Physician autonomy — both in clinical and organizational decision-making — has become a flashpoint across healthcare as the system becomes more consolidated, politicized and influenced by non-clinical stakeholders.
Sixty-five percent of self-employed physicians said autonomy was very important to them in Medscape’s Self-Employed Physicians Report 2025. In Medscape’s Employed Physicians Report 2025, 48% of physicians said that diminished autonomy was the worst part of their job, demonstrating the value of autonomy for both independent and employed physicians.
James McLoughlin, MD, an orthopedic surgeon with Ivy Spine & Orthopedics in Panama City, Fla., recently joined Becker’s to share his definition of physician autonomy and what needs to happen for physicians to get it back.
Question: What does physician autonomy mean to you, and why is it so important in the current healthcare landscape?
Dr. James McLoughlin: Physician autonomy is difficult to define, but for me personally there are a few features of autonomy that I desire and believe benefit both physicians in practice and their patients. First, physicians should be able to make recommendations about treatments that they believe are scientifically sound for their patients without worry about what the insurance “protocol” demands. Protocols that insist on treatments prior to reasonable diagnostic studies are effectively allowing insurers to practice medicine without a license, and without liability for the mandated treatments that they insist on prior to coverage for diagnostic studies. For physicians to have autonomy, insurers must be pushed back into their lane, a non-clinical lane; a lane where the insurer, which has not examined the patient nor discussed pros and cons with the patient, cannot dictate the order of care.
The second feature I would want is a mandate that insurers may not vary reimbursement based on the size of the practice submitting the bill; the corporatization of medicine in pursuit of leverage for reimbursement has completely eroded the practice of medicine. And the insurers are not routinely screened to make sure that the actual care provided is reimbursed to the level it should be. Some insurers have computerized underpayment schemes that automatically underpay, late pay, and never pay. The government interferes with our practices and our lives regularly, so it is time for them to move toward improving healthcare for the patient and physician. We should see the government taking to task large insurers and smaller ones as well, with routine termination of licenses to sell insurance for such schemes.
And finally, the third feature of autonomy I would want is a complete re-vamp if not elimination of the Stark legislation. It was built for a different age, and even its namesake has been quoted as saying it has gone too far. In a time when cooperative management and integrated healthcare are being championed, at least verbally, the Stark legislation poses impossible barriers for physicians to navigate in order to work with other physicians, other fields of medicine, and with hospital administrators on cooperative models. A complete remake of this legislation, if not a jettison of it, is in order. Physicians should not face any business barrier that is not also imposed legally upon other professions such as attorneys, accountants, professional engineers, etc., especially in a time when cooperative healthcare and accountable care and extending care to rural communities and underserved areas are all at least discussed as priorities.
These markers of autonomy are important because they represent the professionalism and decades of dedication to study and to craft that allow a physician to best care for their patients, to advocate for their patients. And this is the bedrock of the patient-physician relationship.
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