Most doctors in the U.S. are now employees, working for others in physician groups, insurance companies or hospitals and health care systems. Meanwhile, the growth of health care administration positions has far outpaced that of physicians in practice, according to an AMA Board of Trustees report whose recommendations were adopted at the Interim Meeting.
This rise in physician employment and health care administrators has created tension, with a disconnect and lack of understanding between these professional groups. This tension has been recognized as a significant source of intrusion on physician autonomy, the board report says.
“The large-scale employment of physicians has brought about a change to the profession that has resulted in conflict,” said David H. Aizuss, MD, secretary of the AMA Board of Trustees. “Traditional physician autonomy in patient care is now being influenced by pressures motivated by cost versus high quality patient care.”
Physicians are key decision-makers
“The key concern is that this new organizational and economic reality of medicine will undermine physician autonomy in a way that harms patients,” says the report. There may also be questions about loyalties “where health care institutions’ financial incentives may conflict with patient well-being.”
To that end, delegates directed the AMA to “continue to strongly oppose any encroachment of administrators upon the medical decision-making of attending physicians that is not in the best interest of patients.”
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This aligns with existing AMA policy on physician decision-making in health care systems. The policy notes that certain professional decisions that are critical to high-quality patient care should always be the responsibility of the physician in any practice setting.
It also aligns with the AMA Code of Medical Ethics, which establishes the importance and therapeutic nature of the patient-physician relationship. This is shown in Opinion 1.1.1, “Patient-Physician Relationships,” as well as opinion 1.1.3, which emphasizes the importance of the health and well-being of patients.
Building trust is key to resolving physician-administrator tension and helping to reduce drivers of burnout. An AMA STEPS Forward® toolkit, “Building Bridges Between Practicing Physicians and Administrators,” contains more in-depth information to help organizations recognize the drivers of physician-administrator distrust, explore methods to strengthen trust and outline strategies to improve these relationships.
Reducing physician burnout is a critical component of the AMA Recovery Plan for America’s Physicians.
Far too many American physicians experience burnout. That's why the AMA develops resources that prioritize well-being and highlight workflow changes so physicians can focus on what matters—patient care.
Meanwhile, the “AMA STEPS Forward Wellness-Centered Leadership Playbook” (PDF) helps health care leaders discover ways they can build a culture of trust and eliminate the physician-administrator gulf that contributes to physician burnout. Learn how to build physician-administrator trust and boost well-being.
Read about the other highlights from the 2023 AMA Interim Meeting.
