This may hurt - specialist physicians' job satisfaction

American Demographics, July, 1997 by Bill Stoneman

If they had to do it all over again, 83 percent of specialist physicians would still go into medicine. And why not? The pay is typically quite good. And befitting a person of long training and great skill, the specialist is often an esteemed person in his or her community. Family practitioners also say they would follow the same career path, but in somewhat smaller numbers, according to a survey of 382 doctors who subscribe to Scientific American Medicine, an internal medicine reference text updated monthly.

Generalists and specialists are equally satisfied with their jobs today, at about 75 percent. But when asked to look ahead three years, an entirely different picture emerges. Nearly half--46 percent--of specialists think their job satisfaction will decrease, compared with 32 percent of family practitioners. Increased satisfaction is anticipated by 23 percent of family practitioners and only 13 percent of the specialists.

Thats because cost-containment efforts, particularly by health maintenance organizations, have their biggest guns aimed at specialists, says Albert M. Ellen, an obstetrician/gynecologist in Albany, New York, and commissioner for government affairs with the Medical Society of the State of New York. Surgical sub-specialists are frightened about what the future will be like as a result of the HMOs curtailing reimbursements below what anyone could have imagined, Ellen says.

Not only are managed-care organizations trying to rein in the fees specialists pocket, but they are also trying to shift care that patients receive away from the specialist and back to the generalist, Ellen says. This is typically done by requiring specialist referrals from a patients primary-care physician. These generalist gatekeepers are sometimes offered financial incentives not to make referrals, he says.

For more information on the Scientific American Medicine Poll, contact the publications representative, Howard Greene, Greene Inc., 71 South Central Avenue, Valley Stream, NY 11580; telephone (516) 825-0400.