Quality of Outpatient Pediatric Care: The Influence of Physicians' Background, Socialization, and Work/Information Environment on Performance

In this study we test the relative influences of physicians' background (religion and social class of origin), socialization (type of medical school, years of house-staff training, certification, and years in practice), and worklinformation environment on the quality of outpatient pediatric care. Work/information environment consists of type of practice (which Freidson hypothesizes to be an important determinant of physician behavior); whether or not the physician has a university appointment; and the sources the physician turns to for practice-related information (type and number ofjournals, and spouse's influence on the practice). We find that physicians' background and socialization characteristics have no direct effect on performance when controlling for the worklinformation environment, whereas the latter has a large effect. Physicians who work in large prepaid multispecialty group practices, who read many scientific journals, and who have a university appointment score high on both technical skill and psychological-developmental management.