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UBC Theses and Dissertations

Physician office site characteristics a cognitive behavioral approach Bottomley, John

Abstract

This thesis is concerned with a cognitive-behavioural approach toward location theory. Specifically it deals with the 'site characteristics' of medical practice sites and their relationships to the 'Degree of Specialism' and 'Need Constructs' of the physicians operant from the sites. The 'Need Construct' of physicians is seen to vary between actors as a result of the different temporal and functional practice characteristics found within the Medical Community. The practice site location decisions of specialist physicians are seen to be dependent on the actor's 'internal needs' for complex functional linkages with other specialist physicians and with medical facilities such as hospitals and diagnostic radiology and laboratory sites. Primary care physicians in contrast are seen as making practice site location decisions in response to the 'external needs' of their patients and hence, adopt sites minimizing inconvenience to this group. Physicians are thus seen, through function and functioning as adopting sites possessing those characteristics that will satisfy their dominant set of needs. Hence, physicians with a high 'Degree of Specialism' adopt sites with a high degree of linkage with other physicians and ancilliary medical facilities, whereas physicians with a low 'Degree of Specialism' adopt sites to minimize inconvenience to their patients. In order to test the hypotheses derived from the above conceptual structure, an interview survey was conducted in Vancouver, British Columbia, Canada. Instruments were developed and pre-tested using standard psychometric techniques to measure the 'Degree of Specialism' and the 'Need Construct' of a physician actor. The 'site characteristics' of a medical practice site were measured on nine variables falling into two groups. Group one comprised those variables measuring the relative-locational aspects of a practice site to other physician practice sites, diagnostic facilities, hospitals, etc., whereas group two comprised variables measuring intrinsic qualities of the site such as the number of physicians practicing from the site. A random sample of twenty primary care physicians and twenty specialist physicians were interviewed to provide the data for the study. A hypothesis testing and correlation analysis was performed on the data to test the study hypotheses. These analyses confirmed that statistically significant relationships existed between the 'Degree of Specialism' and the 'Need Construct' of an actor, between the 'Need Construct' and the 'Practice Site Characteristics' of an actor and between the 'Degree of Specialism' and the 'practice Site Characteristics' of an actor. It was also shown that there existed statistically significant differences between the 'site characteristics' of Specialist and Primary Care physicians. This was also the case for the "Need Constructs' of the two groups. On the basis of the analyses conducted it was concluded that the conceptual structure of the study provided useful insights into the processes of physician site adoption. Recommendations for further research suggest that two fruitful areas of study would be to investigate, over time, changes in the spatial pattern of the medical community relating this to changes in the functional structure of the profession and to investigate explicitly the relationships between the 'Degree of Specialism', 'Need Constructs', and, 'Time Budgets' of physician actors.

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