Skip to main content
Erschienen in: Journal of General Internal Medicine 6/2018

29.01.2018 | Original Research

Physician Perception of Pay Fairness and its Association with Work Satisfaction, Intent to Leave Practice, and Personal Health

verfasst von: Audiey C. Kao, MD, PhD, Andrew J. Jager, MA, Barbara A. Koenig, PhD, Arlen C. Moller, PhD, Michael A. Tutty, PhD, Geoffrey C. Williams, MD, PhD, Scott M. Wright, MD

Erschienen in: Journal of General Internal Medicine | Ausgabe 6/2018

Einloggen, um Zugang zu erhalten

Abstract

Background

Primary care physicians generally earn less than specialists. Studies of other occupations have identified perception of pay fairness as a predictor of work- and life-related outcomes. We evaluated whether physicians’ pay fairness perceptions were associated with their work satisfaction, turnover intention, and personal health.

Methods

Three thousand five hundred eighty-nine physicians were surveyed. Agreement with “my total compensation is fair” was used to assess pay fairness perceptions. Total compensation was self-reported, and we used validated measures of work satisfaction, likelihood of leaving current practice, and health status. Hierarchical logistic regressions were used to assess the associations between pay fairness perceptions and work/life-related outcomes.

Results

A total of 2263 physicians completed surveys. Fifty-seven percent believed their compensation was fair; there was no difference between physicians in internal medicine and non-primary care specialties (P = 0.58). Eighty-three percent were satisfied at work, 70% reported low likelihood of leaving their practice, and 77% rated their health as very good or excellent. Higher compensation levels were associated with greater work satisfaction and lower turnover intention, but most associations became statistically non-significant after adjusting for pay fairness perceptions. Perceived pay fairness was associated with greater work satisfaction (OR, 4.90; 95% CI, 3.94–6.08; P < 0.001), lower turnover intention (OR, 2.46; 95% CI, 2.01–3.01; P < 0.001), and better health (OR, 1.33; 95% CI, 1.08–1.65; P < 0.01).

