Impact of payment methods on professional equity of physicians

Abstract

Background: Professional equity, evaluation of own contributions and received rewards compared to contributions and rewards of other physicians has not been assessed according to payment methods. The aim of this study is to compare levels of professional equity among physicians paid by fee-for-service (FFS), alternative payment plans (APPs), and blended schemes.

Methods: In 2011, medical practitioners in the Saskatoon Health Region, Saskatchewan, were surveyed using a questionnaire developed for physicians to measure professional equity. Intangible rewards were measured by the dimensions of fulfilment and recognition, and tangible rewards by the dimension of income. The three-dimensional structure of the questionnaire was first corroborated through a confirmatory factor analysis (CFA). Analyses of variances were then performed to account for differences in the levels of professional equity. A linear regression model predicting levels of professional equity was used to test the interaction between specialty and payment method, controlling by number of patients, gender, and age group.

Results: In total, 382 (48.1%) physicians participated: 35.6% were family/general practitioners (FPs); 61% were clinical/surgical specialists; and, 3.4% were pathologists. The internal structure of the questionnaire was confirmed by the CFA. Physicians paid by FFS perceived lower professional equity than those paid by APP (p = .005). Practitioners
under APPs reported higher levels of income (p = .03) and recognition (p = .001) equity than those with FFS. FPs
perceived lower fulfilment (p = .003) and income (p = .008) equity compared to medical-surgical specialists. Furthermore, controlling by number of patients seen per week, higher levels of professional equity are predicted among FPs paid by APPs and blended schemes in comparison to FPs paid by FFS.

Conclusions: Higher levels of professional equity were perceived among physicians paid by APPs in comparison to those paid by FFS. Physicians paid by APPs considered that they are receiving fair economic rewards and appropriate recognition. In addition, enhanced levels of professional equity could be predicted among FPs with APPs and blended schemes. APPs could be explored to improve the professional equity of FPs and, indirectly, promote improved primary health care.