A survey of students, residents, faculty, and deans at medical schools in the United States

Steven R. Simon, Richard J D Pan, Amy M. Sullivan, Nancy Clark-Chiarelli, Maureen T. Connelly, Antoinette S. Peters, Judith D. Singer, Thomas Inui, Susan D. Block

Research output: Contribution to journalArticle

87 Citations (Scopus)

Abstract

Background and Methods: Views of managed care among academic physicians and medical students in the United States are not well known. In 1997, we conducted a telephone survey of a national sample of medical students (506 respondents), residents (494), faculty members (728), department chairs (186), directors of residency training in internal medicine and pediatrics (143), and deans (105) at U.S. medical schools to determine their experiences in and perspectives on managed care. The overall rate of response was 80.1 percent. Results: Respondents rated their attitudes toward managed care on a 0-to-10 scale, with 0 defined as 'as negative as possible' and 10 as 'as positive as possible.' The expressed attitudes toward managed care were negative, ranging from a low mean (±SD) score of 3.9±1.7 for residents to a high of 5.0±1.3 for deans. When asked about specific aspects of care, fee- for-service medicine was rated better than managed care in terms of access (by 80.2 percent of respondents), minimizing ethical conflicts (74.8 percent), and the quality of the doctor-patient relationship (70.6 percent). With respect to the continuity of care, 52.0 percent of respondents preferred fee-for-service medicine, and 29.3 percent preferred managed care. For care at the end of life, 49.1 percent preferred fee-for-service medicine, and 20.5 percent preferred managed care. With respect to care for patients with chronic illness, 41.8 percent preferred fee-for-service care, and 30.8 percent preferred managed care. Faculty members, residency-training directors, and department chairs responded that managed care had reduced the time they had available for research (63.1 percent agreed) and teaching (58.9 percent) and had reduced their income (55.8 percent). Overall, 46.6 percent of faculty members, 26.7 percent of residency-training directors, and 42.7 percent of department chairs reported that the message they delivered to students about managed care was negative. Conclusions: Negative views of managed care are widespread among medical students, residents, faculty members, and medical school deans.

Original languageEnglish (US)
Pages (from-to)928-936
Number of pages9
JournalNew England Journal of Medicine
Volume340
Issue number12
DOIs
StatePublished - Mar 25 1999
Externally publishedYes

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Managed Care Programs
Medical Schools
Students
Fee-for-Service Plans
Internship and Residency
Medical Students
Medicine
Surveys and Questionnaires
Continuity of Patient Care
Terminal Care
Internal Medicine
Telephone
Patient Care
Teaching
Chronic Disease
Pediatrics
Physicians

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Simon, S. R., Pan, R. J. D., Sullivan, A. M., Clark-Chiarelli, N., Connelly, M. T., Peters, A. S., ... Block, S. D. (1999). A survey of students, residents, faculty, and deans at medical schools in the United States. New England Journal of Medicine, 340(12), 928-936. https://doi.org/10.1056/NEJM199903253401206

A survey of students, residents, faculty, and deans at medical schools in the United States. / Simon, Steven R.; Pan, Richard J D; Sullivan, Amy M.; Clark-Chiarelli, Nancy; Connelly, Maureen T.; Peters, Antoinette S.; Singer, Judith D.; Inui, Thomas; Block, Susan D.

In: New England Journal of Medicine, Vol. 340, No. 12, 25.03.1999, p. 928-936.

