Fisher B A
Schools of Public Health & Medicine, Loma Linda University, CA, USA.
Physician Exec. 1998 Jul-Aug;24(4):45-51.
For more than a decade, dynamic changes in the health care industry have created new organizations for physicians. The major change for physicians has not been the organization itself, but the principles by which it is governed. This fundamental shift is studied with its impact on physicians, by analogy, becoming more like serfs or more like citizens. A review of the general organizational direction and results of non-physician health care organizations is made followed by the statistical trends of physician groups. Historical comparisons of non-health care industries are made with current organizational choices of physicians and physician groups. Observations of physician decisions are made identifying the direction they send physician status along the continuum from serf to citizen. Physicians are unknowingly making decisions regarding the principles by which they will be governed in new organizations. The choices they are making give them less autonomy and less opportunity to make future choices. The seductive invitation to spend less time in administrative matters and more time practicing medicine is a siren's call that will diminish the status of physicians and the autonomy by which medicine is practiced.
十多年来，医疗行业的动态变化为医生创建了新的组织形式。对医生来说，主要的变化并非组织本身，而是其治理原则。通过类比，这种根本性转变对医生的影响在于，他们变得更像农奴还是更像公民。本文先回顾了非医生医疗组织的总体组织方向和成果，接着阐述了医生群体的统计趋势。将非医疗行业的历史情况与医生及医生群体当前的组织选择进行了比较。通过观察医生的决策，确定他们在从农奴到公民的连续统中推动医生地位变化的方向。医生们在不知不觉中就新组织的治理原则做出决策。他们所做的选择使他们的自主权减少，未来做出选择的机会也变少。减少处理行政事务的时间、增加行医时间这种诱人的邀请，是一种会降低医生地位以及行医自主权的危险诱惑。
