The Effect of Bureaucracy on the Professional Autonomy of the Physician

Bureaucracy is frequently viewed as being detrimental to certain aspects of professionalism. This paper examines the relationship between bureaucratic structure and degree of professional autonomy within the client-professional relationship. Perceived autonomy of physicians in three types of bureaucratic settings-non-bureaucratic, moderately bureaucratic, and highly bureaucratic-are compared. The data reveal that those associated with the moderately bureaucratic setting are most likely, and those in the highly bureaucratic setting are least likely, to perceive themselves as autonomous. These findings suggest that there is an optimal level of bureaucratic organization with respect to professional autonomy within the clientprofessional relationship.