Discussion

Physicians who thought their pay was fair reported greater work satisfaction, lower likelihood of leaving their practice, and better overall health. Addressing pay fairness perceptions may be important for sustaining a satisfied and healthy physician workforce, which is necessary to deliver high-quality care.
Literatur
1.
Zurück zum Zitat Stoddard JJ, Hargraves JL, Reed M, Vratil A. Managed care, professional autonomy, and income: effects on physician career satisfaction. J Gen Intern Med. 2001;16(10):675–84.CrossRefPubMedPubMedCentral Stoddard JJ, Hargraves JL, Reed M, Vratil A. Managed care, professional autonomy, and income: effects on physician career satisfaction. J Gen Intern Med. 2001;16(10):675–84.CrossRefPubMedPubMedCentral
2.
Zurück zum Zitat Leigh JP, Kravitz RL, Schembri M, Samuels SJ, Mobley S. Physician career satisfaction across specialties. Arch Intern Med. 2002;162(14):1577–84.CrossRefPubMed Leigh JP, Kravitz RL, Schembri M, Samuels SJ, Mobley S. Physician career satisfaction across specialties. Arch Intern Med. 2002;162(14):1577–84.CrossRefPubMed
3.
Zurück zum Zitat Jawahar IM, Stone TH. Fairness perceptions and satisfaction with components of pay satisfaction. J Manag Psychol. 2011;26(4):297–312.CrossRef Jawahar IM, Stone TH. Fairness perceptions and satisfaction with components of pay satisfaction. J Manag Psychol. 2011;26(4):297–312.CrossRef
4.
Zurück zum Zitat Shaw JD, Gupta N. Pay fairness and employee outcomes: exacerbation effects of financial need. J Occup Organ Psychol. 2001;74:299–320.CrossRef Shaw JD, Gupta N. Pay fairness and employee outcomes: exacerbation effects of financial need. J Occup Organ Psychol. 2001;74:299–320.CrossRef
5.
Zurück zum Zitat Jones FF, Scarpello V, Bergmann T. Pay procedures: what makes them fair? J Occup Organ Psychol. 1999;72:129–45.CrossRef Jones FF, Scarpello V, Bergmann T. Pay procedures: what makes them fair? J Occup Organ Psychol. 1999;72:129–45.CrossRef
6.
Zurück zum Zitat Shaw JD, Gupta N, Delery JE. Pay dispersion and workforce performance: moderating effects of incentives and interdependence. Strateg Manag J. 2002;23:491–512.CrossRef Shaw JD, Gupta N, Delery JE. Pay dispersion and workforce performance: moderating effects of incentives and interdependence. Strateg Manag J. 2002;23:491–512.CrossRef
7.
Zurück zum Zitat Abeler J, Altmann S, Kube S, Wibral M. Gift exchange and workers' fairness concerns: when equality is unfair. J Eur Econ Assoc. 2010;8(6):1299–1324. Abeler J, Altmann S, Kube S, Wibral M. Gift exchange and workers' fairness concerns: when equality is unfair. J Eur Econ Assoc. 2010;8(6):1299–1324.
8.
Zurück zum Zitat Cohn A, Fehr E, Goette L. Fair wages and effort provision: combining evidence from a choice experiment and a field experiment. Manag Sci. 2015;61(8):1777–94.CrossRef Cohn A, Fehr E, Goette L. Fair wages and effort provision: combining evidence from a choice experiment and a field experiment. Manag Sci. 2015;61(8):1777–94.CrossRef
9.
Zurück zum Zitat Fehr E, Schmidt KM. A theory of fairness, competition, and cooperation. Q J Econ. 1999;114(3):817–68.CrossRef Fehr E, Schmidt KM. A theory of fairness, competition, and cooperation. Q J Econ. 1999;114(3):817–68.CrossRef
10.
Zurück zum Zitat Erdogan B, Bauer TN, Truxillo DM, Mansfield LR. Whistle while you work: a review of the life satisfaction literature. J Manag. 2012;38(4):1038–83. Erdogan B, Bauer TN, Truxillo DM, Mansfield LR. Whistle while you work: a review of the life satisfaction literature. J Manag. 2012;38(4):1038–83.
11.
Zurück zum Zitat Anitha J. Determinants of employee engagement and their impact on employee performance. Int J Product Perform Manag. 2014;63(3):308–23.CrossRef Anitha J. Determinants of employee engagement and their impact on employee performance. Int J Product Perform Manag. 2014;63(3):308–23.CrossRef
12.
Zurück zum Zitat Christian MS, Garza AS, Slaughter JE. Work engagement: a quantitative review and test of its relations with task and contextual performance. Pers Psychol. 2011;64(1):89–136.CrossRef Christian MS, Garza AS, Slaughter JE. Work engagement: a quantitative review and test of its relations with task and contextual performance. Pers Psychol. 2011;64(1):89–136.CrossRef
13.
Zurück zum Zitat de Boer EM, Bakker AB, Syroit JE, Schaufeli WB. Unfairness at work as a predictor of absenteeism. J Organ Behav. 2002;23(2):181–97.CrossRef de Boer EM, Bakker AB, Syroit JE, Schaufeli WB. Unfairness at work as a predictor of absenteeism. J Organ Behav. 2002;23(2):181–97.CrossRef
14.
