Burchell R C, White R E, Smith H L, Piland N F
Department of Obstetrics and Gynecology, Lovelace Medical Center Inc, Albuquerque, NM 87108.
JAMA. 1988 Aug 12;260(6):826-31.
Within medicine there is growing uneasiness and debate about changes in medical care delivery. Much of this concern centers on the evolution of organizations and the role of physicians. The emergence of multi-institutional organizations, the rise of investor-owned health care corporations, and the expansion of group medical practice illustrate the increasing organizational influence in medicine. Added to these trends are new financial incentives confronting both physicians and organizations so that the environment increasingly favors conflict. This article reviews the primary strategies for resolving physician-organization conflicts, including cooperation between physicians and organizations, having physician representatives in governance and management, restructuring incentives, and restructuring organizations. Although these strategies have various merits, we suggest that every physician has a personal responsibility to become more involved in organization and management issues. Physicians can play an important role in guiding the evolution of medicine.
在医学领域，对于医疗服务提供方式的变化，人们越来越感到不安并展开了讨论。这种担忧大多集中在医疗机构的演变以及医生的角色上。多机构组织的出现、投资者所有的医疗保健公司的兴起以及集体医疗实践的扩张，都表明了医疗机构在医学领域日益增长的影响力。除了这些趋势，医生和医疗机构还面临着新的经济激励措施，因此这种环境越来越容易引发冲突。本文回顾了解决医生与医疗机构冲突的主要策略，包括医生与医疗机构之间的合作、让医生代表参与治理和管理、调整激励措施以及重组医疗机构。尽管这些策略各有优点，但我们认为每位医生都有个人责任更多地参与到机构和管理问题中。医生在引导医学发展方面可以发挥重要作用。
