However, an oligopsony plus an oligopoly do not make up a free market with perfect competition. Their negotiations would not necessarily increase seller autonomy. It is on plan B's formulary. Theoretically, creating more health plans through such action would increase competition, permitting independent physicians to retain more autonomy by refusing unacceptable contracts. Admittedly, regulatory barriers to new entrants, low profitability, ongoing consolidation of existing plans, and other factors militate against developing sufficient market competition to confer professional autonomy on independent physicians.
Professionalism inherently conflicts with unionization and cartelization.
Thus, overly aggressive incentives from health plans should cause state medical boards to raise questions about conflict of interest. Indeed, unions that represent both workers and retirees, or an unduly broad range of job categories, have occasionally succumbed to conflicts between internal factions. One solution envisions separate professional societies and unions working in parallel. The American College of Physicians-American Society of Internal Medicine, American Medical Association, Federation of State Medical Boards, and other organizations would promote physician professionalism, including autonomy. Individual physicians would decide their relative commitment to professionalism versus unionism.