Physicians and Reform: The State of The Art and The Challenge to Physicians.

Within the context of medical reformation outlined by Hoffman in a series of three papers in South Dakota Medicine and the challenge of legislation involving the independent practice of advanced practice nurses, we undertook two surveys of physicians and patients. We wanted to better understand physicians' attitudes toward certain opportunities for reform and how they conformed to the viewpoints of our patients. We found that, at least with respect to nurse practice legislation, physicians' perceptions were at odds with their patients over questions of access and quality. Moreover, we found attitudinal differences among physicians depending upon whether they were independent or affiliated with a health care system and whether they were primary care physicians or specialists. We concluded that physicians do not yet share the common understanding necessary to advocate for a principle of medical practice encompassing the core needs of patients and the spectrum of caregivers.