This is the first comprehensive review of the scale and scope economies of physician practice in nearly two decades. The research results do not appear to have changed much; nor has much changed in physician practice organization.

Resident recruitment is a high-stakes, resource-intensive activity for teaching institutions, graduate medical education programs, and applicants. Hospitals direct substantial resources toward attracting top candidates, recognizing that residents affect the quality and efficiency of patient care, and the institution's reputation. Applicants devote substantial time, money, and emotional energy to selecting a program, which requires a multiyear commitment and has implications for their future careers.Limited information is available to help programs optimize their recruitment process or inform applicants about how their peers make these decisions. Previous survey studies were often limited to a single specialty with a small number of respondents. 1-6The goals of this study were to (1) identify the factors influencing residents' selection of their residency program; (2) determine whether sex, race/ethnicity, or specialty affect factors important to applicants; and (3) assess whether applicant priorities changed from 2004 to 2012, given the increasing medical student debt and the apparent shift toward ''controllable lifestyle'' specialties. 7,8 We hypothesized that applicants prioritized academic factors over factors related to quality of life or program environment, but the importance of quality of life would increase over the study period. We also hypothesized that priorities would vary according to applicants' specialty, sex, and race/ethnicity.

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Under the Affordable Care Act, the new Center for Medicare and Medicaid Innovation will guide a number of experimental programs in health care payment and delivery. Among the most ambitious of the reform models is the accountable care organization (ACO), which will offer providers economic rewards if they can reduce Medicare's cost growth in their communities. However, the dismal history of provider-led attempts to manage costs suggests that this program is unlikely to accomplish its objectives. What's more, if ACOs foster more market concentration among providers, they have the potential to shift costs onto private insurers. This paper proposes a more flexible payment model for providers and private insurers that would divide health care services into three categories: long-term, low-intensity primary care; unscheduled care, including unscheduled emergency services; and major clinical interventions that usually involve hospitalization or organized outpatient care. Each category of care would be paid for differently, with each containing different elements of financial risk for the providers. Health plans would then be encouraged to provide logistical and analytic support to providers in managing health costs in these categories.