The determinants of physician practice choice and its effect on physician autonomy, satisfaction, and commitment

The effective management of professionals requires achieving a balance between organizational control and professional autonomy. The problem of achieving a balance is important currently in the United States healthcare industry. This dissertation examined the antecedents and consequences of physician autonomy in both traditional fee-for-service (FFS) and non-traditional managed care settings. The population of physicians in one county were surveyed. Two models were developed arguing that physician practice choice affects autonomy. The antecedents and consequences of autonomy were compared both between FFS and managed care practice and between different types of managed care organizations (MCOs). Results indicate that most physicians in the survey area choose managed care practice, and the value physicians place on income is positively associated with the volume of patients from MCOs. FFS practice generated greater autonomy than MCO practice, and autonomy within MCOs positively affected practice satisfaction. Group practice positively affected autonomy within MCOs. Autonomy did not vary across different MCO types but was influenced by the process variables physician decision involvement and organizational formalization, thus suggesting that classifying organizations by autonomy requires knowledge of the processes used in the MCO.