During his residency in emergency medicine for the Medical College of Pennsylvania back in the early 1980s, Richard MacKenzie, M.D., got a piece of memorable advice from his mentor on the topic of physician independence. "He told me to just give it up. He said, 'you'll always work for the man; it's just a question of who the man is.' Physicians are never totally independent. Even in private practice, you have to follow the rules of the federal government or you won't be in practice long. For most traditional group practices, independence is more of a mindset than a financial benefit."
MacKenzie is now ensconced in his role as a physician employed by the Lehigh Valley Physicians Group. He serves as senior vice chair of operations for the emergency department, which handles some 150,000 annual visits. The Allentown, Pa.-based group practice consists of some 500 physicians and, in theory at least, maintains an arm's length distance from Lehigh Valley Health Network, its three-hospital, 900-bed corporate partner. But in reality, "the group supports the mission of the health network. We have shared governance. On paper, it is a separate ownership. In reality, it's their group." Physicians are not contractually obligated to admit solely to Lehigh Valley, but the opportunities to work with competing hospitals are few, MacKenzie says. "As physicians get bought up, and allegiances form, there is no longer an opportunity to work at a competing hospital. If a doctor is bought up by Lehigh Valley, they declare themselves as a Lehigh Valley physician."
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