Physicians are the most valuable resource in the healthcare system, providing a critical point of difference for their patients. Their relationships with their patients, expertise and training, and ability to negotiate for their patients create value in the marketplace that helps them secure contract terms with payers of health care services. To enhance their market leverage, physicians have developed a number of organizational strategies to coordinate their collective efforts, which are designed to strengthen the voice and bargaining power they hold with healthcare payers.
One of these is doctor organization, a form of association that allows groups of physicians to form cooperative business ventures, such as provider networks. The most well-known example is the American Medical Association (AMA), founded in 1847. Physicians have also grouped together through the formation of state and specialty societies, which are based on a similar principle. In some countries, such associations are called medical federations, and they have the advantage of being able to negotiate provider contracts with national insurance companies.
The organization of doctors is a highly debated subject, with many different approaches being discussed. Among them, the debate centers around whether doctors should regulate themselves [1], and if they do, whether this regulation should be centralized or decentralized in terms of both registration and the authority to grant health authorizations. Moreover, there is a dispute as to whether or not medical professionals should be organized as public law corporations or independent professional associations or federations.
This article examines these issues, focusing on the international experiences of medical professional organizations. The differences between the EU-15 countries, Japan, and the United States are examined in detail with a special emphasis on the classification of doctors according to their regulatory bodies, registration, and the centralization/decentralization of registry.
Those countries in which the registration of doctors is centralized are classified as being regulated by medical associations, while those in which the registry is decentralized are classified as being governed by public law corporations. The three countries that have a combination of both centralized and decentralized registry are classified as being in the latter category, while the two remaining countries are in the former category.
A major finding is that the decentralized registry approach has some serious problems for those countries in which they exist. For example, the local councils may not be sufficiently staffed to keep their registries up-to-date, and the criteria for the registration of doctors varies from country to country, which makes official national public statistics untrustworthy for countries with decentralized registry systems. In addition, the process of transferring data between the local colleges and the central registries can cause errors. These problems can have a major impact on the integrity of national public health information and the security of patient confidentiality. Moreover, the process of maintaining the local databases is time-consuming and costly for the local colleges. This, in turn, can impose an unsustainable burden on the national medical associations. This in turn can threaten the sustainability of the local registry as a whole and may affect medical safety in the long run.