Unionization of physicians is a natural response to these negative forces which threatens their independence and their ability to make health care decisions based on their patients' best interests . The basic concept of capitated managed care is considered by many physicians as unethical and immoral, because it puts the best interest of patients at odds with the financial interest of the physicians. Most insurers also have the right to audit patient records for purposes that may include medical necessity. The problem with such reviews is that insurers and physicians have different objectives in their approaches to patient care, and one wonders to what extent financial motivation plays a part in determinations by insurers. Many physicians also feel that medical education should be the duty of medical schools and professional organizations, not HMOs .
Referral is a time-consuming process that causes nightmares in physician offices.
While it may be reasonable that patients see their primary care providers before seeking help from specialists, the complicated referral process serves no additional useful purpose except to discourage referrals by physicians. Patients are often upset at the limited choices of in-plan specialists. Worse still, patients are often referred to specialists not known to their primary care providers . There is also nothing more frustrating than having to call a managed care clerk for treatment pre-authorization, to get permission to prescribe a drug, or to have change medications because of formulary limitations. HMOs and insurers, however, are held to a different standard when they make medical decisions.