An Exploration of the Contemporary U.S. Academic Physician Experience with the Formal Rationalization of Health Care

Abstract

It has been over three decades since it was predicted that the processes of formal rationalization would lead to dire consequences for all physicians. Prompted by a social concern about elevated burnout rates in U.S. physicians, there have been some investigations about organizational influences on their work lives. However, these studies have not used formal rationalization as a conceptual framework. This exploratory study was undertaken to examine the work lives of a group of academic physicians in the United States using McDonaldization thesis features as the organizing framework. Eighteen academic physicians were recruited from a single academic medical center in the United States. Focus groups were conducted by a physician and a medical sociologist, and the transcripts analyzed. Academic physicians could identify programs consistent with the McDonaldization of health care and reacted variably to them. The features were found to interact in differing ways with control over work being superordinate to the other three features. There was evidence for the consequence of irrationality in that inefficiency was increased and the quality of the patient interaction reduced. Physicians’ reactions to overall changes to their work are variable ranging from distress to varying degrees of acceptance.