Grant: CIHR Fellowship

A secondary yet puzzling finding emerged from my dissertation. American-trained physicians are considered higher status and have access to a wider array of opportunities post-graduation, yet they were the most dissatisfied with their careers, sometimes even referring to medical school as "the million dollar mistake". In contrast, lower-status non-US graduates practicing in the US seemed more content with their careers. The puzzle is even more perplexing when considering the impact of disillusionment on access to healthcare. American physicians are frustrated by decreasing reimbursements, increasing malpractice insurance rates and rising medical school debt. Driven by fears of malpractice and pressure from private insurers, some have begun avoiding certain patients altogether, in some cases refusing to take patients with insurance ('cream-skimming'). More than 50% of doctors are so frustrated, they have limited or closed their practices to patients insured by Medicare/Medicaid. This has obvious implications for access among the country's neediest patients. This study will be the first of its kind to examine the relationship between physician status, career satisfaction and access to healthcare. Through interviews with 50-60 high and low-status doctors, I will ask about career satisfaction and how it affects clinical practice. I will then select a subsample for observation to witness how disillusionment interacts with service profession on the 'shop room floor'. I hypothesize that higher status physicians will feel that they had to put more into becoming doctors (more training, higher debt) and thus feel that more is owed to them than physicians who have lower status. This may explain higher levels of disillusionment, thus negatively impacting their willingness to treat certain patients. The US is an ideal case study for understanding the impact of private insurance on physicians and could serve to inform future policy decisions related to privatization in Canada.