ArticleBMC medical education2025
The impact of the formal rationalization of healthcare on physician clinical teaching in a United States academic medical center.
Article in BMC medical education, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundFormal rationalization is the process whereby an organization achieves the greatest efficiency through the control of work and is occurring in the United States as an effort to control healthcare costs. This study aimed to explore the McDonaldization thesis's impact, a contemporary form of formal rationalization, on the academic physicians teaching in a clinical setting where patient care is also being delivered.
methodsFocus groups of physicians from a single academic medical in the Southeast United States were conducted. Eighteen physicians participated in four groups, representing seven specialties. Session transcripts and field notes served as the data set analyzed.
resultsFour major categories of impact on physicians who teaching in the clinical setting were identified: (1) they hold the view that rationalizing processes will diminish positive features of practicing medicine for learners (2) the compensation plan emphasizes clinical productivity and efficiency at the expense of time to teach (3) the appropriate use of patient cares algorithms embedded in the electronic health care system is an emerging learning need that they are struggling to meet (4) this group of academic physicians is adapting in a number of ways to accommodate to these changes.
conclusionPhysicians teaching in clinical settings has changed in response to the continued formal rationalization of healthcare. Physicians in this study expressed concern about the immediate and long-term consequences of these changes but also described their strategies for adapting. Despite their distress, they are adapting to try to preserve and enhance their teaching efforts despite the increasing demands of patient care. Our results support the previous recommendation of teaching job crafting and suggest the potential value of team job crafting. However, these group-level approaches must be accompanied by systems changes that address perception of inequity of recognition between clinical work and teaching held by these physicians. CLINICAL TRIAL NUMBER: Not applicable.
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