Physicians were asked if the patient's physician should accept the insurance company's restriction, appeal the restriction or misrepresent the facts to the insurance company in order to obtain coverage for the patient. RESULTS: Overall, most physicians responded that they would appeal (77%) rather than accept (12%) or misrepresent (11%) a restriction on medically necessary care. Physicians were more likely to misrepresent if the appeals process was longer (OR=1.68, CI 1.09 ± 2.59), less likely to succeed (OR=1.57, CI 1.02 ± 2.42), or involved a more severe condition (OR=2.19, CI 1.39 ± 3.45). Among physicians asked about severe angina, as the appeals process became more cumbersome, they were more likely to choose to misrepresent the facts to the insurer rather than appeal. When asked about a patient with moderate low back pain, physicians' decisions about how to respond to an insurance company restriction were not significantly affected by the hassle associated with the appeals process. CONCLUSION: Physicians' willingness to sanction deception of insurance companies varies according to length of the appeals process, the likelihood of a successful appeal, and condition severity. When the stakes are high, and the hassle of appeals is great, physicians become increasingly willing to sanction deception. Changes in the difficulty of appeals processes may ease the tension physicians' face between patient advocacy and honesty. PURPOSE: To assess general internists' (GIM) satisfaction and recruitment of medical students and compare these to family physicians (FP). METHODS: 5704 physicians were surveyed (adjusted response rate 52%) from a national random stratified sample-19% GIM (n=450, 108 women, 75 were``young'' (age < 45); 341 men, 109 were young) and 22% FP (n=502). Mean global job and specialty satisfaction as well as likelihood of recommending their specialty to medical students were compared by specialty. All were assessed on a 5 point Likert scale (3 = neither agree nor disagree). For general internists, further analyses were done by age and gender and logistic regression was used to model predictors of medical student recruitment. RESULTS: GIM had significantly lower job and specialty satisfaction vs FP (job: 3.52 vs 3.77; specialty: 3.18 vs 3.69, both p < .001). Global satisfaction did not differ by gender alone for GIM. However, younger women and older men had higher job satisfaction then their same gender counterparts (women 3.75 vs 3.28, p=.043, men 3.63 vs 3.28, p=.015) with no difference in specialty satisfaction. GIM was less likely than FP to recruit medical students to their specialty (3.26 vs 3.85, p < .001). Women GIM recruited with more enthusiasm than men (3.56 vs 3.16, p=.022) with younger women the most enthusiastic (young 3.67 vs old 3.35, p=.038). Global specialty satisfaction and female gender were positively associated with medical student recruitment by internists. CONCLUSION: General internists have lower job and specialty satisfaction than family physicians. This dissatisfaction leads to less recruitment of medical students into internal medicine. Increasing numbers of young women in GIM may change this trend but recruitment needs to be seen as an important outcome of physician satisfaction to keep the specialty viable. (27); plan cost rating, 64 (29); service restrictions 71 (24). TC rates were: HAART, 68%; PPD,14%; and flu shots, 32%. In multivariable models there were no significant differences between MC and FFS coverage for any of 7 IPC, 4 HPQ, or 4 TC quality indicators. Models controlling for race, education, sexual preference, and duration of physician ± patient relationship, which varied by plan type, were no different. Tests for an interaction between physician and FFS/MC differences were non-significant. CONCLUSION: For patients with HIV in Boston, managed care coverage was not associated with lower quality care. These experienced HIV providers do not appear to practice differently depending on insurance type. Our findings suggest that managed care coverage can be as effective as FFS coverage even for patients with a complex, expensive, chronic illness. We hypothesized that physicians would frequently field questions about CAM from their patients, but, due to a lack of education about these treatments, would feel uncomfortable discussing them. We therefore surveyed a metropolitan area group of physicians to ascertain their patterns of communication with patients regarding CAM and the factors that influence them to discuss CAM with their patients or refer them for CAM treatments. METHODS: Seven hundred fifty one randomly selected physicians in all specialties in the Denver, Colorado metropolitan area were asked about their exposure to, knowledge of, and belief in 16 CAM modalities and patterns of physician Ð patient communication regarding CAM. Analyses were conducted using the SAS system (version 6, fourth edition, Cary, NC, 1989) and included the two-tailed t-test, Pearson