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Just as a blazing meteor wiped out large dinosaurs, health care reform may eliminate solo practitioners.
I read with great appreciation John Cox's editorial “Access, Quality, and Cost” in Journal of Oncology Practice.1 The editorial highlighted health care reform efforts that are predicted to change the way we practice oncology. Just as a blazing meteor wiped out large dinosaurs, health care reform may eliminate solo practitioners like me.2 And I am not sure that the systems of care that will replace me are better for the patient. Private oncologists and institutions across the country are scurrying to join forces so that they can benefit from economies of scale, but in fact, many of these large groups are collapsing under the weight of their own fixed and operational costs as reimbursement dwindles and erodes already narrow margins. I fear that survival in such a system will focus on growing volumes and will result in overutilization of services and drugs. Last spring I invited the CEO of ASCO, Allen Lichter, to visit my office and showed him that dinosaurs can still deliver cost-effective, high-quality oncology care. Nonetheless, I will soon be forced to assimilate with either my hospital or another dust cloud of physicians who aspire to become big enough to avoid bankruptcy.
I foresee no immediate remedy for the plight of the dinosaurs. The “invasion of the doctor snatchers” is well underway. However, I would like to outline several points that express some doubt as to whether these critical masses will succeed in solving quality and access problems. Also, I would like to challenge readers to consider how we can best utilize a growing treasure of soon-to-be-retired health care professionals.
How can a vibrant though heterogeneous group of older dinosaurs who are struggling to survive be utilized to capture their wisdom, their insights into personal clinical care, and their love of the profession?
It took me decades to become an experienced and sage practitioner who has built up a huge following, not because of some innate talent, but because of the hard years of refining skills I first developed in my fellowship through the entrepreneurial and academic freedom to grow. I never based my practice on the number of chairs in my chemotherapy room but by the respect I gained from colleagues and patients, who knew that I offered the best advice and care on an individualized, evidence-based platform. I no longer can promise my patients that I will be able to deliver that kind of care in the future, but I will keep on trying because I truly love what I do.
I thank Steven L. Sangirardi for his inspiration and encouragement.
The author indicated no potential conflicts of interest.