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I appreciate Dr Badruddoja's review of my article and then his taking the time to prepare a response. I hope that the large readership of the Archives will note his letter because—I belive—he expresses the frustrations of many surgeons and physicians around the country. There are several points mentioned by Dr Badruddoja that I particularly would like to address.
First, I understand that the Permanente Medical Group has a unique relationship with insurance provider—Kaiser Foundation Health Plan. The relationship has not been without tumultuous times, but we have managed to maintain a healthy, working relationship over the past 50 years.
Second, I am fortunate to be allied in an HMO system, which is intimately affiliated with universities on the West Coast. While many surgeons in the country may be less fortunate, I would advise that they seek such an association. In addition, even if the opportunity of
Bodai BI. The Myth of Managed Care-Reply. Arch Surg. 1997;132(5):557. doi:10.1001/archsurg.1997.01430290103022