I think a lot of it is due to bureaucracy. There seems to be a lot of failure to adapt to new systems to implement things fast and effectively. Even if you look at something simple as billing and your chart, it's a highly inefficient and costly process. Considering how computer literate most people are nowadays, and how widespread they are it really makes no sense that records are only kept on paper and are difficult to obtain or even find if you should happen to switch doctors. In addition, lack of detailed, easily shared records makes it really hard for doctors (at least from my exp) to know your whole history. They tend to get snippets of my life that don't give them all the pieces they need to make decisions without ordering a million tests.
I don't think medical practices are failing, however, it is challenging for physicians to run a practice these days. The risk, costs, and non-patient care demands are making private practice a less attractive alternative for some. And, younger physicians want work life balance. So, working for someone else seems to be a better option for more and more these days.
Couple this with the environment where operational efficiencies are rewarded; making small private practice more challenging.
I don't believe independent medical practices will ever go away. Certain communities, specialities, technology and effective management practices can help physicians maintain their independence.
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