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Researchers recommend a reorganization of the medical profession into larger groups with a multispecialty mix. We analyze whether there is evidence for the superiority of these models and if this organizational transformation is underway.

We summarize the evidence on scale and scope economies in physician group practice, and then review the trends in physician group size and specialty mix to conduct survivorship tests of the most efficient models.

The distribution of physician groups exhibits two interesting tails. In the lower tail, a large percentage of physicians continue to practice in small, physician-owned practices. In the upper tail, there is a small but rapidly growing percentage of large groups that have been organized primarily by non-physician owners.

While our analysis includes no original data, it does collate all known surveys of physician practice characteristics and group practice formation to provide a consistent picture of physician organization.

Our review suggests that scale and scope economies in physician practice are limited. This may explain why most physicians have retained their small practices.

Larger, multispecialty groups have been primarily organized by non-physician owners in vertically integrated arrangements. There is little evidence supporting the efficiencies of such models and some concern they may pose anticompetitive threats.

This is the first comprehensive review of the scale and scope economies of physician practice in nearly two decades. The research results do not appear to have changed much; nor has much changed in physician practice organization.

Professional formation and evaluation in medical education lacks a reliable conceptual foundation. This shortcoming results from an insufficient appreciation of the history of medical ethics as the source of the concept of medicine as a profession. This chapter therefore explores the medical ethics of the Scottish physician-ethicist, John Gregory (1724–1773) and the English physician-ethicist, Thomas Percival (1740–1804), who between them invented the concept of medicine as a profession. Three components of this concept are identified: the commitment to scientific and clinical competence; the commitment to protect the patient's health-related interests; and passing on medicine as public trust, not merchant guild.

Since the beginning of the 20th century environmental health researchers have known about the association between toxicant exposure and disease. However, that knoweldge has not been well integrated into mainstream medicine. Shedding light on why is the focus of this chapter.

To shed light on this issue I analyze the 2011 American Academy of Pediatrics’ clinical practice guidelines for Attention Deficit/Hyperactivity Disorder (ADHD), focusing specifically on the omission of environmental health research pertaining to ADHD symptoms and exposures, such as lead and mercury.

I found that while environmental researchers have been documenting the link between lead and ADHD for over forty years, the American Academy of Pediatrics has completely omitted this research from its 2012 clinical practice guidelines. Moreover, I argue this omission can be traced to competitive pressures to protect medical jurisdiction, and a reductionist worldview that emphasizes treatment over prevention.

This is the first attempt to analyze the way clinical practice guidelines help reinforce and perpetuate dominant medical perspectives. Moreover, to shed explanatory light, this chapter offers a synthetic explanation that combines materialist and ideological factors.

Beyond the specific case of ADHD, this chapter has implications for understanding how and why environmental health research is omitted from other materials produced by mainstream medicine, such as materials found in the medical school curriculum, continuing medical education, medical journals, and on the medical association web sites.

Purpose: The current study aims to cast light on the divide between academic research in management accounting and its applicability to practice by examining, from the standpoint of nursing, how this gap is perceived and what challenges may be involved in bridging it.

Design/Methodology/Approach: The current study compares the findings of Tucker and Parker (2014) with both quantitative as well as qualitative evidence from an international sample of nursing academics.

Findings: The findings of this study point to the differing tradition and historical development in framing and addressing the research–practice gap between management accounting and nursing contexts and the rationale for practice engagement as instrumental in explaining disciplinary differences in addressing the research–practice gap.

Research Implications Despite disciplinary differences, we suggest that a closer engagement of academic research in management accounting with practice “can work,” “will work,” and “is worth it.” Central to a closer relationship with practice, however, is the need for management accounting academics to follow their nursing counterparts and understand the incentives that exist in undertaking research of relevance.

Originality/value: The current study is one of the few that has sought to look to the experience of other disciplines in bridging the gap. Moreover, to our knowledge, it is the first study in management accounting to attempt this comparison. In so doing, our findings provide a platform for further considering how management accounting researchers, and management accounting as a discipline might, in the spirit of this study’s title, “Learn from the Experience of Others.”

The accounting, medical, and legal professions share characteristics common to peer-reviewed professions. These professions also share challenges to professionalism. All three have been criticized for declining professionalism and for choosing commercial success over serving the public interest. Although the medical and legal professions have taken steps to promote a higher level of professional conduct by their members, the accounting profession has not launched initiatives to promote professionalism.

