Another limitation on a patient’s choice of medical care services is the limited availability of market information. Although the Federal Trade Commission (FTC) has eliminated many of the traditional bans on physician advertising, the highly personal nature of medical care makes it difficult to compare prices and services. It is also difficult to obtain a personalized bid for medical services. This lack of information increases the physician’s duty to provide the comparative information to the patient that is necessary to make an informed choice of treatment.

Even patients with information about the market for medical services are often financially limited in their ability to choose a physician. These financial limitations stem from attempts by employers and their insurance companies to limit the cost of medical care. The primary vehicles for reducing costs are managed care organizations. It is important to recognize that the more the patient’s choice of physician is limited, the greater is the physician’s duty to protect the patient’s interests. If the plan is sufficiently restrictive (as is often true for specialty care in an MCO), this duty to guard the patient’s interests may extend to the administrators of the plan and the employer that selects the plan.

Market models also assume that there is time to collect and evaluate market information, but many serious medical problems arise quickly and must be treated quickly, limiting the patient’s choice of physicians to whomever is geographically available. Even in nonemergency cases, the discomfort and risk involved in shopping for physicians severely limit the patient’s ability to choose a physician. An equally serious problem is financial limitations. The poor have always been limited in their choices of medical care providers—a limitation increasingly being felt by the middle class.

Finally, market models are based on the fungibility of goods: that one product is much the same as another, allowing them to be interchanged based on price. Patients do not like to treat physicians as fungible. One traditional definition of a profession was that it mattered who did the work, not just the price of the job. Although the medical profession does not like to stress the differing abilities of its practitioners, no medical care practitioner would be comfortable picking a name from the phone directory if their family member needed treatment.