The increasing involvement of insurers and hospitals in monitoring patient care is encroaching on the psychiatristis autonomy in making clinical decisions. This study examined the prevalence of constraints on psychiatric inpatient practices, as well as how characteristics of psychiatrists affect the type and the degree of these external pressures. Characteristics of psychiatrists, such as length of time in practice, income, sex, and medical school education outside the United States, were associated with the prevalence of external pressures. The study concluded that constraints on psychiatristsi practices are widespread. Their ability to resist pressures depends on their bargaining power, which seems to be lower for those who have relatively little experience, who are female, or who have gone to medical school outside the United States.
Psychiatrists appear to be willing to trade off more constraints for higher incomes.
Severely ill patients and those with little or no insurance are more likely than others to be affected by these limits on psychiatrists autonomy.