Methods: We use data from 120 dentists in the Dental Practice Direct Observation Study and 123 physicians in the Direct Observation of Primary Care Study. We compare personal characteristics (age, marital status, sex, years in practice), practice-related characteristics (practice type, payer-mix, geographic setting), and use these as autonomy predictors. Four items (Likert-scored 1-5; range 4-20) assesse autonomy along these dimensions: satisfaction with control over 1) patient care, 2) practice environment, 3) practice management, 4) leisure/family time. We report descriptive statistics, psychometric properties for the autonomy scale by profession, and multivariate regression examines predictors of autonomy.
Results: Dentists were older, longer in practice, more likely male, in solo/partnership practice, and less likely to have uninsured/publicly insured patients. Cronbach's alpha coefficients for scales were significantly different across professions: 0.68 and 0.82 (physicians and dentists, respectively); similarly, items exhibited different factor loading structures. Mean score on each autonomy item was higher for dentists; overall, dentists scored 2.35 (p<0.001) points higher on combined scale compared to physicians (15.4 vs. 13.0, respectively). This difference was slightly attenuated (2.35 to 2.19, p<0.001) yet remained significant in multivariate-adjusted analysis.
Conclusions: Dentists had greater autonomy compared to their physician counterparts. Differences were not explained by personal and practice-level characteristics. We suggest several alternative predictors of autonomy that should be investigated in future research.
Supported by NIH/NIDCR grant R01-DE015171.