Physicians in transition: A symbolic framework approach to physician autonomy and satisfaction in different work settings

This dissertation is a study of what factors affect physicians' perceptions of autonomy and level of satisfaction, and how these attitudes change over time. The U.S. health care sector is undergoing a period of change. At the institutional level, legitimating agents now include not only the medical profession, but also the state, large-scale employers, and third-party payers whose interests increasingly lie in cost efficiency. At the organizational level, health care service organizations are diversifying their frameworks to accommodate environmental turbulence by assuming for-profit status and investor-ownership. There is also the entry of managed care brokers into the sector. I predict that the presence of competing symbolic frameworks in a work setting adversely affects physician autonomy and satisfaction in those settings. Using this approach, I reclassify key elements of physician autonomy and satisfaction and organizational factors. I predict how organizational, professional and individual characteristics affect autonomy and satisfaction. Finally, I assess the over time effects of environmental changes at the institutional level on the relationship between physicians and their work settings.;The results from two nationwide surveys of young physicians carried out in 1987 and 1991 indicate that physician autonomy is affected by differences in organizational and professional frameworks. They also show that physician satisfaction is less influenced by organizational or professional characteristics of the work settings, and is strongly determined by level of perceived autonomy and characteristics of work. Over time, physician mobility suggests a preference on the part of physicians for more traditional types of work settings. However, when we look at changes in attitudes over time, physicians in more traditional forms report a decline in autonomy and satisfaction.;I conclude that physician autonomy and satisfaction are influenced by environmental, organizational and individual factors. The results indicate that both health care service organizations and physicians are moving to a middle ground where there is a combination of organizational and professional values.