I just got a frantic call from an old colleague of mine.  He’s a modern-day David fighting against one of the Goliaths of medical corporations, AMG.  My friend and I have served the northwest suburbs of Chicago for decades.  When I opened in Barrington, EHS (Evangelical Hosp Systems) ran the local hospital. EHS had a heart of gold and a charitable policy like none other.

A simple phone call to the COO of Good Shepard Hospital could zero out the account of a patient who was about to go to collection or worse, whose choice was pay the hospital bill or feed the kids.  More than once, the hospital provided babysitters for a patient whose spouse was in the ICU or dying from a horrible disease.

During those golden years, Good Shepherd’s staff was comprised of some of the best generalists and specialists you could find anywhere.  The physician practices were all privately owned and unencumbered by insurance companies or employers, thus decisions regarding testing or referrals were made by the patient’s physician in conjunction with the patient.

Over the years, the insurers slowly took control of the medical decisions by creating specialist and diagnostic panels that both generalists (Internal Medicine/Family Practitioner) and patients were required to use or suffer a financial penalty.  In the last 15 years, a new player joined the game. 

Hospital corporations, like EHS, started to merge into much larger and powerful healthcare conglomerates.  As they grew, they started buying medical practices.  Their business models were ingenious.  First, the hospital bought a large number of internal medicine and family practices.  Then, they purchased key specialty groups and fed all of their patients into a few, corporate owned specialty practices. 

Over time, this new model changed and continues to change the referral pattern by choking off the patient flow that independent specialists need to keep their offices open. Eventually, independent specialists either give their practices to the hospital corporation or they retire.  As the number of specialists decrease, independent generalists begin to have problems obtaining specialty consults. Eventually, the generalists either give their practices to the hospital conglomerate or they have to retire. 

Specialty care is an essential part of medical care. Imagine the following scenario:

“This is Dr Segal’s office.  His patient, Mr. X, needs to see a cardiologist this week.   Can you please find him an appointment and call him?”

“I’m really sorry.  We are so busy taking care of our employed physician’s patient that we couldn’t fit your patient in for at least 120 days.”

“Dr Segal, would like to talk to Dr AMG?  Can you have your doc call mine?”

“Is Dr Segal an AMG doc?”


“Sorry, I can’t help you.”

Now, do you understand why my old friend and colleague is frantic? He’s an independent and recognizes that the above scenario is actively unfolding in Barrington.  Unfortunately, I think Goliath wins this and all future rounds.  Unfortunately, you lose, too.  As your choices for specialty care dwindle, so may the quality of your health care.

I’m happy I’m retired.  .

Whenever possible, support independent physicians!

Here’s your joke for the day.

There was a man named Billy. Billy worked at a pickle factory. One day Billy comes home to his wife and says…

…“Honey, I want to put my pp in the pickle slicer.  His wife tells him that’s absurd and not to do it and then went to sleep. Billy goes to work the next day and comes home and tells his wife, “Honey, I put my pp in the pickle slicer!” His wife yelled, “What happened? Was it bloody? Did it hurt?” The man tells his wife, “No, but I got fired and so did she.

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