Not that physicians don't still seek clinical autonomy, which, by the way, is a slippery thing to define. But depending on what they mean, that desire can often stand in direct conflict with many of the quality improvement techniques sought to implement standards of care, for one example, or to optimize the supply chain, for another.
Doctors are naturally (and rightly) suspicious of anything that claims to improve quality and cut costs, so your job is difficult enough just make a case with them on those issues—and you'd better be able to prove it.
Pressure to Cut Costs, Boost Quality
Your priorities are changing. Boards, if they're paying attention, want quality improved and costs cut. Employers, payers, and even individuals are focused more on cost directly. But they don't just want cost cuts, they want value for their high expenditures on healthcare. According to a recent note from Deloitte, spending will reach 24% of the total federal budget, 21% of the average state's budget, and 20% of the average household's discretionary spending in 2012.
Your board wants you to demonstrate (that is, prove) that you have high quality and lower relative costs than your competitors. And they don't just want you to cut costs. In many cases, your customers want you to be responsible for the health of the patient following the care, and let's face it, you have very limited control over that.