To the Editor:

No one understands and manages a physician's office better than a physician. Physicians, like me, who have sold their practices to a hospital or a physician practice management company (PPMC) have seen their short-term profits, their years of autonomy and their smooth office operations disappear.

I thought a PPMC would improve my office management, be a stronger force in negotiations with managed care companies, and provide additional capital for growth and development. On the contrary, I saw my office operations deteriorate, and little capital was invested in medical equipment, computer systems or expansion into new areas of service.

When our group was bought by yet another PPMC, my office ran even less efficiently because the new staff lacked personal relationships with my patients and the computer system was not user-friendly. My practice had become an inefficient, disorganized entity over which I had very little control.

Fortunately, I was able to pursue a career in academic medicine (which had always been my goal) after being an employed physician for only 21 months. But I now realize I should have maintained the autonomy of my thriving solo practice before moving into teaching.

While changes in the health care system will come and go, physicians must remain the foundation upon which all medical care is based.