Employed family physician satisfaction and commitment to their practice, work group, and health care organization.

“The reality of the growing dissatisfaction with the practice of medicine has reached a crisis level”(Weinstein and Wolfe 2007). This belief has led to the growing number of studies of physician job satisfaction (Breslau, Novack, and Wolf 1978; Pasternak, Tuttle, and Smith 1986; Schulz and Schulz 1988; Buciuniene, Blazeviciene, and Bliudziute 2005; Scott et al. 2006; Van Ham et al. 2006; Whalley et al. 2006; Keeton et al. 2007;). Job satisfaction studies are important because they have identified outcomes linked to satisfaction, such as turnover (Beasley et al. 2004; Misra-Hebert, Kay, and Stoller 2004; Landon et al. 2006; Joseph et al. 2007; Wright and Bonett 2007;), cutting back hours (Landon et al. 2006), mental health (Williams et al. 2002), quality of care (Grembowski et al. 2005), and burnout (Linzer et al. 2001). Satisfied physicians also appear to engender greater satisfaction, trust, and confidence in their patients (Grembowski et al. 2005). Satisfaction studies are also important because they have identified job and organizational predictors of satisfaction (Gaertner 1999; Freeborn 2001; Duffy and Richard 2006; Van Ham et al. 2006;) that can be changed to improve satisfaction, and they decrease the likelihood of subsequent bad outcomes such as burnout or turnover. While physician satisfaction continues to receive attention, physician commitment has received far less (Lakin 1998; Burns et al. 2001; Freeborn 2001;). Outside of health care, commitment and satisfaction are considered among the two most important employee attitudes because both lead to a variety of important behaviors such a performance, turnover, absenteeism, and helping behaviors (Currivan 1999; Meyer and Herscovitch 2001; Wagner 2007; Solinger, van Olffen, and Roe 2008;). But for some reason, commitment has been largely ignored in studies of physicians. Commitment has been defined in many ways, but a common theme is that commitment to something can be thought of as the force that binds a person to something, where the “something” is typically a behavior (e.g., “I am committed to providing better care”) or an entity (e.g., “I am committed to my practice”) (Meyer and Herscovitch 2001). Commitment has cognitive, emotional, and behavioral components (Solinger, van Olffen, and Roe 2008). Low commitment can lead to behaviors such as turnover, but high commitment can lead to helping behaviors directed to patients or colleagues (Solinger, van Olffen, and Roe 2008), making the study of physician commitment an important gap to fill. Another important gap in the literature on physician attitudes, in addition to the omission of commitment, is that studies have not examined satisfaction and commitment directed to the entities that physicians most associate themselves with: one's practice, one's workgroup (people with whom you take call), and one's employer, which we refer to as the physician's health care organization (HCO) or parent organization.1 Instead, existing research has typically only focused on the latter (Schulz, Girard, and Scheckler 1992; Burdi and Baker 1997; LePore and Tooker 2000; Linzer et al. 2000; Sturm 2001; Beasley et al. 2004, 2005). Results show that HMO employed and non-HMO physician satisfaction varies widely, as do the predictors of satisfaction. But these studies have not compared measures of satisfaction (or commitment) with entities that physicians affiliate. This is an important omission for at least two reasons: (a) satisfaction with or commitment toward these different entities may differentially predict outcomes such as turnover and job performance and (b) different variables may predict each type of satisfaction and commitment. If (a) and (b) are true, then current efforts to improve physician satisfaction and/or commitment may need to be redirected. This study is an attempt to fill that gap. The purpose of this study was to compare satisfaction and commitment scores among family physicians toward their practice, workgroup, and HCO and to determine what work factors predict the different types of satisfaction and commitment. The sample consisted of family medicine physicians employed by large multispecialty group practices, a group for whom this may be especially important in light of the low numbers of medical students intending to pursue a career in primary care (Hauer et al. 2008).