Author Affiliations: Department of Medicine (Drs Rasinski, Yoon, and Curlin) and MacLean Center for Clinical Medical Ethics (Drs Yoon and Curlin), University of Chicago, Chicago, Illinois; and Department of Psychiatry, Columbia University Medical Center and the New York State Psychiatric Institute, New York (Dr Lawrence).
Nicotine dependence, obesity, and alcoholism respond to treatment by primary care physicians, but research suggests established treatment protocols are rarely used.1- 3 It may be that physicians shy away from addressing these multifaceted, often obdurate conditions because they find that treating them is unsatisfying.4- 6 We use the results of a national survey of primary care physicians to examine correlates of physician satisfaction in treating these conditions. We hypothesized that physician satisfaction would be lower for physicians who believe patients are responsible for these conditions and who are dissatisfied with their careers. We hypothesized that treatment satisfaction would be higher for physicians who view medicine as a calling.
The data are from a national mail survey of 1504 US primary care physicians (those with a primary specialty of general internal medicine, family medicine, or general practice, and with no secondary specialty) who were 65 years or younger. The survey was conducted from 2009 to 2010. The overall response rate was 63% after excluding 77 primary care physicians who had invalid addresses or were no longer practicing. Data were weighted to represent the population of US primary care physicians. A more detailed description of the research design is presented elsewhere.7 Outcome measures were questions about how much personal satisfaction physicians experience when taking care of patients with alcoholism, obesity, and nicotine dependence. With respect to predictors, physicians were asked to indicate for each condition to the extent to which the condition resulted from choices for which patients are responsible. Career satisfaction was measured as agreement or disagreement with the statement, “If I had it to do over again, I would not choose medicine as a career.” Finally, physicians were asked whether they agree or disagree with the statement, “For me, the practice of medicine is a calling.” We used separate multivariable logistic regression models to estimate independent effects of patient responsibility, physician career satisfaction, and practice of medicine as a calling on each of the 3 conditions. Physician specialty, sex, age, race/ethnicity, region, immigration status, religious affiliation, and importance of religion were also included as covariates in the models.
Physicians were most satisfied with treating nicotine dependence (62% experienced “some” or “a lot” of satisfaction), followed by obesity (57% experienced “some” or “a lot” of satisfaction) and alcoholism (50% said they experienced “some” or “a lot” of satisfaction; P < .01 for all comparisons). Multivariable analyses (Table) showed that physicians who indicated that medicine was a calling were significantly more likely to report satisfaction treating each condition (nicotine dependence, adjusted odds ratio [AOR], 1.9; obesity, AOR, 1.9; alcoholism, AOR, 1.6). Those dissatisfied with medicine as a career were significantly less likely to report satisfaction treating nicotine dependence (AOR, 0.7) and alcoholism (AOR, 0.6). Physicians who believed that the patient was responsible for the condition were significantly less likely to report satisfaction treating alcoholism (some vs no responsibility, AOR, 0.3; a lot vs no responsibility, AOR, 0.3).
This study is limited in that data were generated by physician self-reports. In addition, nonresponders may differ from responders in ways that bias the results. Also, causal direction cannot be determined from cross-sectional data such as these. Future research should examine the relationship of physicians' sense of calling, their career satisfaction, their attribution of responsibility for the disorders to patients, and their satisfaction in treating the disorders to the actual implementation of treatment plans for these 3 common medical disorders that have such important health consequences.
Correspondence: Dr Rasinski, Department of Medicine, University of Chicago, 5841 S Maryland Ave, AMB B203, Chicago, IL 60637 (firstname.lastname@example.org).
Published Online: August 27, 2012. doi:10.1001/archinternmed.2012.3269
Author Contributions:Study concept and design: Rasinski, Yoon, and Curlin. Acquisition of data: Rasinski, Yoon, and Curlin. Analysis and interpretation of data: Rasinski, Lawrence, and Yoon. Drafting of the manuscript: Rasinski and Lawrence. Critical revision of the manuscript for important intellectual content: Rasinski, Lawrence, and Yoon. Statistical analysis: Rasinski. Obtained funding: Curlin. Administrative, technical, and material support: Rasinski. Study supervision: Rasinski and Yoon. Data publication: Lawrence.
Financial Disclosure: None reported.
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