Articles: professional-practice.
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Physicians are moving into organized settings where their autonomy is more constrained and where management has more responsibility for physician satisfaction. The relationship of management practices to physician autonomy and satisfaction was explored in a survey of 185 psychiatrists in the State of Hessen in the Federal Republic of Germany (FRG). Analysis revealed that controlling for physician and institutional characteristics, management practices in relationship to participative activities, supportive communication, and peer review activities were the most important predictors both of perceived clinical autonomy and of work satisfaction. ⋯ Perceived clinical autonomy was an important factor in explaining satisfaction, whereas a few other physician and institutional characteristics were significant in predicting satisfaction. Unexpectedly, there was more perceived clinical autonomy among psychiatrists in larger, less well funded, more managerially constrained, state institutions than in smaller, community general hospitals and private organizations. Implications for further research are discussed.
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Larger, more complex medical care organizations have the inherent capability to improve the quality of the care they deliver because of the improved competency that follows higher volumes of service, the interdependence of staff, and the emergence of responsible leadership in large organizations. The potential for slackened physician-patient relationships, however, could jeopardize that quality. We suggest that professional associations can counterbalance the negative influences of large organizations. We envision that the changing political and economic environment of medical practice, along with the greater professional and public scrutiny of care in highly visible large organizations, will act together to exert pressure on organized practices to examine and demonstrate quality clinical practice.
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Corporatization of health care is dramatically transforming the medical workplace and profoundly altering the everyday work of the doctor. In this article, the authors discuss recent changes in U. S. health care and their impact on doctoring, and outline the major theoretical explanations of the social transformation of medical work under advanced capitalism. ⋯ S. experience, no country or health system can be considered immune. Indeed, U. S. experience may be instructive for doctors and health care researchers in other national settings as to what they may expect.