title: Changing roles for primary-care physicians: addressing challenges and opportunities.
abstract: Direct-to-consumer advertising is but one example of a process called disintermediation that is directly affecting primary-care physicians and their patients. This paper examines the trends and the actors involved in disintermediation, which threatens the traditional patient-physician relationship. The paper outlines the social forces behind these threats and illustrates the resulting challenges and opportunities. A rationale and strategies are presented to rebuild, maintain and strengthen the patient-physician relationship in an era of growing disintermediation and anticipated advancements in cost-effective office-based information systems. Primary care--as we know it--is under siege from a number of trends in healthcare delivery, resulting in loss of physician autonomy, disrupted continuity of care and potential erosion of professional values (Rastegar 2004; Future of Family Medicine Project Leadership Committee 2004). The halcyon days of medicine as a craft guild with a monopoly on (1) technical knowledge and (2) the means of implementation, reached its zenith in the mid-twentieth century and has been under pressure ever since (Starr 1982; Schlesinger 2002). While this is a trend within the US health system, it is likely to affect other delivery systems in the years ahead.
authors.affiliation: Kenan-Flagler Business School, University of North Carolina at Chapel Hill, USA. unikorn@bellsouth.net
authors.forename: C P
authors.initials: CP
authors.lastname: McLaughlin
authors.forename: A D
authors.initials: AD
authors.lastname: Kaluzny
authors.forename: D C
authors.initials: DC
authors.lastname: Kibbe
authors.forename: R
authors.initials: R
authors.lastname: Tredway
mesh_terms: D000329:Advertising / Q000379:methods; D010819:Physician's Role; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000458:organization & administration*; D024382:Professional Role; D011785:Quality Assurance, Health Care; D014481:United States