We discuss the initiatives instigated by the legal and medical professions using the five elements of professionalism framework (Hamilton, 2008a). Specifically, the framework highlights the importance of growth in personal conscience, demands compliance with the ethics of duty, inspires realization of aspirational goals, requires accountability of peer professionals, and emphasizes devotion to serving the public good. We recommend that members of the accounting profession use the five elements of professionalism framework to define, demonstrate, and assess professionalism. We conclude that promoting professionalism is a means for restoring professional identity for individual accountants as well as a means for fulfilling the accounting profession's contract with society.

The research analyzes good practices in health care “management experimentation models,” which fall within the broader range of the integrative public–private partnerships (PPPs). Introduced by the Italian National Healthcare System in 1991, the “management experimentation models” are based on a public governance system mixed with a private management approach, a patient-centric orientation, a shared financial risk, and payment mechanisms correlated with clinical outcomes, quality, and cost-savings. This model makes public hospitals more competitive and efficient without affecting the principles of universal coverage, solidarity, and equity of access, but requires higher financial responsibility for managers and more flexibility in operations.

In Italy the experience of such experimental models is limited but successful. The study adopts the case study methodology and refers to the international collaboration started in 1997 between two Italian hospitals and the University of Pittsburgh Medical Center (UPMC – Pennsylvania, USA) in the field of organ transplants and biomedical advanced therapies.

The research allows identifying what constitutes good management practices and factors associated with higher clinical performance. Thus, it allows to understand whether and how the management experimentation model can be implemented on a broader basis, both nationwide and internationally. However, the implementation of integrative PPPs requires strategic, cultural, and managerial changes in the way in which a hospital operates; these transformations are not always sustainable.

The recognition of ISMETT’s good management practices is useful for competitive benchmarking among hospitals specialized in organ transplants and for its insights on the strategies concerning the governance reorganization in the hospital setting. Findings can be used in the future for analyzing the cross-country differences in productivity among well-managed public hospitals.

Workplace voice is well-established and encompasses behaviors such as prosocial voice, informal complaints, grievance filing, and whistleblowing, and it focuses on interactions between the employee and supervisor or the employee and the organizational collective. In contrast, our chapter focuses on employee prosocial advocacy voice (PAV), which the authors define as prosocial voice behaviors aimed at preventing harm or promoting constructive changes by advocating on behalf of others. In the context of a healthcare organization, low quality and unsafe patient care are salient and objectionable states in which voice can motivate actions on behalf of the patient to improve information exchanges, governance, and outreach activities for safer outcomes. The authors draw from the theory and research on responsibility to intersect with theories on information processing, accountability, and stakeholders that operate through voice between the employee-patient, employee-coworker, and employee-profession, respectively, to propose a model of PAV in patient-centered healthcare. The authors complete the model by suggesting intervening influences and barriers to PAV that may affect patient-centered outcomes.

Purpose – This paper explores differences in decision-making approaches between physician executives and nonphysician executives in a managerial setting.

Design/Methodology/Approach – Fredrickson and Mitchell's (1984) conceptualization of the construct of comprehensiveness in strategic decision making is the central construct of this paper. Theories of professional identity, socialization, and institutional/dominant logics are applied to illustrate their impact on strategic decision-making approaches of physician and nonphysician executives.

Findings – This paper proposes that high-status professionals, specifically physicians, occupying senior management roles are likely to approach decision making in a way that is consistent with their professional identity, and by extension, that departments led by physician executives are less likely to exhibit comprehensiveness in strategic decision-making processes than departments led by nonphysician executives.

Originality/Value – This paper provides conceptual evidence that physicians and nonphysicians approach management differently, and introduces the utility of comprehensiveness as a construct for strategic decision making in the context of health care management.

This paper examines how medical practice, like all other productive activities, has been subject to the transformative elements of the forces and the relations of production involving class struggle and intra-class conflict. It will explore changes in the relations of production of medical practice which have been catalyzed by powerful productive forces. The current period of medical production involves the transformation of simple commodity production into a transitional stage of capitalist production with the seemingly unbounded growth of the medical productive forces. This development was precipitated by the intervention of capital as a whole, to restrict the drain on their variable capital through the placement of units of financial capital into the management of medical production, using the leverage of access to patients. In response, physicians have consolidated and centralized their practices to create enterprises with market power to limit the extraction of surplus by financial capital, and by their own employment of productive labor to extract surplus from hired physician labor and other clinical workers. Rationalization of the production of medical service commodities, and the sharing of surplus generated from exploitation of an expanded labor force by managed care financial capital and their capitalist partners owning medical enterprises, constitutes the contemporary relations of production. The contradictions of this mode of medical production and the potential for its reproduction will be analyzed.