Benefits of and Barriers to Large Medical Group Practice in the United States

Abstract

DURING THE 7 decades since the committee's 1932 report, medical reformers—including physician leaders in groups like the Mayo Clinic,² Palo Alto Medical Clinic,³ Scripps Clinic,⁴ and Permanente Medical Group (Kaiser)⁵—have argued that group practice, especially large multispecialty group practice, can improve the quality of health care, decrease costs, and provide a professionally desirable working environment for physicians^6-11 (Table 1). As medical care has become increasingly complex and expensive, and as awareness of medical errors¹² and the possibilities for using organized processes to improve quality have grown,¹³ the problems identified by the committee have become more salient than ever. Furthermore, the growth of managed care appeared to create new reasons for physicians to practice in groups, especially large groups^14-17 (Table 1).