Fee-for-Service Doctors Preferred, AMA Study Finds

Patients were more satisfied with doctors who practiced by themselves or in a small single-specialty group and charged on a fee-for-service basis than with any other type of medical practice, according to a study in today’s Journal of the American Medical Assn.

The patients--17,671 were surveyed in three cities--were far less happy with visits to prepaid group practices, commonly called health maintenance organizations (HMOs), a type of practice that President Clinton’s forthcoming health plan will seek to encourage.

The American Medical Assn. is the nation’s largest trade group for physicians.

The study was based on visits to 367 medical offices in Boston, Chicago and Los Angeles during a nine-day period in 1986. It asked patients to rate their satisfaction with the overall visit, waiting time, the doctor’s technical competence, courtesy, respect for the patient and other personal traits.

The study was criticized Tuesday by the Group Health Assn. of America, which represents HMOs and other group health services. Noting the use of 1986 data, the association said the study ignored more recent research by Consumer Reports and others that found “HMO members as satisfied as their counterparts covered by traditional insurance.”

Overall, the JAMA study found that 65% of the patients gave an “excellent” rating to doctors practicing by themselves or in a small single-specialty group and charging patients for each service.

Of several other combinations of practice settings and payment styles, HMOs, in which patients generally pay an annual fee in return for all their medical needs, were rated near the bottom; 49% of patients gave HMOs an “excellent” rating.

The study found that fee-for-service doctors practicing alone and small single-specialty doctors also received higher “excellent” ratings in several categories including technical competence (75% compared with 60% for HMOs), personal qualities (82% to 68%), shortness of waits for appointments (65% to 40%), office waiting time (36% to 29%) and explanations of their condition (67% to 50%).