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Updated: Jun 5, 2026

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

Published on: February 16, 2011

The citizen physician: governance principles make the difference.

Brent A Fisher¹

¹Alaska Heart Institute, Anchorage, AK, USA. bfisher@alaskaheart.com

The Journal of Medical Practice Management : MPM

|January 20, 2011

Summary

This summary is machine-generated.

Physicians are shifting from self-governing medical groups to autocratic structures due to reduced reimbursement. Applying Federalist Papers principles can restore physician citizenship and improve governance in healthcare organizations.

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Last Updated: Jun 5, 2026

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

Published on: February 16, 2011

Area of Science:

Healthcare Management
Medical Practice Governance
Health Policy

Background:

Historically, medical practice allowed citizen participation within self-governing organizations.
Recent decades show a trend towards autocratic, centrally controlled healthcare structures.
Reduced outpatient reimbursement has significantly impacted physician autonomy and organizational models.

Purpose of the Study:

To analyze the shift in medical group governance over the past 15 years.
To explore the impact of reduced reimbursement on physician roles.
To propose a governance framework for reestablishing physician citizenship in medical groups.

Main Methods:

Qualitative analysis of organizational changes in medical groups.
Review of historical trends in healthcare reimbursement.
Application of political philosophy principles (The Federalist Papers) to healthcare governance.

Main Results:

Physicians have transitioned from citizen members to providers of manual labor in centrally controlled organizations.
The current model offers limited physician participation beyond clinical duties.
The Federalist Papers offer principles for restoring governance and citizenship.

Conclusions:

Governance principles from The Federalist Papers can be applied to modern medical groups.
Reestablishing physician citizenship is crucial for improving healthcare organizations.
This approach can enhance organizational structures regardless of ownership.