Will physicians be able to maintain their traditional status as independent practice owners? That question was recently examined by HealthLeaders. What are your thoughts? Will market pressures cause more private practices to join larger systems?
This article references Merritt Hawkins’ new 2011 Survey of Final-Year Medical Residents. Please let me know if you would like a copy of the complete survey report and I will be happy to provide you with one. I look forward to your remarks.

The independent practitioner is going the way of the independent pharmacist as the big boys like CVS and Target swallowed them. But, there are still corner pharmacies doing, in some instances, a big business. Why?

They picked a niche
They emphasized service
They diversified their products (liquor instead of greeting cards)
They changed their business models

Doctors, are you listening?
BTW: Med school applications are up 3.2%

The primary care physician is the antiquated dino with nowhere to go but to the natural history museum of medicine. Specialists are doing OK . For a primary care doctor to do a profitable procedure other than primary care medicine would require a lot of years of specialized training ie. back to a teaching hospital. Very few are doing "alternative medicine" which might be considered quackery, below standards of care and perhaps not within their area of expertise or acceptable by the Board of Medicine in their jurisdiction.
And even so, many insurers may deny paying for that service. In this economy we presently enjoy; few patients have the extra cash to spare for "niche" medicine. Concierge medicine is a failure just based on its premise ie....pay me $1500/year and I will cater to your every need. Most doctors do that anyways without that extra $$$$
PCP's ,like dinos in a herd, or mega group practice is probably the way medicine is headed perhaps into the "tar pits" Specialty care is the future, especially with the explosion of new knowledge and medical advancements. Specialty Boards of certification with accredited years of training are now the standard.
Med school applications may be up but what does that really mean. It means more medical student applications and of those that make it very few become Family Medicine doctors.

While practicing anesthesiology for several years at a local hospital, I had the honor to share in the lunch room debate about the wrong path of medicine(Hillary care back then). It seemed that most doctors just complained about everything bad that was happening in medicine, yet many were the same doctors who continued to accept 60% of medicare allowable because they were promised "volume" by the insurance company.

In my MBA classes, I learned that business was about profits and not volume. As a person, I knew that quality of life was about quality time and not more fast paced work. As a physician, I knew that quality and rewarding medicine was about diagnosing, treatment and the gratification of seeing your patient heal. Nothing will ever replace that feeling because not one profession has the power to save and better lives the way that we, as physicians, do.

Medicine remains a very rewarding profession. What has changed is the business of medicine. If Physicians were more savvy about business, I have no doubt that physician satisfaction level will markedly increase. This means either to learn more about business yourself, or join a group that is more business savvy. If you don't, someone else, such as a hospital, will do it for you.

Physician heal thyself

While some would argue that the private practice of non-specialty, non-procedural care is an unsustainable business model, I think that is short sighted. PCP's are being squeezed because of how medical services are being reimbursed today. They will not be reimbursed the same way in the future and, I believe, will have more, not less, leverage as the evolving US healthcare system takes shape. Themes are:
Integrated but not necessarily joint
The new captain of the ship
Bulk rate for disease and population management, not piece work
Metrics not effort