CTS Physician Surveys and the HSC 2008 Health Tracking Physician Survey

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To provide an in-depth look at the issues and challenges physicians face in the rapidly changing health care system, HSC conducts nationally representative surveys of non-federal physicians who spend at least 20 hours a week in direct patient care. HSC has conducted five physician surveys to date.

The Community Tracking Study (CTS) Physician Survey was conducted in 1996-97, 1998-99, 2000-01 and 2004-05. Each of the first three surveys included responses from approximately 12,000 physicians; the fourth included more than 6,600 physicians. Data collection was focused primarily on physicians practicing in 60 randomly selected U.S. communities, allowing analyses to be conducted at both the national and community level. The CTS Physician Surveys were conducted by telephone by The Gallup Organization. Many of the same questions were asked during each round of the CTS Physician Survey, allowing researchers to track changes over time.

In 2008, the CTS Physician Survey was replaced by the HSC Health Tracking Physician Survey, which included information from more than 4,700 physicians and was conducted by mail by Westat. The new survey name reflects the substitution of the clustered 60-site sample design with a more efficient national sample. Additional changes to the survey include using a mailed survey instrument instead of telephone interviews, and significant modifications to the survey instrument to better represent current issues in care delivery and to adapt to the new data collection mode. The sample and data collection mode changes were dictated by resource availabilityand because of rapidly declining response rates achievable using telephone surveys of physicians. Because of changes in survey administration, results from the 2008 physician survey cannot be compared to findings from earlier CTS Physician Surveys. However, the HSC 2008 Health Tracking Physician Survey establishes a new baseline that will allow future tracking of how physicians organize and practice medicine.

Both the CTS Physician Surveys and the HSC 2008 Health Tracking Physician Survey cover a wide variety of physician and practice dimensions, from basic physician demographic information, practice organization and career satisfaction to insurance acceptance, compensation arrangements, information technology use and charity care provision. The 2008 survey also includes questions on care management, quality reporting, care coordination, malpractice concerns, ownership of hospitals and medical equipment, and greater detail on use of information technology.

Examples of Survey Questions

• During the last month how many hours did you spend providing charity care?
• Does another physician group, hospital or group of hospitals, insurance company/health plan/HMO or other organization have an ownership interest in the practice in which you work?
• Indicate whether your practice has access to computers or IT to: Some examples: access patient notes, write prescriptions, obtain drug interaction information, e-mail patients.
• Do you have adequate time to spend with your patients during their office visits?
• During the past year were you unable to obtain certain health services for your patients? Some examples: non-emergency hospital admission, outpatient mental health services.
• Which of the following items is a major problem, minor problem, or not a problem in your ability to provide high quality care. Some examples: patients' inability to pay for needed care; rejection of care decisions by insurance companies, difficulties communicating with patients because of language or cultural barriers.
• Do the financial incentives in the practice favor reducing services to patients, expanding them, or neither?
• Importance of various factors in determining physician's compensation. Some examples: productivity, patient satisfaction surveys, overall practice performance.
• Does your main practice use electronic medical records?
• Does your main practice provide the following services to patients with asthma, diabetes, depression, or congestive heart failure? (examples: written materials in English, written materials in other languages, nurse care managers, non-physician staff to education patients, group visits)

• Effects of physician practice arrangements, ownership and compensation arrangements on the practice of medicine.
• Relationships between the distribution of practice revenue and physician practice style and satisfaction.
• Effects of patient socio-demographic characteristics or market factors on physicians' practice revenues or income.
• Relationship between patient characteristics and physicians' ability to provide needed medical services or high quality of care.
• Impact of federal, state and local policies affecting physician practice—including Medicare and Medicaid policy—on physician behaviors and perceptions of their impact on quality of care.
• Impact of managed care participation on physician behavior, perceptions of quality of care provided and physician satisfaction.
• Changes between 1996-97, 1998-99, 2000-01 and 2004-05.

Data Files for Public Use. Public use and restricted use data files are available for researchers to do their own analysis of this survey. There is also a Physician Survey Summary File, which contains market-level means for most of the variables collected in the CTS Physician Survey. For more information, read about Using the HSC Data Files.

Finding Additional Information. Additional information about this survey can be found in various HSC Technical Publications. The user's guides for this survey provide summary information about the CTS in general and this survey in particular. The user's guides also include information about how to use the data file, as well as appendices with copies of the survey instruments. The codebooks list the variables on the data files and their frequencies. The methodology reports have detailed information documenting how the survey was conducted.