A Changing Service - Office and clinic care

In the main, the patient sees his or her physician in an office or at a site reserved for group practice; in a hospital outpatient department; in an ambulatory surgical center; or in a freestanding surgical center.

Office-Based Practice

Most physicians practice on their own; even so, the solo practice is declining as a way of medical life. The solo practitioner survives in isolated or rural areas, but hardly at all elsewhere. For the physician, solo practice is both simpler because of the independence and freedom it guarantees and more complex because the service responsibility may continue 24 hours a day, seven days a week. For the patient, the main advantage of solo practice is both the closer relationship that can develop and less fragmented care.


Very common today is the partnership, an agreement between two or more physicians under which the participants share office space, staff, and equipment. The physicians retain their independence in the sense that they have their own practices, but they usually share patient responsibilities under given circumstances. A physician who has to be out of contact with the office may, for example, give a patient another partner's number so as to have continuous backup. Spreading the care responsibilities and reducing the workload, each physician may also have more time for each patient.

The patient may find major advantages in the partnership. He or she can become acquainted with the physician's partner and in this way obtain personalized care at all times. Backup support may be especially important in obstetrics, where deliveries may occur without warning, and in cardiology, where emergencies are equally unscheduled.


Where three or more physicians associate in an arrangement that is normally less formal than a partnership, it is termed a group . The physicians belonging to the group may practice in a single specialty or in diverse fields of medicine. An example of the latter would be a group of three doctors offering internist, obstetrics-gynecological, and pediatric services. In other ways the group shares the advantages and disadvantages of the typical partnership. Like the partnership, the group has one particular advantage, however: other physicians are available for consultation and education. The group format may also make possible relatively sophisticated laboratory and other facilities.

Health Maintenance Organizations

The health maintenance organization (HMO) ranks as a special kind of group practice, one that involves a fixed monthly or annual fee system rather than a fee-for-service arrangement. The fixed fee ensures that the HMO member will receive, at no additional charge, all necessary health services, including hospitalization and the care of specialists. Preventive medicine at no extra cost to the member is a feature of the HMO that has ensured reduced usage of hospital facilities.

Preferred Provider Organizations

Like the HMO, the preferred provider organization (PPO) is at least partly a response to rising health-care costs. Forming a PPO, a group of physicians contracts individually with an insurance company or employer to provide health services for fees that are usually lower than those prevailing in the community or area. The PPO does charge on a fee-for-service basis, but employees making use of the organization's medical services save money because they avoid the copayments of conventional insurance plans and the standard deductibles. Physicians belonging to the PPO have a stable pool of employed members whose health problems may be extremely diverse. For the employer or insurance company, a particular advantage is the ability to bargain for lower fees.

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