The citizen physician: governance principles make the difference.

Until recently, medicine was one of the few areas in which an individual could practice a profession as a citizen member of the organization. However, in the last 15 years as dramatic reductions have occurred in outpatient reimbursement, physicians have moved from self-governing organizations with the rights of citizen participation to autocratic, centrally controlled organizations with little offered to physicians other than to provide high-quality manual labor. The principles of prosperity and choice espoused in The Federalist Papers are governance principles that can reestablish citizenship in medical groups no matter who owns them.