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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
Voelker R. Will Primary Care Lead the Revolution?. JAMA. 1994;271(6):413. doi:10.1001/jama.1994.03510300007002