Autonomy vs. accountability: A delicate balance

AMA Leader Commentary. By Ronald M. Davis, MD, Aug. 20, 2007.

AMA LEADER COMMENTARY

A few words about current events in medical practice

SEE ARCHIVES

A message to all physicians from AMA President Ronald M. Davis, MD.

OK, let's begin with the obvious -- physicians are increasingly unhappy in their medical practices. If you want confirmatory data, you can find them in the Physician Morale Survey conducted by the American College of Physician Executives in July 2006. Among 1,200 physicians across the country who responded to the survey, 46% rated their "overall morale as a physician working in U.S. health care" as five or lower on a scale of one (very low morale) to 10 (very high). When asked to judge the morale of physicians they supervise or work with, 59% gave a score of five or lower.

When asked to identify the single biggest factor in lowering morale, 22% and 21% of physicians responding to the survey highlighted low reimbursement rates and loss of autonomy, respectively, over other causes.

Similarly, a study published in the Jan. 22/29, 2003, issue of JAMA showed that measures related to clinical autonomy were strongly associated with changes in physicians' career satisfaction.

In a speech to the AMA House of Delegates in November 2006, my predecessor as AMA president, William G. Plested III, MD, expressed outrage at how "the prerogatives of our profession are being systematically destroyed." He urged physicians to work together to "take back the profession."

At the AMA's Annual Meeting in June, the House of Delegates debated a resolution introduced by the Georgia delegation (entitled "Taking Back the Profession of Medicine"), asking the Association to pledge that all of its positions "will be driven by an unshakeable and uncompromising commitment to return the rightful prerogatives of the profession to the physicians of America."

The reference committee that heard testimony on that resolution and a few related items of business, such as "pay-for-performance," reported that several physicians argued that "patients will only be protected by taking back our profession and simply saying 'no' to pay-for-performance." But the committee also noted that others "just as fervently believe that it is imperative that physicians maintain a seat at the negotiating table ... [and thus] the opportunity to continue to significantly and materially shape quality programs."