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Big Medicine Vs. Small Medicine


If current trends persist, big medicine will dominate American sick care. Where does that leave the rest?

Practice Management, medical practice entrepreneurship, Innovation and Entrepreneurship, physician entrepreneurship

Health service organizations are consolidating in an effort to gain market power and economies of scale. Deloitte models estimate that after the next decade of consolidation, only 50% of current health systems will likely remain.

If current trends persist, big medicine will dominate American sick care. Where does that leave the rest?

The state of private practice is precarious and facing several existential threats.

I do not believe private practice will disappear, but rather adapt to the changing environment and re-emerge as something much different from what we have now and using radically different business models to take advantage of the formal (legal and regulatory) and informal forces changing care.

Some themes are emerging:

1. Here is what disruptive sick care would look like

2. Here's how to practice Other-care

3. Here are 10 ways to beat commodity-care

4. McSickcare isn't so bad

5. Big data might work for big organizations. The challenge is to make it work for all the rest.

6. What works for big systems might not work for smaller practices

7. EMRs for the masses will appear, but not soon enough

8. We are training doctors to fight the last war and it needs to change

9. Physician driven innovation and entrepreneurship will continue to grow

10. The overreliance on technology will create opportunities for smaller practices driven by people as a priority

As care is re-engineered, as high touch replaces high tech and as newly minted doctors graduate with 21st century skills, the pundits might be surprised about the future of independent practice.

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Victor J. Dzau, MD, gives expert advice
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