Vertical Health Care

Nancy-Ann DeParle, JD, director of the Office of Health Reform; Ezekiel Emanuel, MD, special advisor for health policy with the Office of Management and Budget; and Robert Kocher, MD, former member of the National Economic Council, published an article in the August 23, 2010 issue of Annals of Internal Medicine on the economic forces impacting health care and what the most likely outcomes will be.They wrote that it's likely that we'll see what they call vertical health care, or physician employment by hospitals or large practice groups. Vertical healthcare organizations typically have a management hierarchy and centralized processes, like those of the federal government.

The article reported that growth of vertical health care organizations, as well as large, independent group practices, has grown significantly.Only about a quarter of physicians remain in solo or small practices (defined as having less than 6 physicians), compared to 41% who worked in small practices 27 years ago.Following publication of the article, there was an outcry of concern for what some call the "Marcus Welby" way of practicing medicine.Even the American Medical Association came forth to urge the Centers for Medicare and Medicaid to not inadvertently show favoritism toward large health systems.

Physicians in small private practices value their autonomy and, as some have said, their ability to put the well-being of patients--and not the hospital or health care delivery system-- first.A number of physicians I know are struggling to hang on for a few more years, until they retire (or as some jokingly say, until they die on the job).More than likely, though, the physicians entering practice now and in the near future will not be looking to start or join small private practices and will be lured away to (or have no alternative but to work at) large practices or hospital systems.The end of private practice may soon be upon us.