Association Between Components of the Patient-Centered Medical Home and Physician Satisfaction among Primary Care Physicians

Background: An extensive literature has demonstrated the positive association between primary care and improved individual and population health. However, a sizeable proportion of the population lacks access to primary care due to a shortage of primary care physicians in the U.S. This shortage may be expected to worsen because PCPs tend to retire earlier than specialists, and new medical graduates are less likely to enter primary care. Studies indicate improved physician satisfaction to be associated with the lower likelihood of early retirement as well as the increased preference among medical graduates to enter a certain specialties. However, satisfaction tends to be lower among PCPs, compared to specialists, and likely contributes to the workforce shortage.

The Patient-Centered Medical Home has received attention as a means to improve quality and efficiency in healthcare. These are achieved by improving coordination of care and enhancing patient-provider relationships. Additionally, some proponents argue that these PCMH features will also improve satisfaction among PCPs, offering a strategy to address the primary care shortage. Few studies have demonstrated this association, and our specific aim is to test this hypothesis with data from a national sample of physicians.

Methods: We conducted a cross-sectional analysis of data from the 2008 Health Tracking Physician Survey. We identified PCPs practicing in settings with recognized components of the Patient-Centered Medical Home. We estimated the presence of the following PCMH components by comparing HTPS items with PCMH guidelines established by the National Committee for Quality Assurance: enhanced access, patient information management, care management, self-care support, care coordination, and performance measurement. We measured Medical Home Completeness by counting the number of components present. Logistic regressions were performed with physician career satisfaction as the dependent variable and the components and/or completeness of PCMH as independent variables.

Results and Discussion: About 20% of PCPs surveyed reported negative career satisfaction, and many, 82%, practiced in an environment with fewer than half of the components of PCMH. Physicians in practices with enhanced access had lower odds of positive satisfaction (OR=0.59). Conversely, positive satisfaction was associated with the presence of processes for care management (OR=1.66) and performance measurement (OR=1.69). Physicians in practices with more than half of PCMH components were likelier to report positive satisfaction (OR=1.54). These findings suggest that PCMH components are associated with increased satisfaction among PCPs, but certain components may enhance physician satisfaction while others may, in fact, compromise physician satisfaction.