At a time when a vast majority of physicians work in consolidated practices or employed settings, autonomy has emerged as a key concern among the workforce.
An Avalere study sponsored by Physicians Advocacy Institute and published May 13 found that over the last eight years 253,000 additional physicians became employed by hospitals or corporate entities, 48,100 of those in just the last two years.
Another report from SullivanCotter and Lotis Blue found that autonomy was the strongest signal for physician engagement in a survey of more than 1,000 clinicians across 300 organizations. The data suggest physicians prioritize professional integrity and clinical agency, valuing friction reduction over broad perks or generalized culture messaging. Being trusted to use clinical discretion ranked No. 1, underscoring that professional respect and control over care delivery are foundational to physician engagement.
Four physicians recently joined Becker’s to discuss how they define physician autonomy and why it’s so important in modern healthcare.
Editor’s note: Responses have been lightly edited for clarity and length:
Question: What does physician autonomy mean to you, and why is it so important in the current healthcare landscape?
Craig Bailey, MD. Internal Medicine Physician with The Bailey Medical Group (Detroit): Physician autonomy isn’t a privilege doctors want for its own sake, it’s the capacity to exercise clinical judgment as the final authority in the care of the patient, and it matters because the responsibility to that patient can’t be delegated to an administrator, an algorithm, or a payer. What we call the erosion of autonomy is really the separation of authority from responsibility: the physician still carries the duty, but the decisions that determine whether that duty can be met are increasingly made by people who never meet the patient. AI is arriving at the same moment consolidation peaks, and the only question that matters is who captures the benefit. If a health system uses AI to make one physician do the work of two and then cuts staffing, the patient gains nothing. In 2026, physician autonomy comes down to who owns the infrastructure of care.
Connie DiMari, MD. Ophthalmologist at New York Eye and Ear Infirmary of Mount Sinai (New York City): Physician autonomy is the freedom to make uncoerced decisions that are in the best interests of patients. Value-based payment models have undermined this autonomy and have emerged as a root cause of moral injury among physicians. These models create an undeniable conflict of interest between physicians and patients by introducing financial incentives that can distort clinical decision-making. For instance, the Medicare Shared Savings Program rewards physicians with a portion of the savings if they order fewer tests, referrals, and medications. This structure incentivizes cost-cutting over comprehensive care. Patients are unaware of these dynamics and lack protection against their hidden imposition (Medicare Advantage). When I explain that physicians may benefit financially from providing less care, or that beneficial therapies could be denied because they are deemed cost-ineffective, patients are understandably shocked.
Additionally, the complexity and financial risks associated with models like capitation have propelled many physicians toward employment. There is strong evidence that high-spending physicians are systematically pushed out by employers who also benefit when their more costly patients leave along with their physician.
Can physicians working under these payment arrangements truly feel at peace, knowing they are fulfilling their ethical duty to inform patients fully and to prioritize their well-being?
The only way to avoid moral injury is to remove financial incentives and employment pressures based solely on patient spending. At a minimum, patients must be fully informed of all conflicts of interest when choosing a health plan.
Sheldon Taub, MD. Gastroenterologist at Jupiter (Fla.) Medical Center: I’ve been a physician for more than 40 years. The ability to make evidence-based critical decisions, which are in the best interest of the patient, has always been my goal. Initially, these decisions were based on clinical judgment and experience without undue interference from outside sources such as insurance companies, hospitals, and now AI. Maintaining this independence I thought was critical in managing patients. This landscape has dramatically changed in the last several years with a significant erosion of physician autonomy. The ultimate individual who will suffer will be the patient. And unfortunately, I think it’s only going to get worse.
Evan Weiner, MD. Emergency Medicine Physician (Philadelphia): Physician autonomy means self determination in both the particulars of their employment and how they deliver care. I’ve seen erosion of both. I’ve seen jobs where physicians are given no choice
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