Pavlov’s Dog

At a recent panel presentation on the Patient Protection and Affordable Care Act (PPACA) before medical students at the University of Arizona’s College of Medicine campus in Phoenix, the moderator asked the students how many of them intended to open their own practice or work in a small group practice upon graduation and residency. One or two hands went up. He then asked how many planned to work in large groups, or for a hospital or some other specialty organization. All of the rest of the students raised their hands.

One of the physicians on the panel remarked that this illustrated the principle of Pavlov’s Dog: Condition students on the dismal state of solo- or small-group private practice in medicine long enough, and eventually they all will be salivating for regular, salaried jobs in large groups and institutions.

There’s some truth to this conclusion. The grass may well be greener for physicians in solo practice or small groups who practice concierge, boutique or retainer medicine, and you don’t always hear about those opportunities in medical training today. We suspect, however, that the trend to practice in larger, more integrated groups and settings will continue.

Economics is the driver. Medicine will become a team sport, framed by payer and provider consolidation, integration and emerging methods of payment based on the quality, and not quantity alone, of care. Solo- and small-group practices won’t disappear, but they will increasingly be consigned to the margins, and not the mainstream, of care.

We could be wrong, but that’s the beauty of not knowing the future. If we could predict it, there would be nothing to learn.

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