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Clinical and behavioral adaptation to managed care: stepwise suggestions for survival.

The rapid growth of managed care has left many physicians concerned and often bewildered about the new realities of the day. Essentially, managed care is a euphemism for a different kind of authority, responsibility, and accountability. Under "unmanaged care," authority, responsibility, and accountability were gained from and directed toward the patient. This arrangement has been supplanted by a new system in which the physician derives his authority from and is responsible and accountable to both the patient and the managed care company. The diagnosis of managed care is easy enough. It is a chronic disease; it does not go away. For those who can make the adjustment, managed care will not end careers. Rather, it will require a realignment, an adaptation to the societal mandate for "value." With care, foresight, and professionalism, this realignment can be navigated successfully, and disruption in the lives of pediatricians and patients can be held to a minimum.