Over the last two decades, managed care has overtaken the traditional fee for service insurance structures. By 1998, fee for service business had become almost a novelty. Managed care, with its aggressive utilization management techniques and added paperwork requirements, had not been embraced by physicians and consumers. There came the managed care backlash. The assault by physicians and patients on managed care did not halt the growth of managed care, but it did change the composition of the managed care market. The most aggressive form of managed care, HMO, retracted while the less restrictive forms of managed care, such as PPO and POS, flourished. How do physicians personally respond to managed care? This research utilizes large scale national survey data to look into physicians'' work effort within a managed care environment. The information should be useful for considering physician response and work force issues in policy changes that could potentially change existing market structure, especially for national policy makers as well as citizens participating in discussions on health care reform in the United States.