Overview

How times have changed! For a large part of the 20th century, most residents who completed their postgraduate training embarked upon careers as independent practitioners. Over the past several decades, however, the situation has drastically altered. As a result, a more complicated health care delivery system now exists. It consists of multiple practice options available to physicians completing their residency training. This change in the format of the provision of medical services is the result of dramatic changes in health care delivery.

The aim of this chapter is to provide some understanding of the forces that have driven this change and then offer an introductory discussion of the organizational options that are currently available to practicing physicians. These will be presented in four categories, namely, salaried, solo, group, and substitute (locum tenens) practitioners. An outline of the current approaches to preparation for business and management in medicine then follows.

Forces for change

The significant expansion of practice options is the result of a number of forces for change in the provision of health care. These are managed care, amalgamation, and market pressures. Each of these three elements will be discussed briefly.

Managed care. The standard form of physician compensation that was in effect for a very long time was indemnification on a fee-for-service basis. Individuals insured under this system have few prior limitations on obtaining medical services.