The Ecology of Group Medical Practice in the United States

Roemer, Milton I.; Mera, J.A. Corrales; Shonick, William

doi:10.1097/00005650-197408000-00001

Cited by 5 publications

(8 citation statements)

References 5 publications

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“…Previous studies (e.g., Roemer et al, 1974;Rushing and Wade, 1973;Steele and Rimlinger, 1965) have demonstrated that processes of physician location and group formation differ for metropolitan and nonmetropolitan areas.…”

Section: Disaggregationmentioning

confidence: 97%

“…In an earlier study, Roemer et al (1974) reported that the median educational level in a state negatively influenced group practice strength in 1969. This variable, measured at the county level, is included in an attempt to replicate this result at a more refined level of analysis.…”

Section: Constraints In the External Environmentmentioning

confidence: 99%

“…For example, Roemer et al (1974) posited that the need for referrals and new patient contacts motivated group formation more in rural than in urban areas. Rural group structures were expected to be more diffused geographically to maximize patient coverage.…”

Section: Disaggregationmentioning

confidence: 99%

“…However, corporate ownership, executive policy, and central records may be less important to survival in rural than in urban practices, because the autonomy and cooperation suggested by these variables are inherent in the geographic dispersion of rural group organizations. Finally, prepayment should have a less negative impact on survival in rural than in urban areas because it has been suggested that people in thinly settled areas are more willing to accept nontraditional forms of medical care delivery (Roemer et al, 1974).…”

Section: Disaggregationmentioning

confidence: 99%

See 3 more Smart Citations

Medical Group Practice in the United States: Patterns of Survival Between 1969 and 1975

Freshnock¹,

Goodman²

1979

Journal of Health and Social Behavior

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Section: Disaggregationmentioning

confidence: 97%

Section: Constraints In the External Environmentmentioning

confidence: 99%

Section: Disaggregationmentioning

confidence: 99%

Section: Disaggregationmentioning

confidence: 99%

See 2 more Smart Citations

Medical Group Practice in the United States: Patterns of Survival Between 1969 and 1975

Freshnock¹,

Goodman²

1979

Journal of Health and Social Behavior

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“…Different specialty compositions require various types of nonphysician personnel. Therefore, in order to account for these feedbacks, equations (1) and (2) were estimated using two stage least-squares.Recent work by French and Ginsberg[6] and Roemer and others[15] suggests that the formation and the growth of medical groups across states are determined over a long period by a large number of socioeconomic variables. Among these variables are population density, metropolitan concentration, per capita income, proportion of population in poverty, levels of education, recent entry of the state into the nation, and the number of office-based and nonfederal physicians[15, p. 635] .…”

mentioning

confidence: 99%

Further Considerations on the Economics of Group Practice: The Management Input

Scheffler¹

1975

The Journal of Human Resources

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Medical Commerce, Physician Entrepreneurialism, and Conflicts of Interest

Rodwin

2007

Cambridge Q. Healthcare Ethics

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Is medical commerce a recent phenomenon? Does it distort the patientphysician relationship? Are investor-owned firms the main source of medical commercialism? 1 I contend that medicine has generally been commerce in the United States, that medical commerce is a problem when it creates or worsens physicians' conflicts of interest, and that these conflicts thrive in nonprofit organizations as well as in investor-owned firms. I provide a historical sketch to show that physician entrepreneurialism, rather than commerce generally, is the main source of physicians' conflicts of interest. Physicians have a conflict of interest when they have an obligation to act in their patients' interest and have incentives to act in their own interest, also the interest of other parties or they perform roles that prompt them to act in the interest of third parties. 2 Conflicts of interest compromise physicians' loyalty to patients or their independent judgment in acting on behalf of their patients and thereby increase the risk that they may not fulfill their obligations. To reduce this risk, public policy and professional ethics sometimes restrict engaging in activities that create conflicts of interest or regulates them. Self-employed physicians are entrepreneurs in that they earn profits and bear the risk of loss from their practice. 3 They sell medical services, tests, drugs, medical devices, and may own or invest in hospitals or other medical facilities. They have conflicts of interest arising from incentive to manage their practice and to advise, prescribe, refer, and make clinical choices that promote their income, even at the patient's expense. 4 A Continuum of Entrepreneurial Opportunities in Private Medical Practice The degree of entrepreneurial opportunities physicians have depends on how private practice is organized. Consider solo primary care practitioners, paid fee-for-service, who examine patients, diagnose problems, prescribe medicine, provide simple treatment, and refer patients to specialists. Such practitioners can increase their income by raising fees or providing more services, either by treating more patients or by performing more services for existing patients. If solo practitioners have more time than patients, pursuit of income might lead them to perform unnecessary services. Thanks are due to Jerome P. Kassirer, Albert R. Jonsen, and Joseph Fins for helpful comments on a draft. The history and themes herein are further developed in a book I am now writing, titled Medical Profession, Market and State in France, the United States and Japan.

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The Ecology of Group Medical Practice in the United States

Cited by 5 publications

References 5 publications

Medical Group Practice in the United States: Patterns of Survival Between 1969 and 1975

Medical Group Practice in the United States: Patterns of Survival Between 1969 and 1975

Further Considerations on the Economics of Group Practice: The Management Input

Medical Commerce, Physician Entrepreneurialism, and Conflicts of Interest

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