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The Myth of the Independent Physician: Implications for Health Law, Policy, and Ethics

74 Pages Posted: 12 Oct 2013  

Jessica Mantel

University of Houston Law Center

Date Written: October 10, 2013


Physicians increasingly are moving away from solo or small group practices and joining large organizations, a trend now accelerating with the implementation of health care reform. Because physicians control as much as 90 percent of all health care spending, understanding how health care organizations influence physicians’ treatment decisions is of fundamental importance, particularly for policymakers, scholars, and ethicists concern with the quality, cost, and rationing of health care. Informed by research in the fields of psychology, sociology, and behavioral economics, this Article argues that physicians employed by or affiliated with health care organizations are part of an organizational dynamic that profoundly influences their treatment decisions. Unfortunately, much of health law, policy and ethics narrowly focus on the individual physician, failing to appreciate the powerful link between an organization’s culture and physicians’ clinical decisions. Scholars, policymakers, and ethicists therefore must give greater attention to the organization. Of particular concern are health organizations with cultures that bias physicians’ clinical decision-making in ways that lead to the provision of poor quality or inefficient care or the withholding of necessary care. The Article concludes with a discussion of possible ways to promote more virtuous organizational cultures that minimize these risks while respecting community standards of compassion and fairness.

Keywords: health law, health policy, physicians, organizational culture, enterprise liability, professional ethics, cognitive schemas, heuristics, cognitive motivation, medical decision-making, not-for-profit hospitals

Suggested Citation

Mantel, Jessica, The Myth of the Independent Physician: Implications for Health Law, Policy, and Ethics (October 10, 2013). Case Western Reserve Law Review (2013); U of Houston Law Center No. 2013-A-15. Available at SSRN:

Jessica Mantel (Contact Author)

University of Houston Law Center ( email )

4604 Calhoun Road
Houston, TX 77204-6060
United States

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