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In 2012 Ezekiel Emanuel, MD published his article Physician Autonomy and Health Care Reform, in JAMAIt was in response to the flurry of concerns among American doctors that in the new light of the ACA they felt under attack and that they were losing control.

Throughout the last few years of conversations with executives and physicians have had many similarities but the most consistent is the shared theme of loss of autonomy.  One great observation is that fear of loss is undefined in its most generic form.  For some it is loss of relationships, others see loss of control over their practice, decision making, contracts, income, or almost any number of individual motivations on which expectations were shattered.

Humbly, I submit to Dr. Emanual that he promotes a new definition of autonomy that subdues essential freedom and pushed an agenda of control in the guise of collaboration.  People are always smart enough to know when freedom is being restrained.

The one constant that we know is that in whatever form we define autonomy it remains one of the key drivers for personal satisfaction in our work.  Other characteristics of great places to work dovetail from the fundamental ownership of one’s self.  For instance, loyalty can only come from the essential nature of giving freely out of a feeling of owning that part of our autonomy.  Any form of allegiance born from an environment stripped of personal freedom falls into the category of coercion.

When do you feel most free?  What things do you give to others best from your sense of freedom and autonomy? How do you give autonomy back to the people who work for you?

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