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Complements or Competitors?

Kevin Grumbach, MD; Janet Coffman, MPP

JAMA. 1998;280:825-826.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

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

In this issue of THE JOURNAL, Cooper et al³ call attention to another force that may challenge the professional sovereignty of physicians. These authors document the explosion in the supply of nonphysician clinicians (NPCs) occurring in the United States. Between 1992 and 1997, there has been a 2- . . . [Full Text of this Article]

From the Center for California Health Workforce Studies (Dr Grumbach and Ms Coffman), Center for the Health Professions (Dr Grumbach and Ms Coffman), Primary Care Research Center (Dr Grumbach), and Department of Family and Community Medicine (Dr Grumbach), University of California, San Francisco.

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