017 that includes analysis of potential team-patient satisfaction linkages, taking the conceptual perspective that both the mere presence of health care teams and specific team features like cohesion may each be impactful. METHODS: A systematic, PRISMA-guided literature review across four databases (PubMed, CINAHL, Business Source Complete, and ScienceDirect) to examine potential team-patient satisfaction linkages in the existing team literature was performed. RESULTS: In-depth review of 24 relevant studies found the following: (a) The extant literature examining the team-patient satisfaction relationship currently suffers from limitations around study design, construct definition, and variable operationalization, which render less confidence overall in the body of work, and (b) despite the limitations, extant work does suggest that there may be instances where the presence of a health care team does favorably impact patient satisfaction. PRACTICE IMPLICATIONS: Future research should attend to several issues related to study design improvements, more precise operationalization and measurement of both teams and patient satisfaction, expansion of focus beyond patient satisfaction within the same study, and inclusion of more ambulatory care delivery settings in team-satisfaction research.

The challenges of consumerism for primary care physicians.

Implementation of retail health consumer tactics in primary care poses challenges for primary care doctors that must be recognized and addressed.

Activities and Sensemaking Associated With Frontline Role Expansion in Primary Care Settings.

EXECUTIVE SUMMARY: Many healthcare settings are embracing a dynamic of role expansion across occupational boundaries. This dynamic is particularly evident in organizations that are early adopters of innovations designed to improve care delivery. This study explores role expansion of frontline healthcare workers in primary care settings associated with early adoption of the patient-centered medical home. Qualitative data in the form of interviews were collected from 2012 to 2014 from six primary care practices functioning as early adopters of patient-centered medical homes. Fifty-one staff members were interviewed across the six practices. The author identified three forms of role expansion among frontline workers in these primary care practices. This role expansion was accompanied by key instances of work improvisation and enhanced social connections among staff and patients that fed into particular forms of sensemaking. Transformation of primary care delivery may be enhanced through expansion of frontline workers' roles, particularly at the early adoption phase.

Comparing Retail Clinics With Other Sites of Care: A Systematic Review of Cost, Quality, and Patient Satisfaction.

BACKGROUND: Retail clinics, also referred to as walk-in or convenient care clinics, share common features such as a limited menu of primary care services, on-demand patient appointments, greater use of nonphysician providers such as nurse practitioners, and more convenient hours and access points for patients. OBJECTIVES: Given their rising popularity as an alternative primary care delivery site, it is important to examine retail clinics' impact on patient outcomes. This study's aim was to systematically review the extant literature on retail clinics in the United States with respect to 3 outcomes of interest: quality, cost, and patient satisfaction. RESEARCH DESIGN: A systematic search of 4 databases was done using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies needed to be empirical, measure care in retail, walk-in, or convenient care clinic, and present quality, cost, and/or satisfaction findings. MEASURES: The majority of studies used commercial, administrative claims databases to procure patient outcome data (n=9). Nine of the 15 studies examined costs, 6 examined quality, and only 1 examined patient satisfaction. RESULTS: Overall, retail clinic care compares favorably with similar care in other settings in terms of lower costs, although the evidence on quality and patient satisfaction is minimal and less conclusive. CONCLUSIONS: Future research on retail clinic care requires more rigorous study designs, richer quality measures, inclusion of the patient experience in outcomes, less reliance on administrative claims data, and greater independence from industry stakeholders with interest in seeing the retail clinic model grow.

Physician Use of Health Care Teams for Improving Quality in Primary Care.

OBJECTIVES: Health care teams may be used to improve quality in the primary care setting. Absent in the extant literature on health care teams is knowledge of how physicians seek to deploy this innovation on an everyday basis to improve care quality. This study's aim was to explore how physicians use teams in practice to deliver higher-quality care. METHODS: A qualitative study using data collected through 39 interviews with primary care physicians and 9 interviews with medical assistants, employed across different primary care settings in the northeastern region of the United States. RESULTS: Physicians used teams for 2 care quality functions: "getting basic care duties off their plate" to have more time for complex care delivery and "as relational extensions" of themselves to enhance the patient experience and provide care continuity. Physicians identified the following ingredients for using teams for these functions: (a) achieving long-term continuity working with the same team members; (b) having the correct mix of personalities and skills sets on the team; and (c) a "who is doing what" focus in the team for achieving role clarity. CONCLUSIONS: The findings illuminate how primary care physicians attempt to use teams to improve care quality and enhance their role as care providers.

Making sense of effective partnerships among senior leaders in the National Health Service.

