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Solo Practice Vs. Integrated Health Systems: What’s Best For Primary Care Reform?

The buzzwords of cutting-edge primary care reform – the medical home, coordination of care, electronic health records – have usually been associated with large integrated health systems such as Intermountain Healthcare, Group Health, and Kaiser Permanente. If you believe the arguments that economies of scale and financial resources give such organizations built-in advantages over the traditional small group practice, you may be inclined to believe that solo practice is going the way of the dodo. Indeed, immediate past AAFP President Roland Goertz, MD, MBA penned an editorial a few months ago, “Helping Small Practices Survive Health System Change,” that, while touting some services that the Academy offers family physicians in these practices, betrayed a decidedly pessimistic outlook on their long-term future.

Not everyone agrees, however. In the September issue of the Journal of Family Practice, Jeff Susman, MD cast solo practices as vital engines of primary care innovation: Read more »

*This blog post was originally published at Common Sense Family Doctor*

Integrating Major Health Systems Could Make Things Worse

Health reformers propose the proliferation of integrated health systems, like the Mayo Clinic or Kaiser Permanente, which, according to the Dartmouth Atlas, lead to better patient care and improved cost control.

To that end, accountable care organizations (ACOs) have been a major part of health reform, changing the way healthcare is delivered. Never mind that patients may not be receptive to the new model, but the creation of these large, integrated physician-hospital entities that progressive policy experts espouse comes with repercussions. Monopoly power.

To prepare for the new model of healthcare delivery, physician practices have been consolidating. In many cases, they’re being bought by hospitals. Last year, I wrote how this is leading to the death of the private practice physician.

But with consolidation comes a tilt in market power. Health insurers, desperate to control costs, are finding it more difficult to negotiate with hospital-physician practices that dominate a market. And patients are going to side with the hospital — insurers that leave out popular doctors and medical facilities face a backlash from patients. Witness the power that Partners Healthcare has in the Boston market that’s mostly driven by patient demand for big-reputation, high-cost Massachusetts General Hospital and Brigham and Women’s Hospital. Read more »

*This blog post was originally published at*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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