Something Lost, Something Gained in Primary Care

And the growth is in primary care. "Primary care is, you know, the backbone, and I think as we look at the expectations of the future, the primary care doctors will be at the forefront of that relationship with patients," says Dustman.

The idea is for "patients to be treated consistently based on evidence based approaches," Dustman said. "Physicians strive for the best protocol and best outcomes at the appropriate cost."

At Parkview, the work starts and ends with the leadership and the manner in which the board operates. In the physician group, 13 of 15 board members are physicians, he said.

"Organized under the board, we have a line of businesses that [have] similar specialties and work in a similar geography, each with its own executive committee. The majority of physicians are on each committee," says Dustman. They report to the physician groups "in terms of letting them be responsible and accountable in the decisions in what the practices are going to look like," he said.

"I would say some of the issues we had to address aggressively as a group involved the integration of culture, our vision–a lot of work has been done in that regard," he said.

Initially, the physician group was planned to be more administrative, "but at the end of the day it didn't accomplish the physician leadership to the depth we were hoping to accomplish," says Mark Nafziger, the Parkview Health chief operating officer and executive vice president, who oversees PPG operations.

In the aftermath of healthcare reform, "there are certain realities that all of us as healthcare providers face," said Nafziger. "Probably all the sources of funding aren't going to increase. We acknowledge that healthcare has to be more effective. There's going to be more of an emphasis on the role of the patient accessing the system through improved insurance coverage so there will be greater number of patients accessing primary care," Nafziger said.

No doubt the essence of primary care is far different than decades ago when Saul Finkelstein ran his practice. But he was a shrewd man, as my parents had recalled, and maybe he would have grown frustrated running his own practice in the modern era and would have decided to sell to a group like Parkview Health.

Something is lost in all this, and something gained.