Physicians and Nonphysician Clinicians

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Abstract
For most of the 20th century, physicians have enjoyed a privileged position in US society. This "professional sovereignty" was buttressed by regulations that shielded physicians from competitors, such as laws granting the profession control over training and licensure and restricting opportunities for others to practice medicine.1 Physicians exercised considerable latitude in setting their own fees and in practicing medicine, with minimal external oversight or intrusion. Many physicians perceive that the managed care revolution is threatening to end this "golden era." Managed care organizations impose fee schedules, authorize clinical decisions, and restrict practice opportunities through selective contracting.2