Specialists regaining clinical autonomy

April 1, 2003

Pharmaceutical Representative

The proportion of specialist physicians who believe they have enough control over clinical decisions jumped sharply between 1997 and 2001.

The proportion of specialist physicians who believe they have enough control over clinical decisions to meet patients' needs jumped sharply between 1997 and 2001, increasing 13 percentage points from 72.7% to 85.7%, according to a study released by the Washington-based Center for Studying Health System Change.

The study, based on an ongoing national survey of 12,000 practicing physicians, also found big increases in the proportion of specialists who believe they can make clinical decisions in the best interests of patients without reducing their incomes and maintain continuing relationships with patients to promote high-quality care. In contrast, the study found primary care physicians' views on these issues changed little between 1997 and 2001.

Managed care less intrusive

According to HSC, specialists are being given more autonomy because managed care companies, responding to regulatory and market pressures, now offer broader provider networks and have eased restrictions on care by eliminating prior approvals for specialty referrals and certain tests and procedures.

"Clinical autonomy is a core professional value for physicians - they don't like being second-guessed. Striking a balance between encouraging physicians to be more cost-conscious without threatening their clinical autonomy is a tough proposition for health plans," said HSC Senior Researcher J. Lee Hargraves, who co-authored the study.

Unlike those of specialists, primary care physicians' views about clinical autonomy and continuity of care remained almost flat between 1997 and 2001. The Center for Studying Health System Change stated that one explanation for this may be the sharper decline in the use of capitation among specialists and health plans than among primary care physicians. PR

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