BACKGROUND: Changing health care systems depend on strong organizational leadership that realizes the collaborative potential of both physician and nonphysician leaders. PURPOSE: The aim of this study was to seek insight into the everyday health care leader experience by examining 24 physician and nonphysician leaders working in the U.K. National Health Service. We explored (a) how they make sense of and act with respect to specific collaborative tensions in their interactions and (b) which aspects of their everyday leadership contexts heighten the probability for producing and resolving such tensions. METHODOLOGY: We conducted 24 in-depth interviews with physician and nonphysician leaders in job titles including Chief Operating Officer, Managing Director, Medical Director, and Clinical Director. Ideas from the social psychological perspectives of sensemaking, organizational role theory, and organizational citizenship behavior helped frame the study. RESULTS: We identified four areas of ongoing tension between senior leaders. Each of these was linked to a set of underlying drivers, with the strongest support for drivers with interpersonal roots. Effective strategies for resolving tensions involved significant effort by leaders at improving the interpersonal dynamics associated with everyday interaction and forging relational connections through enhanced trust within the leadership team. CONCLUSION: This study outlines the organizational and individual characteristics that lend to effective collaboration among senior health care leadership and the types of collaborative tensions likely to be experienced by senior health care leaders. PRACTICE IMPLICATIONS: Organizations should provide greater role clarity for senior leadership roles, promote "soft" interpersonal competencies within them, and better assess potential leaders for success in senior roles. Organizational support in the form of facilitation, time, and spaces to learn together can provide a better context for collaborative decision-making.

Satisfaction, Burnout, and Turnover Among Nurse Practitioners and Physician Assistants: A Review of the Empirical Literature.

Examining the work-related psychological states of nurse practitioners and physician assistants is important, given their increased role expansion. The current PRISMA-guided review examined studies published between 2000 and 2016 for both these groups. The review also examined features of the research to draw conclusions about overall quality. Applying theories in job enrichment and job demands, 32 articles were identified that contained analyses of satisfaction, burnout, stress, and turnover. Key findings include the lack of robust research designs, overemphasis on job satisfaction, lower levels of satisfaction across both groups, and higher intrinsic versus extrinsic satisfaction levels generally. The literature can develop by using larger, more representative samples, including subgroup analyses that incorporate everyday work contexts, and more predictive modeling. The results suggest that both occupations experience role expansion in both positive and negative ways that may require additional policy or managerial interventions.

Medical Home Implementation Gaps for Seniors: Perceptions and Experiences of Primary Care Medical Practices.

OBJECTIVE: The study objective was to better understand specific implementation gaps for various aspects of patient-centered medical home (PCMH) care delivered to seniors. The study illuminates the physician and staff experience by focusing on how individuals make sense of and respond behaviorally to aspects of PCMH implementation. METHOD: Qualitative data from 51 in-depth, semi-structured interviews across six different National Committee for Quality Assurance (NCQA)-accredited primary care practices were collected and analyzed. RESULTS: Physicians and staff identified PCMH implementation gaps for their seniors: (a) performing in-depth clinical assessments, (b) identifying seniors' life needs and linking them with community resources, and (c) care management and coordination, in particular self-management support for seniors. Prior experiences trying to perform these aspects of PCMH care for older adults produced collective understandings that led to inaction and avoidance by medical practices around the first two gaps, and proactive behavior that took strategic advantage of external incentives for addressing the third gap. CONCLUSION: Greater understanding of physician and staff's PCMH implementation experiences, and the learning that accumulates from these experiences, allows for a deeper understanding of how primary care practices choose to enact the medical home model for seniors on an everyday basis.

The Battle Of The Bundle: Lessons From My Mother's Partial Hip Replacement.

For one family, Medicare's bundled payment program felt more like a health care assembly line than coordinated care.

The strategic nature of individual change behavior: How physicians and their staff implement medical home care.

BACKGROUND: The patient-centered medical home (PCMH) model of care is central to primary care system success and transformation. Less is known about which PCMH activities primary care workers most frequently perform, if or why they might view that work more favorably, and how such work may function strategically to advance individual and organizational adaptation to new demands, as well as deliver good patient care. PURPOSE: Understanding better how primary care physicians and staff perceive, experience, and use certain types of PCMH work for adapting to new demands looms a key imperative for gaining insights into PCMH implementation at the workplace level. METHODS: Using a worker adaptation perspective that emphasizes the role of social learning and individual agency, this study explores the strategic nature of PCMH implementation through 51 in-depth interviews with physicians and staff in six accredited PCMHs. FINDINGS: Select medical home activities were identified, in which primary care physicians and staff most engaged on a daily basis, and they fell into five distinct PCMH work domains labeled team care, medical home responsibilities, care management, access, and medication management. These activities had common features such as high levels of familiarity, simplicity, and camaraderie. In addition, through their experiences performing these activities, physicians and staff appeared to gain strategic benefits for themselves and the larger organization including enhanced self-efficacy and readiness for change. CONCLUSIONS: The findings show that particular forms of PCMH work not only advance patient care in favorable ways but also enhance individual and organizational capacity for adapting to this innovative model and its demands. This knowledge adds to our understanding of how to implement PCMH care in ways that are good for workers, primary care organizations, and patients and offers practical guidance as to which forms of PCMH work should be encouraged, incented, and rewarded.