Zurück zum Zitat van Vegchel N, de Jonge J, Bosma H, Schaufeli W. Reviewing the effort-reward imbalance model: drawing up the balance of 45 empirical studies. Soc Sci Med. 2005;60(5):1117–31.CrossRefPubMed van Vegchel N, de Jonge J, Bosma H, Schaufeli W. Reviewing the effort-reward imbalance model: drawing up the balance of 45 empirical studies. Soc Sci Med. 2005;60(5):1117–31.CrossRefPubMed
15.
Zurück zum Zitat Rasmussen V, Turnell A, Butow P, et al. Burnout among psychosocial oncologists: an application and extension of the effort-reward imbalance model. Psychooncology. 2016;25(2):194–202.CrossRefPubMed Rasmussen V, Turnell A, Butow P, et al. Burnout among psychosocial oncologists: an application and extension of the effort-reward imbalance model. Psychooncology. 2016;25(2):194–202.CrossRefPubMed
16.
Zurück zum Zitat Heikkila K, Nyberg ST, Theorell T, et al. Work stress and risk of cancer: meta-analysis of 5700 incident cancer events in 116,000 European men and women. BMJ. 2013;346:f165.CrossRefPubMedPubMedCentral Heikkila K, Nyberg ST, Theorell T, et al. Work stress and risk of cancer: meta-analysis of 5700 incident cancer events in 116,000 European men and women. BMJ. 2013;346:f165.CrossRefPubMedPubMedCentral
20.
21.
Zurück zum Zitat Huff C. Direct primary care: concierge care for the masses. Health Aff (Millwood). 2015;34(12):2016–9.CrossRef Huff C. Direct primary care: concierge care for the masses. Health Aff (Millwood). 2015;34(12):2016–9.CrossRef
23.
Zurück zum Zitat Brazier JE, Harper R, Jones NM, et al. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ. 1992;305(6846):160–4.CrossRefPubMedPubMedCentral Brazier JE, Harper R, Jones NM, et al. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ. 1992;305(6846):160–4.CrossRefPubMedPubMedCentral
24.
Zurück zum Zitat Khullar D, Chokshi DA, Kocher R, et al. Behavioral economics and physician compensation--promise and challenges. N Engl J Med. 2015;372(24):2281–3.CrossRefPubMed Khullar D, Chokshi DA, Kocher R, et al. Behavioral economics and physician compensation--promise and challenges. N Engl J Med. 2015;372(24):2281–3.CrossRefPubMed
25.
Zurück zum Zitat Trowbridge E, Bartels CM, Koslov S, Kamnetz S, Pandhi N. Development and Impact of a Novel Academic Primary Care Compensation Model. J Gen Intern Med. 2015;30(12):1865–70.CrossRefPubMedPubMedCentral Trowbridge E, Bartels CM, Koslov S, Kamnetz S, Pandhi N. Development and Impact of a Novel Academic Primary Care Compensation Model. J Gen Intern Med. 2015;30(12):1865–70.CrossRefPubMedPubMedCentral
27.
Zurück zum Zitat Haas JS, Cook EF, Puopolo AL, et al. Is the professional satisfaction of general internists associated with patient satisfaction? J Gen Intern Med. 2000;15:122–8.CrossRefPubMedPubMedCentral Haas JS, Cook EF, Puopolo AL, et al. Is the professional satisfaction of general internists associated with patient satisfaction? J Gen Intern Med. 2000;15:122–8.CrossRefPubMedPubMedCentral
28.
Zurück zum Zitat Reddy A, Pollack CE, Asch DA, Canamucio A, Werner RM. The effect of primary care provider turnover on patient experience of care and ambulatory quality of care. JAMA Intern Med. 2015;175(7):1157–62.CrossRefPubMedPubMedCentral Reddy A, Pollack CE, Asch DA, Canamucio A, Werner RM. The effect of primary care provider turnover on patient experience of care and ambulatory quality of care. JAMA Intern Med. 2015;175(7):1157–62.CrossRefPubMedPubMedCentral
29.
Zurück zum Zitat Frank E, Dresner Y, Shani M, Vinker S. The association between physicians’ and patients’ preventive health practices. CMAJ. 2013;185(8):649–53.CrossRefPubMedPubMedCentral Frank E, Dresner Y, Shani M, Vinker S. The association between physicians’ and patients’ preventive health practices. CMAJ. 2013;185(8):649–53.CrossRefPubMedPubMedCentral
30.
Zurück zum Zitat Bleich SN, Bennett WL, Gudzune KA, Cooper LA. Impact of physician BMI on obesity care and beliefs. Obesity (Silver Spring). 2012;20(5):999–1005.CrossRef Bleich SN, Bennett WL, Gudzune KA, Cooper LA. Impact of physician BMI on obesity care and beliefs. Obesity (Silver Spring). 2012;20(5):999–1005.CrossRef
32.
Zurück zum Zitat Folger R, Konovsky MA. Effects of procedural and distributive justice on reactions to pay decisions. Acad Manag J. 1989;32(1):115–30. Folger R, Konovsky MA. Effects of procedural and distributive justice on reactions to pay decisions. Acad Manag J. 1989;32(1):115–30.
33.
Zurück zum Zitat Carter MZ, Armenakis AA, Field HS, Mossholder KW. Transformational leadership, relationship quality, and employee performance during continuous incremental organizational change. J Organ Behav. 2013;34(7):942–58. Carter MZ, Armenakis AA, Field HS, Mossholder KW. Transformational leadership, relationship quality, and employee performance during continuous incremental organizational change. J Organ Behav. 2013;34(7):942–58.
