Medical practice where HMOs dominate: the perspective of physicians in Minneapolis-St. Paul

Physicians in the Twin Cities are part of a progressive medical community which has traditionally participated in and often provided leadership for innovation and change in healthcare delivery. Recently, the health maintenance organizations (HMOs) and other managed care systems in which they have participated and even founded have grown to dominate the medical care of Minneapolis-St. Paul with 50% of the population enrolled. Although in this healthy, homogeneous, and middle-class community physicians say they are satisfied that the quality of healthcare for patients still continues to be good, the lives of physicians--their mode of practice and their interactions with patients, colleagues, and hospitals--have changed fundamentally. Whether physicians practice in staff or group HMOs or continue to practice in their own offices, they say they are no longer "in control"; the plans "call the tune".