Doctor Organization and the Challenge of Professional Autonomy

doctor organization

Doctors are trained to treat individual patients. But they also have a responsibility to ensure that their patients get the best care possible, which often requires them to work together as part of multidisciplinary teams. This can be difficult to achieve in a health system that is organized around physicians’ specialty groups rather than patients. Those groups typically have separate administrative structures and a strong culture of protecting their turf. The result is that physicians don’t like to collaborate with colleagues whose turf might be encroached upon, especially when those collaborative efforts would affect their pay.

The problem with the cottage-industry form of doctor organization is that it impedes teamwork, which is critical to improving patient outcomes and reducing costs. To do so, the physicians involved must accept a degree of devolution from their professional autonomy in order to build and sustain high-performance health care systems.

Some doctors are already doing this. They are helping their hospitals and other organizations redesign their delivery systems by assuming leadership roles that combine professional expertise with management skills. Such roles, which are sometimes called “clinical leadership” or “professional-managerial hybrid” roles [1, 2], allow front-line clinicians to challenge their peers and engage in broader improvement processes such as collaborative quality improvement.

Those types of changes will become increasingly important as the economic pressures that are reshaping health care increase the importance of efficiency, quality and cost containment. They are also likely to increase the need for health care providers to reorganize their delivery systems to support physician-led teamwork.

A major obstacle to achieving these goals is the deep-seated belief that medical professionals have a right to autonomy. The cultural barriers to change that doctors face-their resistance to being measured, their need to be perfect and their reluctance to criticize colleagues or even work with others-speak to this fundamental belief.

The world of medicine is going through an explosion of knowledge. The problem is that that information is being generated in a system that doesn’t know how to absorb it or distribute it evenly. Patients, in turn, are distressed by inconsistent or contradictory messages from their doctors.

There are many ways to organize health care to make it more efficient and better at meeting the needs of patients. Some of these involve colocating the various physicians who manage the same patient population in one location. This can be done by building new facilities or by moving groups from one area to another in a complicated, multiyear effort. Others require changing the way in which physicians are paid so that they can be incentivized to share information and collaborate with one another. As a result of these and other initiatives, the traditional structure of physician group practices will gradually be replaced by new ones that emphasize collaboration and high performance.