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      Physician, practice, and patient characteristics related to primary care physician physical and mental health: results from the Physician Worklife Study.

      Health Services Research
      Adult, Diagnosis-Related Groups, Family Practice, organization & administration, statistics & numerical data, Health Services Research, Health Surveys, Humans, Job Satisfaction, Mental Health, Middle Aged, Models, Psychological, Occupational Health, Physical Fitness, Physicians, Family, classification, psychology, Stress, Psychological, epidemiology, United States, Workplace

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          Abstract

          To study the impact that physician, practice, and patient characteristics have on physician stress, satisfaction, mental, and physical health. Based on a survey of over 5,000 physicians nationwide. Four waves of surveys resulted in 2,325 complete responses. Elimination of ineligibles yielded a 52 percent response rate; 1,411 responses from primary care physicians were used. A conceptual model was tested by structural equation modeling. Physician job satisfaction and stress mediated the relationship between physician, practice, and patient characteristics as independent variables and physician physical and mental health as dependent variables. The conceptual model was generally supported. Practice and, to a lesser extent, physician characteristics influenced job satisfaction, whereas only practice characteristics influenced job stress. Patient characteristics exerted little influence. Job stress powerfully influenced job satisfaction and physical and mental health among physicians. These findings support the notion that workplace conditions are a major determinant of physician well-being. Poor practice conditions can result in poor outcomes, which can erode quality of care and prove costly to the physician and health care organization. Fortunately, these conditions are manageable. Organizational settings that are both "physician friendly" and "family friendly" seem to result in greater well-being. These findings are particularly important as physicians are more tightly integrated into the health care system that may be less clearly under their exclusive control.

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          Significance tests and goodness of fit in the analysis of covariance structures.

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            Physicians' characteristics influence patients' adherence to medical treatment: results from the Medical Outcomes Study.

            The influence of physicians' attributes and practice style on patients' adherence to treatment was examined in a 2-year longitudinal study of 186 physicians and their diabetes, hypertension, and heart disease patients. A physician-level analysis was conducted, controlling for baseline patient adherence rates and for patient characteristics predictive of adherence in previous analyses. General adherence and adherence to medication, exercise, and diet recommendations were examined. Baseline adherence rates were associated with adherence rates 2 years later. Other predictors were physician job satisfaction (general adherence), number of patients seen per week (medication), scheduling a follow-up appointment (medication), tendency to answer patients' questions (exercise), number of tests ordered (diet), seriousness of illness (diet), physician specialty (medication, diet), and patient health distress (medication, exercise).
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              A review of current practices for evaluating causal models in organizational behavior and human resources management research

              G Medsker (1994)
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