Primary care as a loss leader

If medical practice was like Wal-Mart, primary care is like the $3 generics that bring people into the store.

Philip Alper on primary care contributing the large multispecialty practices:

The self-satisfied primary physician in the multispecialty group has always worked in his group environment. If his group is typical, primary care may function as a loss-leader into the provision of more lucrative procedural services, both diagnostic and therapeutic. And if not a loss-leader, the primary care contribution to the group’s income certainly reflects a lower return on investment (ROI, in economists’ jargon).

Primary care physicians in multispecialty groups may be comfortable with this. After all, no health system can exist without primary care. Besides, primary care also serves as a very efficient internal referral service. This perspective fails to impress many specialists in multispecialty groups, who frequently complain that primary care physicians are unfairly favored, even when their total earnings remain far lower.