From the doctor's workshop to the iron cage? Evolving modes of physician control in US health systems

Kitchener, Martin James ORCID: https://orcid.org/0000-0001-6249-557X, Caronna, Carol A. and Shortell, Stephen M. 2005. From the doctor's workshop to the iron cage? Evolving modes of physician control in US health systems. Social Science & Medicine 60 (6) , pp. 1311-1322. 10.1016/j.socscimed.2004.07.008

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Abstract

As national health systems pursue the common goals of containing expenditure growth and improving quality, many have sought to replace autonomous modes (systems) of physician control that rely on initial professional training and subsequent peer review. A common approach has involved extending bureaucratic modes of physiciancontrol that employ techniques such as hierarchical coordination and salaried positions. This paper applies concepts from studies of professional work to frame an empirical analysis of emergent bureaucratic modes of physician control in US hospital-based systems. Conceptually, we draw from recent studies to update Scott's (Health Services Res. 17(3) (1982) 213) typology to specify three bureaucratic modes of physician control: heteronomous, conjoint, and custodial. Empirically, we use case study evidence from eight US hospital-based systems to illustrate the heterogeneity of bureaucratic modes of physician control that span each of the ideal types. The findings indicate that some influential analysts perpetuate a caricature of bureaucratic organization which underplays its capacity to provide multiple modes of physician control that maintain professional autonomy over the content of work, and present opportunities for aligning practice with social goals.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Business (Including Economics)
Subjects:	H Social Sciences > H Social Sciences (General) H Social Sciences > HD Industries. Land use. Labor > HD28 Management. Industrial Management J Political Science > JK Political institutions (United States) R Medicine > RA Public aspects of medicine
Uncontrolled Keywords:	Physicians; Professionals; Control; Organizations; Healthsystems; USA
Publisher:	Elsevier
ISSN:	0277-9536
Last Modified:	21 Oct 2022 10:19
URI:	https://orca.cardiff.ac.uk/id/eprint/39833

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