Can Physician Autonomy Survive?
For years restrictions on physician autonomy were the leading complaint among doctors, but today paperwork heads the list, with autonomy close behind.
For many doctors, the distinction blurs – for example, lengthy pre-authorization requirements both increase paperwork and limit autonomy. The “fail first” requirement for drugs is particularly demoralizing, since payers often require you to exhaust generic options before prescribing a newer and better medicine. Sometimes such intrusions on physician autonomy shorten lives.
Most patients want their doctor to make these decisions. Like you, they resist the idea that your medical judgment should be limited by rules and regulations created by people who never touched a patient.
These autonomy restrictions take place in an environment of reduced payments, liability risk, and steady contraction of face-to-face time with patients. Together, they undermine the relationship between doctor and patient – the foundation of most providers’ career in medicine.
Not surprisingly, more doctors are choosing alternatives like retirement, nonclinical duties or a concierge model. Meanwhile, the number of doctors shifting from private practice to hospital or group employment continues apace.
It’s worth noting that employed physicians see nearly 20 percent fewer patients than those in private practice. These shifts are expected to result in a doctor shortage sometime in the future.
Such a shortage, along with some long-awaited stabilization in healthcare reform, could permit the profession to push back. If physicians can regain some of the trust they lost, rightly or wrongly, in pharmaceutical gift scandals, they may be able to eliminate some unreasonable restrictions on their autonomy.
Healthcare Practice Strategies - Fall 2017