The Myth of the Independent Physician: Implications for Health Law, Policy, and Ethics
74 Pages Posted: 12 Oct 2013
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
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