To the Editor: Dr. Scovern's Sounding Board article (Sept. 22 issue)* describes conflicts among cost containment, high-quality patient care, and the physician's need for job satisfaction in the setting of a health maintenance organization (HMO). However, in other HMOs these problems do not arise to the degree Scovern indicates. Specific details of his article suggest elements that were lacking in his case that can make the difference between a smoothly running HMO and an ethically problematic one. First, Dr. Scovern is apparently a subspecialist with certification in allergy and rheumatology who was nevertheless expected to function in his HMO as….
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