"Keeping the Faith" and Market Realities: Physicians in an HMO

Abstract

This article examines the efforts of physicians affiliated with prepaid practice groups to overcome negative occupational and, to some extent, societal attitudes about this form of practice. These physicians have responded by constructing a role that is "even more professional" than the one traditionally assumed by physicians; they emphasize patient care and avoid what they consider to be mundane administrative tasks. The surprising negative consequences of this role construction were revealed when the contract between the group practice and the HMO (health maintenance organization) with which the group had an exclusive contract to deliver patient care was dissolved. Although the physicians succeeded in creating a highly professional role for themselves, they lost their patients. The author argues that the model which has traditionally defined medical professionalism contributed to this outcome.