The futures of physicians: Agency and autonomy reconsidered

J. Warren Salmon*, William White, Joe Feinglass

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


The corporatization of U.S. health care has directed cost containment efforts toward scrutinizing the clinical decisions of physicians. This stimulated a variety of new utilization management interventions, particularly in hospital and managed care settings. Recent changes in fee-for-service medicine and physicians' traditional agency relationships with patients, purchasers, and insurers are examined here. New information systems monitoring of physician ordering behavior has already begun to impact on physician autonomy and the relationship of physicians to provider organizations in both for-profit and 'not-for-profit' sectors. As managed care practice settings proliferate, serious ethical questions will be raised about agency relationships with patients. This article examines health system dynamics altering the historical agency relationship between the physician and patient and eroding the traditional autonomy of the medical profession in the United States. The corporatization of medicine and the accompanying information systems monitoring of physician productivity is seen to account of such change, now posing serious ethical dilemmas.

Original languageEnglish (US)
Pages (from-to)261-274
Number of pages14
JournalTheoretical Medicine
Issue number4
StatePublished - Dec 1990


  • cost containment
  • ethics
  • managed care
  • medical ethics
  • medical practice
  • physicians
  • utilization review

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Public Health, Environmental and Occupational Health


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