Eric E. Shore, DO, MBA

• React to this article in the Discussion Forum.

I am in essential agreement with much of what he says with regard to the manner in which the practices that are being acquired are being "managed." The types of companies he refers to are usually run by people who's affiliation with Medicine is tangential at best, and are affected with that most insidious of diseases: "Quarteritis." They feel the need to justify their existence each quarter of each year, thus showing the Wall Street analysts that their company is worthy of investment. It is unfortunate that this is the case because there is nothing inherently wrong with increasing revenue streams from each practice (everyone who is in private practice tries to do that every day). They simply take the wrong tack doing it in many cases because of a lack of understanding of the medical marketplace (i.e. patient's needs and physicians' feelings of professional disenfranchisement). If the principles of TQM were applied, and the attempt to provide 100% patient (customer) satisfaction (a very real possibility using modern techniques), the increasing revenue would materialize.

As for his second assertion that cutting costs have proven difficult, this statement is true, but only as far as it has gone so far. By shifting our paradigm of medial practice management and administration (not the same things, by the way), there is much fat that can be cut from most practices without sacrificing either patient care or physician satisfaction. It would, however, require taking a longer view, and realizing that profits from current investments may take 18 to 36 months to realize in the beginning (much less after centralized systems are established), but that these changes would position such a network of practices to take financial advantage of any direction healthcare takes in the future, while assuring a larger measure of physician autonomy and patient satisfaction.

The object of this entire discussion can be summarized as, "let's not be afraid to do it, but let's do it right."