Death of Small Practice OR Rise of an Integrated System

Death of Small Practice OR Rise of an Integrated System

John Vernon Cox, DO, FASCO

Apr 16, 2010

I ran across a post on a healthcare blog that I would encourage folk to read. Jann Sidorov writes about the predicted death of small practices. I love his analogy to an impressionist painting – by standing too close it is easy to miss the bigger picture. Though I see the picture differently than he does.
I have to admit that I do think that the era of small practices providing the bulk of health care in this country is ending. The allure of cottage businesses around the town square and organic farms is that they provide a unique, hand-crafted and loved product. Though the personal touch of a physician is beloved – medicine is molded by science and technology. All of us expect our physicians to be acutely aware of the new therapy / diagnostic approach to alleviate our suffering. We also expect our physicians to adhere to all of the rules of the game – both in quality monitoring and in appropriate business practices. Though there are small practices that can meet these needs, most require help. More are reaching out to associate with large groups or institutions that can dedicate capital – both human and financial – to address the pressures upon us.

Dr. Sidorov belittles the goals of physicians and institutions “lusting” over integrated delivery systems. I must admit that I am one of those ‘lusting’ physicians. I am tired of trying to overcome the financial orientation that medical practices have created to maintain revenue. Each revenue stream (read technological service) that we create fractures healthcare of our patients and makes it harder to provide multidisciplinary care to our patients. The integrated system, where everyone is under one tax id and is pushed in the same direction (at least theoretically) is one where we can all benefit. Systems of care should make it easy to do the right thing. Our current fragmented health system makes it hard.

I do appreciate Dr. Sidorov challenging the common view regarding small practices, and agree that the market will moderate the consumption of practices and will moderate the enthusiasm of consolidation.


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