Physician autonomy in the managed care era: the physician-citizen or subject?

Until recently, medicine was one of the few areas in which an individual could practice a profession as a citizen member of the organization. However, in the recent overhauling of medical organizations in search of cost efficiency, physicians have moved from self-governing organizations with the rights of citizen participation to autocratic, centrally controlled organizations with little for physicians to do but provide high-quality manual labor. The principles of prosperity and choice espoused in The Federalist Papers are governance principles that can re-establish citizenship in medical groups.