WASHINGTON — A quiet revolution is transforming the way medical care is delivered in this country, and it has very little to do with the sweeping health care legislation that President Obama just signed into law.
But it could have a big impact on that law's chances for success. Traditionally, American medicine has been largely a cottage industry. Most doctors cared for patients in small, privately owned clinics — sometimes in rooms adjoining their homes.
But an increasing share of young physicians, burdened by medical school debts and seeking regular hours, are deciding against opening private practices. Instead, they are accepting salaries athospitals and health systems. And a growing number of older doctors — facing rising costs and fearing they will not be able to recruit junior partners — are selling their practices and moving into salaried jobs, too.
As recently as 2005, more than two-thirds of medical practices were physician-owned — a share that had been relatively constant for many years, according to the Medical Group Management Association. But within three years, that share dropped below 50 percent, and analysts say the slide in physician ownership has continued.
For patients, the transformation in medicine is a mixed blessing. Ideally, bigger health care organizations can provide better, more coordinated care. But the intimacy of longstanding doctor-patient relationships may be going the way of the house call.
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