Reflections on Change in Medical Practice

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Abstract
The trend in the provision of medical care to large-scale organizations is clear. While this has been most conspicuous in hospitals, nursing homes, and renal dialysis treatment centers, it is gathering momentum in the practice of medicine itself. The competitive pressures for cost containment, the ability of large medical organizations to contract efficiently with third parties, the ample supply of newly trained physicians seeking immediate practice, and new capital financing opportunities are some of the many reasons for this rapid aggregation. This will in time structurally change medical practice and the way in which it is perceived by patients and the public. (JAMA1983;250:2820-2825)

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