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The Relationship Between Perceived Practice Quality and Quality Improvement Activities and Physician Practice Dissatisfaction, Professional Isolation, and Work-Life Stress

Quinn, Mariah A. MD*†; Wilcox, Allison BA; Orav, E John PhD*†§; Bates, David W. MD, MSc*‡¶; Simon, Steven R. MD, MPH*

doi: 10.1097/MLR.0b013e3181a393e4
Brief Report

Background: The importance of physician well-being has been well-documented. However, little is known about how physicians’ self-reported quality improvement (QI) activities and quality of care are related to their practice dissatisfaction, professional isolation, and work-life stress.

Methods: We surveyed a random sample of 1884 physicians in Massachusetts by mail and assessed their practices’ participation in QI activities and quality of care, as well as their feelings of professional isolation, work-life stress, and practice dissatisfaction.

Results: A total of 1345 physicians responded (71.4% response rate). Most respondents reported QI activities in their practices (85%) and subsequent evaluation of these activities (62%). Approximately one-third (33%) reported quality problems in their practice. In linear regression analyses, the presence of quality problems was independently associated with increased professional isolation, work-life stress, and practice dissatisfaction. In contrast, physicians from practices that were involved in the evaluation of QI activities had significantly less isolation, stress, and dissatisfaction. Participation in QI activities was also independently associated with less dissatisfaction. A substantial fraction of physicians reported moderate to severe problems with isolation (17%), work-life stress (31%), and dissatisfaction (27%).

Conclusions: Substantial practice dissatisfaction, professional isolation, and work-life stress are experienced by physicians and they seem to be inversely correlated with QI activities. Physicians who perceive quality problems in their practices are more likely to experience dissatisfaction, isolation, and stress. Efforts to engage physicians in QI and systems change should assess how these programs affect physicians themselves and the care that they deliver.


From the *Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts; †Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts; ‡Department of Clinical and Quality Analysis, Partners Health Care System, Inc, Boston, Massachusetts; §Department of Biostatistics and ¶Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts.

Supported by grant number 1UC1HS015397 from the Agency for Healthcare Research and Quality and by the Massachusetts e-Health Collaborative and by an Institutional National Research Service Award, 5 T32 HP11001-19 (to M.A.Q).

A preliminary analysis of these data were presented as a poster at the 2008 meeting of the Society of General Internal Medicine.

The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation or approval of the manuscript.

Reprints: Mariah A. Quinn, MD, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Ave, Sixth Floor, Boston, MA 02215. E-mail:

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© 2009 Lippincott Williams & Wilkins, Inc.