Winkenwerder W, Nash D B
Health Care Financing Administration, Department of Health and Human Services, Washington, D.C.
Cancer Invest. 1988;6(2):209-17. doi: 10.3109/07357908809077048.
The roles described are not all-inclusive, since a small proportion of physicians, as in times past, will continue to pursue diverse careers outside of an tangential to health care. Neither are the roles mutually exclusive, as physician-managers are also organizational employees, as independently contracting professionals may also be partly fee for service, as physician entrepreneurs may be fee for service practitioners or contracting professionals, and so forth. The point is, that as the delivery of health care becomes a more complex and formalized process, and as large organizations delivering and insuring health care become more predominant, the various roles of physicians are becoming more distinctly obvious. What are the implications of this trend toward greater internal segmentation of the medical profession? At this juncture, they are not entirely clear. It could mean that some groups of physicians will achieve higher status and more rewards than other groups, which might result in greater conflicts within the medical profession. Undoubtedly, the emergence of corporately managed health care and the development of new (and possibly divergent) roles for physicians confronts the medical profession and its members with the gnawing questions of who they really are and what do they really want to be? Ultimately, the greatest challenge may be in finding a common set of commitments and values which transcend our many different roles, and which provide physicians with a clear and continuing sense of ourselves as medical professionals.
所描述的角色并非涵盖所有情况，因为仍有一小部分医生会像过去那样，继续在与医疗保健有一定关联的领域之外追求多样化的职业。这些角色也并非相互排斥，比如医生管理者也是组织雇员，独立签约专业人员也可能部分按服务收费，医生企业家可能是按服务收费的从业者或签约专业人员等等。关键在于，随着医疗保健服务成为一个更加复杂和正规化的过程，以及提供医疗保健服务和保险的大型组织变得更加占主导地位，医生的各种角色正变得愈发明显。这种医学专业内部进一步细分的趋势有何影响呢？在这个时候，其影响还不完全清楚。这可能意味着一些医生群体将比其他群体获得更高的地位和更多的回报，这可能导致医学专业内部产生更大的冲突。毫无疑问，企业管理的医疗保健的出现以及医生新角色（可能存在差异）的发展，使医学专业及其成员面临着令人苦恼的问题：他们究竟是谁，以及他们真正想成为什么样的人？最终，最大的挑战可能在于找到一套共同的承诺和价值观，这些承诺和价值观超越我们众多不同的角色，并为医生提供一种清晰且持续的自我认知，即作为医疗专业人员的自我认知。
