Page 12 - Delaware Medical Journal - January 2018
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Physician Autonomy in the 21st Century:
Decline, Importance, and Response
Robert J. Laskowski, MD, MBA; Joseph Lyons, MA, CPA
Patients trust their physicians and grant them access to the most personal aspects of their lives. With this trust, patients traditionally have given physicians autonomy in their profession. Physician autonomy is closely linked with the profession’s commitment to assure the delivery of high quality, individualized care to meet a patient’s specific needs and act as their unbiased advocate. Physician autonomy has declined markedly as
the practice of medicine in the United States has changed. We analyzed
the effects on physician autonomy of four current trends in American medical practice (increase of physician employment; change from fee-for- service [FFS] reimbursement; use of team-based care models; and use of electronic health records.) We examined these trends for their effects as potential benefits and/or risks to both patients and physicians. We also considered the effects of these trends in practice on patients’ expectations for expertise, advocacy, and innovation in care. Our analysis supports an overall decline in physician autonomy related to changes in medical practice. Despite the decline in physician autonomy, it appears that these changes
in medical practice will benefit both patients and physicians. However, the loss of physician autonomy is associated with significant risks for patients as well. These risks need to be managed. We make recommendations to mitigate these risks.
BACKGROUND
Individuals with specialized knowledge and skills form professions that are encouraged to exist in a society because they provide specialized services that the society values. The fact of their specialization differentiates them
from other members of society. These professional services require uncommon knowledge and skills that can be developed only through years of training and experience. Consequently, the evaluation of the quality of professional the profession. Because of this specialized nature, a profession’s leadership generally
own content, membership, and, to a large extent, function within society. Members
of “professionalism.” Society largely
delegates the oversight of professional activity to the profession itself. This
is a very special status. The implicit of the activities of a profession merit this delegation of control. Autonomy exists within a profession because it is granted by society, as a societal privilege. It is
an important characteristic that helps to 1
as physician “control.” This control can be over standards of professional practice that span a broad range. Considerations of physician autonomy include areas of clear public interest such as the establishment of the criteria required to call oneself
a physician and practice a particular specialty, peer-reviewed monitoring
of quality and safety, the choice of
an individual patient, and the ability to exercise independent judgment to act in an individual patient’s interest as their expert caregiver and advocate. Physician autonomy also extends to more mundane and billing practices. While these latter issues have obvious importance to physicians, they are of much less concern to the public.
In examining the areas of physician autonomy that are of interest to the public, one sees an implicit contract between society and physicians in medical practice. People in society want to be healthy.
They employ the services of physicians
to help them regain their health when ill and maintain it when they are well. They expect the services that their physicians provide will be safe, effective, and of the highest quality. They want to trust that their physicians will always act with the patient’s best interests as the top priority. And, given our American society’s faith in technology, patients often desire that the care they receive include the most them. Patients give exceptional access
to the most private aspects of their
lives, including their bodies, based on
the expectations that they have of their physician and the trust that they place in him/her. In this context, patients give the privilege of control to their doctor and his or her colleagues. It is a privilege based on trust and expectations. Autonomy in medical practice exists because of its
The content and structure of medical practice in the United States today differs starkly from a few decades ago.2 Physicians generally are no longer
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Del Med J | January 2018 | Vol. 90 | No. 1
Abstract
