Many of the country’s large-scale health systems, like Kaiser Permanente, the Mayo Clinic or the VA, operate at a greater cost-efficiency when compared to a traditional practice.

Currently, however, they are an exception to the norm. Most doctors are affiliated with small-group practices, with little interaction between each other. That is one reason why care is so fragmented, with only a minority of doctors using electronic medical records.

Eventually, I see these small practices having a difficult time surviving the recession, and combined with declining reimbursements, being bought by hospitals or integrated systems. So, eventually, we’ll see less independent practices, and more large health organizations providing care.

But it probably won’t be anytime soon.