The futures of physicians: Agency and autonomy reconsidered

Abstract

The corporatization of U.S. health care has directed cost containment efforts toward scrutinizing the clinical decisions of physicians. This stimulated a variety of new utilization management interventions, particularly in hospital and managed care settings. Recent changes in fee-for-service medicine and physicians' traditional agency relationships with patients, purchasers, and insurers are examined here. New information systems monitoring of physician ordering behavior has already begun to impact on physician autonomy and the relationship of physicians to provider organizations in both for-profit and 'not-for-profit' sectors. As managed care practice settings proliferate, serious ethical questions will be raised about agency relationships with patients. This article examines health system dynamics altering the historical agency relationship between the physician and patient and eroding the tradiational autonomy of the medical profession in the United States. The corporatization of medicine and the accompanying information systems monitoring of physician productivity is seen to account of such change, now posing serious ethical dilemmas.

The theory of agency and breastfeeding

“…Prior to the 1970s a paternalistic model of doctor-patient communication was predominant. Then in the early 1970s, in line with neoliberalism , the role of health professionals in terms of agency and autonomy was reconsidered (Salmon, White, & Feinglass, 1990). A shared decision-making approach emerged (Emanuel & Emanuel, 1992) and paternalism was considered acceptable only in emergency situations.…”

Dr Jekyll and Mr Hyde? Undue Pharmaceutical Industry Influence and the Institutional Corruption of the Medical Profession – A Qualitative Analysis of Industry-Medicine Relationships in Hungary and the Netherlands

“…The proletarianization of medicine asserts that the autonomous qualities of the medical professiondetermining the content of medical practice, the manner in which it is carried out, and what the goals of professional work should beare diminished (Freidson, 1984). Proletarianization rests on the concept of the bureaucratization of professional work in large organizations whereby the evolution of managed care, quality assurance schemes, and standardization of medical practices has diminished the control of the medical profession over medical practice (Salmon et al, 1990). These controls have in turn created a rise in a managerial elite charged with bureaucratic oversight of physicians, their existence and control over the practical components of healthcare delivery further undermining medical autonomy regarding both self-regulation and individual clinical decision-making (Calnan & Spyridonidis, 2011;Kennedy, 2015).…”

Part IV: Reformers in medical education and practice: Effect of managed care organization in the United States

“…In their comprehensive study, Salamon et al (31) revealed that beginning in 1970, when data were first collected in computerized form, the federal government and private organizations began providing statistics on the mushrooming cost of health services. Concomitantly, data began to accumulate regarding diagnosing procedures, clinical decision analysis and patient outcomes.…”

“…Three areas effected by managed care were singled out: first, the doctor-patient relationship would be restricted by a third party insurance; second, ethical dilemmas would be created when decisions regarding patient needs conflict with what is covered by the insurance plan; and third, readily available data analysis will prompt demands by management for greater standardization and the enforcement of restrictions (31).…”