Will Primary Care Lead the Revolution?

Abstract

OPTIONS ABOUND at the Sharp Community Medical Group in San Diego, Calif. Its 600 physicians can choose to provide as few as 15 or as many as 50 from a menu of patient care items. Capitation rates are commensurate with physicians' levels of participation. "We are a medical group formed by physicians, for physicians," says the group's president, Paul Reeb, Jr, MD. A continent away, in Baltimore, Md, 17 primary care physicians have maintained their autonomy by forming a "group practice without walls." They have more leverage in snapping up managed care contracts, but they retain their own practice assets and decision-making powers. The alternative, says Baltimore Medical Group chair Alan Kimmel, MD, could be answering to a hospital board, insurance company, or government entity, or worse—being locked out of the market. In eastern Tennessee, Jerry Miller, MD, started a thriving primary care group in the late 1970s. A decade