When do doctors follow patients’ orders? Organizational mechanisms of physician influence

• We examine the degree to which physicians acquiesce to patients’ requests.
• We find doctors are more likely to acquiesce in small than in large work settings.
• Payment and evaluation systems underpin patient influence in organizations.
• Prescriptive measures such as guidelines and formularies do not affect acquiescence.

Physicians, like other professionals, are expected to draw from specialized knowledge while remaining receptive to clients’ requests. Using nationally representative U.S. survey data from the Community Tracking Study, this paper examines the degree to which physicians are influenced by patients’ requests, and how physicians’ workplaces may mediate acquiescence rates through three mechanisms: constraints, protection, and incentives. We find that, based on physicians' reports of their responses to patients' suggestions, patient influence is rare. This influence is least likely to be felt in large workplaces, such as large private practices, hospitals, and medical schools. We find that the protection and incentives mechanisms mediate the relationship between workplace types and physician acquiescence but more prescriptive measures such as guidelines and formularies do not affect acquiescence. We discuss these findings in light of the ongoing changes in the structure of medicine.