| Profound changes have occurred since the 1960's in the, structure, organization, and financing of health care. These changes undermined physician autonomy and private mechanisms for regulating physician behavior. Organizations responsible for maintaining standards in the medical profession had to contend with a host of conflicting interests emanating from federal and state agencies, corporations, consumers, and the medical profession itself.;Data for the analysis come from public agencies, professional associations and journals, consumer organizations, newspaper articles, interviews, and legal cases. For empirical anchor, this thesis contains three case studies of physician drug abuse, sexual misconduct, and substandard care in New Jersey, Massachusetts, and Maryland. This approach blends organization theory, comparative, and quantitative analysis.;When government and corporations entered the medical field, they pushed aside customary practices and procedures. Organizational leadership had to change in keeping with consumer demands, legal process, and bureaucratic regimen. Once this occurred, medical boards assumed a more proactive role in physician discipline. They formed regional and national alliances and, in the process, became less dependent on professional associations to support their activities. Actions against physicians resulting in loss or restriction of licenses increased substantially. Cases involving substandard care, incompetence, or negligence achieved priority.;Managed care and the corporate integration of the health-care industry will continue to test boards' mettle. Health-care reformers periodically call for an overhaul of board operations To survive in this new climate, boards have become more active in the political arena. They often pursue an agenda that seeks to augment their regulatory authority.;This thesis examines the primary public institutions responsible for disciplining physicians--state medical boards. These institutions were a principal means by which physicians gained monopoly powers over the medical field. Studying their development, evolution, and transformation provides a window on the politics of professions in the making of American health-care policy. It helps to explain the transition from self-regulation to government regulation, from primarily private to primarily public enforcement, and from decentralized to centralized controls. |
