The Emerging Role of Salaried Physicians: An Organizational Proposal

Abstract

D AALARIED medical practice has had a relatively slow development in the United States. Our public health and military services have employed small numbers of t 3 > salaried doctors for the past 200 years, and during most of this century American medical schools employed *tZ? physicians as faculty, administrators, and occasional researchers. In general, however, U.S. physicians have been dedicated to independent, entrepreneurial practice with fee-for-service reimbursement. Nevertheless, the medical profession in the United States has begun to move in the direction of salaried practice. Over the past several decades we have seen rapid growth of voluntary and proprietary hospitals, and more recently, of corporate medical care systems. Large numbers of doctors now pursue their increasingly technical work in major institutions where salaried practice is common. The arrival of HMOs and neighborhood health centers on our medical scene has brought us salaried outpatient clinicians in unprecedented numbers. The expanding number of recent medical school graduates, combined with the modern expectations of a prolonged, compensated, hospital training period, have added many thousands of resident physicians to the list of salaried doctors. And expanding biomedical research, medical administrative, and regulatory roles have created new jobs filled by physicians on salary. We have now reached the point where salaried physicians constitute approximately one half of the active physicians in the United States. This estimate is derived from data collected by the American Medical Association in its Physicians Masterfile (1) and its 198o Periodic Survey of Physicians (2). Using the AMA definitions, physicians who are reimbursed predomi-