Physician Performance: The Roles of Knowledge, Skill, and Environment

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Abstract
Physician performance (both the type and quality of care) is determined by the synergistic combination of the physician's clinical skill and the practice environment. This literature review examines the research on physician performance from three perspectives: (a) the knowledge, skill, and personal characteristics of the physician; (b) the practice environment; and (c) the human environment. Specialty certification, age, and clinical experience are the most important individual characteristics affecting physician behavior. The physical environment, especially the type of hospital, volume of services, geographic location, and physician remuneration systems, are associated with both patient outcome and the types of services available to patients. The human environment, including physician access to colleagues, physician identification with patients, and team support systems, affects the range of services and patient survival. In light of the research confirming the need to work with both the physician and the environment to enhance patient outcome, educational programs should be moved into the work environment. Future research should explore the interdependence between the individual and the workplace.