Professional oligarchy in medical group practice: toward the development of a middle-range theory.
The article presents the findings from a study of 27 large, multi-specialty medical groups that suggests a new middle range theory that the governance of medical groups is evolving away from professional autonomy due to environmental changes resulting from the expansion of managed care. The article takes a contingency theory approach to the governance of medical groups to determine the locus-of-control for strategic and management decision making. The findings support the contention that successful medical groups limit decision making at the highest level in the organization to a small number of physician leaders, thereby creating a new organizational form, professional oligarchy.
Fahey
D F
DF
West Covina Medical Clinic, CA.
D003625:Data Collection; D003659:Decision Making, Organizational; D006075:Governing Board / Q000458:organization & administration / Q000706:statistics & numerical data; D006123:Group Practice / Q000458:organization & administration*; D008329:Managed Care Programs / Q000458:organization & administration; D008511:Medicine / Q000458:organization & administration; D017146:Models, Organizational; D009937:Organizational Objectives; D008486:Physician Executives / Q000458:organization & administration / Q000706:statistics & numerical data; D017009:Professional Autonomy; D013038:Specialization; D014481:United States