Equity among physicians and the wish to reallocate time
Dobson, Roy Thomas
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Objective: To examine the relationship between perceptions of equity among physicians and the wish to reallocate time by creating a fitted, multistage model of the equity distress- wish to reallocate time pathway using structural equation modelling (SEM). Background: The reorganizing of work among various health care professionals and better management of scarce resources are seen as necessary for the delivery of effective and efficient health care. Physicians play a key role in the health care system, and any substantive changes in their work will require their cooperation. Gaining support from physicians for changes in the allocation of their time will depend, in part, on the degree to which these changes are seen to promote their professional and personal objectives. Whether physicians perceive their practice conditions to be equitable, and how they choose to respond to efforts by others to make changes in the work they do and the rewards they receive, has important implications for the successful reform of health care in Canada. Design: A modified panel study using questionnaires mailed to a stratified random sample of 840 physicians in Saskatchewan and British Columbia. A total of 384 physicians responded at baseline (110 from Saskatchewan and 274 from British Columbia). At follow-up, 240 usable questionnaires were returned from the remaining 371 eligible respondents for a response rate of 64.7% (72 from Saskatchewan and 168 from British Columbia). Measures: Reliable constructs were developed for: intrinsic and extrinsic equity; distress; coping with practice demands; and the four components of professional activity (patient care, teaching and research, continuing education, and administration). Latent variables were created for: local health care conditions; distributive equity; wish to reallocate professional time; and wish to reallocate administrative time. Results: SEM produced a well-fitted model (P = 0.112; NFI = 0.991; RMSEA = 0.029; P for Test of Close Fit =0.965; and Hoelter 0.05 Index =255) that explained a substantial amount of variance at each stage of the model, and supported the hypotheses of the main pathway. The contributions of practice condition variables to the model, however, were shown to relate almost exclusively to the equity stage of the model. Discussion/Conclusions: Inequity was significantly associated with distress. In turn, distress was significantly associated with the wish to reallocate time. The state of local health care contributed substantially to perceptions of equity among physicians. The physician's ability to cope with time demands was associated with the equity, distress, and wish to reallocate professional time (patient care, teaching & research, and continuing education). Wish to reallocate administrative time was associated with time already allocated to administrative duties, but was not associated with ability to cope with time demands. The impact of inequity on the allocation of time and the organization of the work of physicians and other health care practitioners over time should be examined in a larger study of a longitudinal design.