Research output: Contribution to journalArticle

Simon, SR, Pan, RJD, Sullivan, AM, Clark-Chiarelli, N, Connelly, MT, Peters, AS, Singer, JD, Inui, T & Block, SD 1999, 'A survey of students, residents, faculty, and deans at medical schools in the United States', New England Journal of Medicine, vol. 340, no. 12, pp. 928-936. https://doi.org/10.1056/NEJM199903253401206
Simon SR, Pan RJD, Sullivan AM, Clark-Chiarelli N, Connelly MT, Peters AS et al. A survey of students, residents, faculty, and deans at medical schools in the United States. New England Journal of Medicine. 1999 Mar 25;340(12):928-936. https://doi.org/10.1056/NEJM199903253401206
Simon, Steven R. ; Pan, Richard J D ; Sullivan, Amy M. ; Clark-Chiarelli, Nancy ; Connelly, Maureen T. ; Peters, Antoinette S. ; Singer, Judith D. ; Inui, Thomas ; Block, Susan D. / A survey of students, residents, faculty, and deans at medical schools in the United States. In: New England Journal of Medicine. 1999 ; Vol. 340, No. 12. pp. 928-936.
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abstract = "Background and Methods: Views of managed care among academic physicians and medical students in the United States are not well known. In 1997, we conducted a telephone survey of a national sample of medical students (506 respondents), residents (494), faculty members (728), department chairs (186), directors of residency training in internal medicine and pediatrics (143), and deans (105) at U.S. medical schools to determine their experiences in and perspectives on managed care. The overall rate of response was 80.1 percent. Results: Respondents rated their attitudes toward managed care on a 0-to-10 scale, with 0 defined as 'as negative as possible' and 10 as 'as positive as possible.' The expressed attitudes toward managed care were negative, ranging from a low mean (±SD) score of 3.9±1.7 for residents to a high of 5.0±1.3 for deans. When asked about specific aspects of care, fee- for-service medicine was rated better than managed care in terms of access (by 80.2 percent of respondents), minimizing ethical conflicts (74.8 percent), and the quality of the doctor-patient relationship (70.6 percent). With respect to the continuity of care, 52.0 percent of respondents preferred fee-for-service medicine, and 29.3 percent preferred managed care. For care at the end of life, 49.1 percent preferred fee-for-service medicine, and 20.5 percent preferred managed care. With respect to care for patients with chronic illness, 41.8 percent preferred fee-for-service care, and 30.8 percent preferred managed care. Faculty members, residency-training directors, and department chairs responded that managed care had reduced the time they had available for research (63.1 percent agreed) and teaching (58.9 percent) and had reduced their income (55.8 percent). Overall, 46.6 percent of faculty members, 26.7 percent of residency-training directors, and 42.7 percent of department chairs reported that the message they delivered to students about managed care was negative. Conclusions: Negative views of managed care are widespread among medical students, residents, faculty members, and medical school deans.",
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N2 - Background and Methods: Views of managed care among academic physicians and medical students in the United States are not well known. In 1997, we conducted a telephone survey of a national sample of medical students (506 respondents), residents (494), faculty members (728), department chairs (186), directors of residency training in internal medicine and pediatrics (143), and deans (105) at U.S. medical schools to determine their experiences in and perspectives on managed care. The overall rate of response was 80.1 percent. Results: Respondents rated their attitudes toward managed care on a 0-to-10 scale, with 0 defined as 'as negative as possible' and 10 as 'as positive as possible.' The expressed attitudes toward managed care were negative, ranging from a low mean (±SD) score of 3.9±1.7 for residents to a high of 5.0±1.3 for deans. When asked about specific aspects of care, fee- for-service medicine was rated better than managed care in terms of access (by 80.2 percent of respondents), minimizing ethical conflicts (74.8 percent), and the quality of the doctor-patient relationship (70.6 percent). With respect to the continuity of care, 52.0 percent of respondents preferred fee-for-service medicine, and 29.3 percent preferred managed care. For care at the end of life, 49.1 percent preferred fee-for-service medicine, and 20.5 percent preferred managed care. With respect to care for patients with chronic illness, 41.8 percent preferred fee-for-service care, and 30.8 percent preferred managed care. Faculty members, residency-training directors, and department chairs responded that managed care had reduced the time they had available for research (63.1 percent agreed) and teaching (58.9 percent) and had reduced their income (55.8 percent). Overall, 46.6 percent of faculty members, 26.7 percent of residency-training directors, and 42.7 percent of department chairs reported that the message they delivered to students about managed care was negative. Conclusions: Negative views of managed care are widespread among medical students, residents, faculty members, and medical school deans.

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