The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #70482

D Keane, MPH¹, Kevin Grumbach, MD², D Rittenhouse, MD², Catherine Dower, JD³, Andrew B Bindman, MD⁴, Sunita Mutha, MD, FACP⁵, J Yoon⁴, and W Huen⁴. (1) Center for the Health Professions, University of California, San Francisco, 3333 California St. #410, San Francisco, CA 94118, 415-476-8181, dkeane@itsa.ucsf.edu, (2) Department of Family and Community Medicine, University of California, San Francisco, San Francisco General Hospital, Ward 83, 1001 Potrero Ave, San Francisco, CA 94110, (3) Univ of California, San Francisco - Center for the Health Professions, 3333 California Street, Suite 410, San Francisco, CA 94118, (4) Division of General Internal Medicine, University of California, San Francisco, Box 1364, SFGH Bldg 90, Ward 9, University of California, San Francisco, San Francisco, CA 94143, (5) Center for the Heatlh Professions, University of California, San Francisco, 3333 California Street, Suite 410, San Francisco, CA 94118

Lessons from the 2001/2002 California Physicians Survey can be integrated into public health organizations. The "California Model" of loose networks of private practice physicians organized into large managed care practice organizations is unraveling. Compared to a few years ago, fewer physicians are participating in Independent Practice Associations (IPAs), the most common mechanism through which physicians in private practice participate in managed care. However, Kaiser Permanente physicians consistently express more positive opinions about their practice organization than do physicians working in IPAs and other managed care networks. Compared with office-based physicians, Kaiser Permanente physicians are much more likely to: believe that their practice organization has advantages for shared practice responsibility and quality of care and not just for obtaining managed are contracts and patient volume; receive financial incentives related to performance based on quality of care and patient satisfaction; rate the practice pattern information they receive as accurate, useful and intended to improve quality of care; work in interdisciplinary teams; and disagree that they experience pressures to limit referrals to specialists or ordering of medical tests. Public health leaders can learn from the Kaiser model and incorporate successful aspects into their organizations. A probability sample of eligible physicians in California’s 13 largest counties stratified by county and ethnicity with oversampling of non-white physicians was drawn from the American Medical Association Physician Masterfile. Physicians were survey-eligible if they were listed as providing direct patient care, not in training, and not employed by the federal government. Response rate was 60%.

Learning Objectives:

• List three organizational behaviors preferred by physicians
• Identify 3 IPA organizational behaviors that physicians rate as negative.

Keywords: Managed Care, Physicians

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Kaiser Permanente
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.