Medicare and Physician Autonomy

It would be possible to view the impact of Medicare on physicians from many perspectives: the impact on individual physicians, on a particular specialty, on academic physicians, on graduate medical education and physician specialization, on quality of care, on physician incomes, on physician autonomy, or on a variety of other aspects of medical practice. We have chosen to focus on physician autonomy, a topic that has gained prominence recently as a result of its perceived erosion. One of the critical questions that has been raised about physician autonomy and Medicare is whether or not physicians have traded reduction of clinical autonomy or discretion for preservation of economic autonomy. Although often couched in terms of quality of care and access to care, physicians, particularly through organizations such as the American Medical Association (AMA), have in fact focused on the economic autonomy of physicians. Yet concern about loss of clinical autonomy is a major morale issue within the medical profession (Lee and Culbertson, 1990). Lewis et al. (1991) reported "growing dissatisfaction with the practice of internal medicine, primarily related to concerns over loss of clinical autonomy ...." Medicare and Physician Autonomy