34.
Zurück zum Zitat Bloom M. The ethics of compensation systems. J Bus Ethics. 2004;52(2):149–52.CrossRef Bloom M. The ethics of compensation systems. J Bus Ethics. 2004;52(2):149–52.CrossRef
35.
Zurück zum Zitat Morrison EW, Robinson SL. When employees feel betrayed: a model of how psychological contract violation develops. Acad Manag Rev. 1997;22(1):226–56.CrossRef Morrison EW, Robinson SL. When employees feel betrayed: a model of how psychological contract violation develops. Acad Manag Rev. 1997;22(1):226–56.CrossRef
36.
Zurück zum Zitat Leventhal GS, Karuza J, Fry WR. Beyond fairness: a theory of allocation preferences. In: Mikula G, ed. Justice and Social Interaction. New York: Springer-Verlag; 1980:167–218. Leventhal GS, Karuza J, Fry WR. Beyond fairness: a theory of allocation preferences. In: Mikula G, ed. Justice and Social Interaction. New York: Springer-Verlag; 1980:167–218.
37.
Zurück zum Zitat Gupta N, Jenkins GD. The politics of pay. Compens Benefit Rev. 1996;28(2):23–30. Gupta N, Jenkins GD. The politics of pay. Compens Benefit Rev. 1996;28(2):23–30.
38.
Zurück zum Zitat Brockner J, Siegel PA, Daly JP, Tyler T, Martin C. When trust matters: the moderating effect of outcome favorability. Adm Sci Q. 1997;42(3):558–83.CrossRef Brockner J, Siegel PA, Daly JP, Tyler T, Martin C. When trust matters: the moderating effect of outcome favorability. Adm Sci Q. 1997;42(3):558–83.CrossRef
39.
Zurück zum Zitat Scarpello V, Jones FF. When justice matters in compensation decision making. J Organ Behav. 1996;17(3):285–99.CrossRef Scarpello V, Jones FF. When justice matters in compensation decision making. J Organ Behav. 1996;17(3):285–99.CrossRef
40.
Zurück zum Zitat Burwell SM. Setting value-based payment goals: HHS efforts to improve U.S. health care. N Engl J Med. 2015;372(10):897–9.CrossRefPubMed Burwell SM. Setting value-based payment goals: HHS efforts to improve U.S. health care. N Engl J Med. 2015;372(10):897–9.CrossRefPubMed
41.
Zurück zum Zitat Centers for Medicare & Medicaid Services (CMS), HHS. Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) incentive under the Physician Fee Schedule, and criteria for physician-focused payment models; final rule. Fed Regist. 2016;81(214):77008–831. Centers for Medicare & Medicaid Services (CMS), HHS. Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) incentive under the Physician Fee Schedule, and criteria for physician-focused payment models; final rule. Fed Regist. 2016;81(214):77008–831.
42.
Zurück zum Zitat Christianson JB, Knutson DJ, Mazze RS. Physician pay-for-performance. Implementation and research issues. J Gen Intern Med. 2006;21(Suppl 2):S9–13.PubMedPubMedCentral Christianson JB, Knutson DJ, Mazze RS. Physician pay-for-performance. Implementation and research issues. J Gen Intern Med. 2006;21(Suppl 2):S9–13.PubMedPubMedCentral
44.
Zurück zum Zitat Woolhandler S, Himmelstein DU. Collateral damage: pay-for-performance initiatives and safety-net hospitals. Ann Intern Med. 2015;163(6):473–4.CrossRefPubMed Woolhandler S, Himmelstein DU. Collateral damage: pay-for-performance initiatives and safety-net hospitals. Ann Intern Med. 2015;163(6):473–4.CrossRefPubMed
45.
Zurück zum Zitat Clough JD, McClellan M. Implementing MACRA: implications for physicians and for physician leadership. JAMA. 2016;315(22):2397–8.CrossRefPubMed Clough JD, McClellan M. Implementing MACRA: implications for physicians and for physician leadership. JAMA. 2016;315(22):2397–8.CrossRefPubMed
46.
Zurück zum Zitat Fiscella K, Burstin HR, Nerenz DR. Quality measures and sociodemographic risk factors: to adjust or not to adjust. JAMA. 2014;312(24):2615–6.CrossRefPubMed Fiscella K, Burstin HR, Nerenz DR. Quality measures and sociodemographic risk factors: to adjust or not to adjust. JAMA. 2014;312(24):2615–6.CrossRefPubMed
Metadaten
Titel
Physician Perception of Pay Fairness and its Association with Work Satisfaction, Intent to Leave Practice, and Personal Health
verfasst von
Audiey C. Kao, MD, PhD
Andrew J. Jager, MA
Barbara A. Koenig, PhD
Arlen C. Moller, PhD
Michael A. Tutty, PhD
Geoffrey C. Williams, MD, PhD
Scott M. Wright, MD
Publikationsdatum
29.01.2018
Verlag
Springer US
Erschienen in
Journal of General Internal Medicine / Ausgabe 6/2018
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-017-4303-8

Weitere Artikel der Ausgabe 6/2018

Journal of General Internal Medicine 6/2018 Zur Ausgabe

Innovation and Improvement: Innovations in Medical Education

Asking a Variety of Questions on Walk Rounds: a Pilot Study

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.