Medical Group Practice in the United States

Abstract

THE review of the development and characteristics of Medical Group Practice in the United States which Political and Economic Planning has issued as Broadsheet No. 274 is of special interest in view of the obligations placed on local authorities in Britain under the National Health Service Act to provide, equip and maintain health centres staffed and run by medical practitioners working as a team. The survey shows that American group practice aims at providing a full general and specialist service, including, if possible, in-patient treatment, and in the United States the term is applied to almost any form of organised medical team-work. The main incentives appear to be the inability of individual practitioners to provide a sufficiently complete service, the desire for professional co-operation among medical men and the need to reduce the cost of medical care by decreasing overhead expenditure and bringing specialist and hospital services to undeveloped areas. The main criteria are organised team-work and pooling of income. Day-to-day consultations are supplemented by staff meetings, good record systems, and sometimes also by democratic methods of administration. Groups show much interest in keeping their members up to date and developing their skills, for example, by good libraries, paid annual study leave, and systematic training of junior members. Financial competition within the group not only hinders team-work but also results in friction, and no solution has yet been found for the problem of assessing financially the diverse and constantly, changing ability of physicians. The election of group members is of the highest importance and should be done by the medical men themselves. Some are temperamentally unsuited for group work and should be excluded. Good group practice may have a beneficial influence on medical standards over a wide area ; but in view of the important differences in social background, in the development of health services and in the organisation of the medical profession in the United States, careful consideration will be necessary before the lessons of American experience can be applied to Britain.