To the Editor:

Can you convince me that merging family practices into mega-groups saves time, money, frustration and tears? Every big group I've observed is mismanaged, inefficient, difficult for patients to negotiate with and expensive. There's no accountability: The receptionists can't make decisions, the nurses rotate and the managers are in meetings.

How can a large group justify $250,000 for a CEO when its only source of revenue is the same as mine — patient fees? It can't charge more just because it's big, and as far as I can tell, it has more, not fewer, employees per physician. The doctors can't see more patients than I do, because they don't know them as well. And if they do see more patients, they aren't providing the same service, since every day is a new day, every patient a new patient.

Where is the continuity of care, unique to family practice? It's not in the big groups. They run at a loss, and unless they're bailed out by a hospital, they go out of business. This is the future?

I may be stuck in the '60s, but I'm a reasonably content solo physician. I expect to still be in business when a number of the big clinics go bust.

Editor's response:

Groups clearly aren't the answer for everyone. But in this issue's special cover section, several family physicians in groups organized and led by doctors offer their perspectives on why they're succeeding. The answer seems to be, largely, because the groups are physician-led.