Reform and autonomy: perceptions of the Australian general practice community

Reforms in health care in the 1990s across industrialised nations have had profound consequences for the autonomy of general family practitioners (GPs). Research suggests that the professional automony of GPs, is declining across countries. related to policy reform processes and to challenges from other actors, Important questions remain. however around appropriate ways to conceptualise autonomy, and about the perceptions that GPs themselves hake of their autonomy. It is these questions in the context of more than a decade of general practice reform in Australia that are the focus of this paper. Using a multi-component model of autonomy, which seperates out micro, meso and macro dimensions of autonomy, we undertook an analysis of 343 items on autonomy and reform collected from 3 key general practice journals. We argue that members of the GP community profess in enjoyment for general practice and operate with an ideal of what it means to be a GP. However, the reform process is perceived to challenge this enjoyment and the ideal of professional practice. In particular there exists uncertainty as to what it means to he a GP, with members of the GP community expressing a loss of control across important dimensions of autonomy. While numerically most discussion focused on control over earnings, the intensity of feeling as most evident around control over clinical practice. Our results suggest the importance of using a multi-component model of autonomy as it follows for a nuanced analysis of the relationship between the reform process and autonomy. At the same time, however, our analysis indicates that it is also crucial to recognise autonomy is constituted by the interaction of the components. (C) 2002 Elsevier Science Ltd. All rights reserved.