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Julie Schmittdiel, MA; Joe V. Selby, MD, MPH; Kevin Grumbach, MD; Charles P. Quesenberry, Jr, PhD

JAMA. 1997;278(19):1596-1599.

Abstract
Context.
—Being able to choose one's health care plan has been shown to increase subsequent patient satisfaction with the plan, but it is not known whether choosing one's own primary care physician affects patient satisfaction with the physician.

Objective.
—To compare satisfaction with care between members of a groupmodel health maintenance organization (HMO) who chose their primary care physician and members who were assigned a physician.

Design.
—Cross-sectional mailed survey with response rate of 71.4%.

Setting.
—A large group-model HMO in northern California.

Main Outcome Measure.
—Nine questions on satisfaction with the primary care physician.

Subjects.
—Random sample of HMO members 35 to 85 years of age who were impaneled with a primary care physician.

Results.
—Among the 10205 survey respondents, patients who chose their personal physician (n=4748) were 16 to 20 percentage points more likely to rate their satisfaction as "excellent" or "very good" than patients who were assigned a physician (n=5457) for 9 satisfaction measures (P<.001 for each comparison). The association of choice with satisfaction was not due to physicians with higher patient satisfaction being chosen more often, or to differences in patient demographic or socioeconomic characteristics, health values, or health beliefs, or to differences in physician demographics or specialty. In a logistic regression model that adjusted for all of these characteristics, having chosen one's physician was the single predictor most strongly related to having high overall satisfaction (odds ratio, 2.18,95% confidence interval, 1.95-2.42).

Conclusion.
—These results suggest that even in a setting of limited physician choice, the opportunity to select one's personal physician may influence subsequent satisfaction.

Author Affiliations
From the Division of Research, Kaiser Permanente Medical Care Program (Northern California Region), Oakland, Calif (Ms Schmittdiel and Drs Selby and Quesenberry), and the Department of Family and Community Medicine and the Primary Care Research Center, University of California, San Francisco (Dr Grumbach).

Footnotes
Reprints: Joe V. Selby, MD, MPH, Division of Research, Kaiser Permanente Medical Care Program, 3505 Broadway, Oakland, CA 94611 (e-mail: jvs@dor. kaiser.org).

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