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J Am Board Fam Med. 2009 Jan-Feb;22(1):24-33. doi: 10.3122/jabfm.2009.01.080027.

Perceived complexity of care, perceived autonomy, and career satisfaction among primary care physicians.

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Department of Family and Community Medicine, University of Texas Health Science Center, San Antonio, TX, USA.



The purpose of this study was to examine relationships of both perceived autonomy and perceived complexity of care with career satisfaction.


This secondary analysis used 3 consecutive surveys of family physicians, internists, and pediatricians from the Community Tracking Survey. Two-way analysis of variance assessed interaction effects of perceived complexity of care and perceived autonomy on satisfaction. Logistic regression analysis identified physician characteristics, practice characteristics, practice improvement strategies, perceived complexity, and perceived autonomy that accounted for variance in career satisfaction among physicians.


Although 24% to 27% of physicians felt perceived complexity of care expected was greater than it should be, 83% to 86% felt free to make clinical decisions. Approximately 80% of physicians were satisfied with their careers. Differences in probability of career satisfaction were highly significant (P < .001) for both perceived complexity of care and perceived autonomy as well as their interaction. A multiphysician practice; the ability to obtain high quality ancillary services (such as physical therapy, home health care, and nutritional counseling); managed care revenue, lower levels of perceived complexity of expected care; and perceived autonomy were consistently associated with satisfaction.


Higher perceived autonomy and lower perceived patient complexity as higher than desirable were associated with high career satisfaction among primary care physicians.

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