Relative Importance of Physicians' Personal and Situational Characteristics for the Quality of Patient Care

Abstract

This study measured the relative importance of physicians personal attributes (type of medical school attended time in practice and degree of specialization) and their work settings (type of ambulatory care settings and type of hospital) for the quality of patient care. The sample consisted of 454 physicians from 18 specialty categories in Hawaii in 1968. Relative importance was determined by comparing the marginal influence derived from the part correlation coefficients that were computed through use of Multiple Classification Analysis programs. The study was designed to assess Freidsons hypothesis that work behavior is more likely to be an outcome of the organized pressures of the work environment than of earlier socialization. The direct independent effects of physicians internal characteristics explained marginally 2% of the quality variations in physician performance while external characteristics explained 10% of the total variance. This finding implies that the physicians external characteristics exert a greater influence than internal qualities on physician performance and is consistent with Freidsons analysis of the medical profession. Also observed was a positive effect on physician performance of both training and hospital organization. The following order (descending) of quality performance was observed: 1) trained physicians in highly organized hospitals 2) physicians with less training but in highly organized hospitals 3) highly trained physicians in less organized hospitals and 4) physicians with less training in less organized hospitals. The work setting was somewhat less important for highly trained physicians but more so for physicians with less training. The quality of patient care differed more between hospitals affiliated with medical schools and all other hospitals than between diplomates of an American specialty board or fellows of an American college and physicians who were not diplomates or fellows but had voluntary or municipal hospital staff positions.