correlation coefficients, linear regression, and multivariate analysis. RESULTS: Three hundred and two of 705 deliverable surveys (43%) were returned. Responders averaged 44 years old (+/À 12 years), 63% were male, and 48% were selfdesignated primary care physicians. Seventy-six percent of physicians reported having at least one patient using a CAM therapy, 59% had received queries from patients about specific CAM treatments, 48% had recommended a specific CAM therapy to at least one patient, and 24% had used a CAM modality for themselves. While patients frequently sought out information about CAM modalities from their physicians, only 31% of physicians routinely ask their patients about their use of CAM modalities, and 17% never ask. Physicians most frequently recommended massage, relaxation, acupuncture, and biofeedback to patients, while the modalities physicians used most frequently for themselves were massage, relaxation, herbs, and yoga. Physician recommendation of CAM use to patients was most strongly associated with physician self-use (odds ratio 6.98,p=0.0001). Only 45% of physicians felt at least somewhat comfortable discussing the risks and benefits of CAM with their patients; the overwhelming majority (84%) felt they needed to learn more about CAM modalities to adequately care for patients. CONCLUSION: Education about CAM modalities is a significant unmet need among physicians residing in the Denver metropolitan area, and education may help alleviate the discomfort physicians have when fielding questions about CAM from patients. Physicians who already use CAM treatments for themselves are much more likely to recommend CAM for their patients than those physicians who don't personally use CAM. (1346) responded. The questionnaire included demographic items, the SF-12 to assess physical and psychological function and their satisfaction with, need for and importance of both their VA and non-VA sources of care. Non-VA care was identified using the HCFA enrollment database. RESULTS: Among the entire population, 303 (17%) belonged to a Medicare HMO for the entire 24 months, and 130 (7%) belonged to an HMO for part of the period. Questionnaire responders did not differ from non-responders by marital status, gender, service connected status or HMO enrollment. Among the HMO enrollees, 66% reported having a VA primary care provider and 46% reported receiving all their medical care from the VA. However, 72% reported having a non-VA primary care provider. When comparing VA users who belonged to a Medicare HMO to those who did not enroll in an HMO, the HMO members reported significantly higher levels of educational attainment and financial resources. The psychological and physical function scores did not differ amongst the various Medicare enrolled veterans. CONCLUSION: Users of VA medical care frequently belong to Medicare HMOs, and nearly half of these HMO enrollees report receiving most of their medical care from the VA. VA users who belong to HMOs tend to be better educated and more financially secure. VA care appears to provide a substantial financial benefit to Medicare HMO plans. Little is known about the extent to which characteristics of health care organizations foster or hinder such performance. We evaluated variations in tobacco counseling rates among VA medical centers (VAMC's) nationwide and assessed the medical center and primary care program attributes related to high and low performance. METHODS: We assessed VAMC organizational characteristics (e.g., region, urban location, primary care features) using a previously validated mailout survey fielded to VA primary care directors (100% response). We matched these survey-based measures to two centrally available databases: (1) organizational culture scores derived from the first wave of the National VA Quality Improvement Survey (G. Young, PI) administered to over 100 employees at each VAMC, and (2) tobacco counseling rates for each VAMC from externally-performed chart reviews of randomly sampled users with 1+ primary care and 1+ subspecialty visits (88% match). We used bivariate analyses to examine the relationships between discrete organizational features and counseling rates and multiple linear regression using a forward stepwise algorithm to assess the independent predictors of counseling rates. RESULTS: Counseling rates varied by region (p < .01), with lowest rates in the East (0.73) and highest in the Western states (0.83). More complex VAMC's had lower tobacco counseling rates (p < .0001), consistent with lower rates among urban (p < .0001), academic (p < .01) VA's, with more internal medicine house officers (p < .01) and larger patient caseloads (p < .001). VA's with higher self-reported levels of primary care implementation, higher proportions of veteran users receiving all or most of their care in primary care, and where primary care physicians had responsibility for their patients as inpatients had higher tobacco counseling rates (all p < .05).