The proposed project will (1) develop a typology of large organizational forms within which American physicians work as salaried employees; (2) examine how these organizational forms impact on the role definitions, role expectations, career development patterns and perceptions of physicians (e.g., recruitment, credentialling, advancement, medical staff leadership, job satisfaction and turnover); (3) explore implications of these forms of medical staff organization for the way in which health care services are produced and delivered; and (4) measure the extent to which the factors of selective recruitment and retention, structured incentives, and organizational supports serve to increase the likelihood of physicians in different settings providing selected types of health care services. The study will involve the selection of a national representative sample of health services organizations which employ more than 30 salaried physicians. Within each of 75 such organizations, a telephone survey will be conducted with the physician staff leaders in these organizations. These interviews will be followed by a mailed questionnaire survey of all physicians working in these health services organizations in the specialties of family/general practice, internal medicine, pediatrics, obstetrics/gynecology, and surgery. The proposed study will build upon a previous national study conducted by the UNC Study Team in which the issues were physician recruitment, retention and satisfaction in primary care-oriented multispecialty group practice. Recent work by the investigators has indicated that important qualitative changes may be taking place between physicians and their organizational employers where such physicians work for salary compensation. The fact that physicians entering salaried practice arrangements is no longer """"""""atypical,"""""""" coupled with the fact that organizations which employ these physicians are now an accepted part of mainstream medical care, makes the effort to better understand the importance of these developments (and variation within this general domain) for the long-term career orientations of physicians, and the content and the context of professional work of physicians in these settings.
