While a HCFO grantee, Richard Kravitz, M.D. explored one of his key research interests: assessing physician behavior and quality of health care.

In his HCFO study, Kravitz explored whether physicians' practice characteristics (the size and complexity of the organization(s) in which they practice) have an effect on: (1) physicians' career satisfaction; (2) their perceived ability to provide care; and (3) their perceived ability to obtain necessary services for their patients. Kravitz and his colleagues found that, while physicians have a generally high level of career satisfaction, they would like to be more successful in obtaining mental health services for their patients and in fostering more continuity of care to ensure higher quality.

Across the 33 specialties examined, there was considerable variation in satisfaction levels, with pediatricians being the most satisfied specialists. Kravitz and colleagues found that procedurally oriented specialists, such as obstetrician-gynecologists, were at greatest risk for dissatisfaction. He also discovered that physicians are most satisfied when they perceive that they are able to obtain the health care services that their patients need and deliver high quality care.

"In this era of health care consumerism, it is easy to neglect the physician perspective on quality" says Kravitz. "This is a mistake. The same conditions of practice that detract from physician satisfaction also undermine quality of care for patients."

Kravitz's work has not been limited to analyses of physician perceptions and behavior. His research portfolio covers an array of subjects, including patient expectations, the malpractice system, the effect of managed care on health services and the influence of language in primary care practice. "My overriding interest has been to identify effective ways of engaging patients as partners with physicians in producing desired outcomes."

Kravitz has also explored the many issues surrounding direct-to-consumer (DTC) advertising, including the effect of advertising on the patient-physician interaction. "Our research has shown that patients request DTC advertised drugs in 5-10 percent of primary care visits and that up to 15 percent of patients who are denied a prescription for an advertised drug would consider leaving that physician's practice" says Kravitz. "However, what we don't know is whether, on balance, DTC advertising increases over-prescribing, reduces under-prescribing, or both." With support from the NIH, Kravitz and his colleagues are currently conducting a study that will help to answer this question.

In addition to his current position as professor of medicine at the University of California Davis, Kravitz is the director of the UC Davis Center for Health Services Research in Primary Care. "Our work at the Center is intended to improve medical practice and influence health policy" Kravitz says. "Our multi-disciplinary team of physicians, social scientists, and statisticians has addressed issues ranging from producing hospital quality report cards to understanding patients' perspectives on informed consent."

Kravitz received his B.S. from Stanford University, his M.D. the University of California, San Francisco, and his M.S.P.H. in Epidemiology from the University of California Los Angeles.

Articles from HCFO-funded project

Leigh, J., R. Kravitz, M. Schembri, S. Samuels, and S. Mobley. "Physician Career Satisfaction Across Specialties," Archives of Internal Medicine, Vol. 162, No.14, July 22, 2002, pp. 1577-84.

Ringel S., B. Vickrey, M. Schembri and R. Kravitz "Neurologists' Assessment of Their Ability to Provide High Quality Care," Neurology (in press).