The consolidation of physician specialty practices in to larger corporate health care systems in urban areas is creating a new challenge for today's doctors when the music stops: there might not be a chair available.
There are simply many fewer hospital systems in large urban areas than there are specialy practices, so the number of specialist positions a large health care system is willing to absorb might be limited. As doctors and hospital systems coalesce into as-yet-to-be-clearly-defined "Accountable Care Organizations," the cost of too many specialists in an organization is being carefully weighed.
This is playing out in our area as more and more cardiology groups join forces with hospital systems. The concern in some circles is what will happen to laggard practices in similar geographic locales. Will they be able to go it alone and refuse government payments for services? Will they have to align themselves with an alternate hospital system that might not be there first choice? Or might they just simply fade away as the specialists in these practices retire?
It's hard to know where this might sift out, but the construct developing suggests that certain specialty services might be even harder for patients to obtain in the years ahead.
But then again, that's probably been the plan of our new health care reformers all along.