The day of solo practitioners is coming to an end. In its place will be gaggles of gastroenterologists and flocks of physicians. Mega practices are becoming the norm in American medical care.

Here’s a few pictures of this trend, somewhat dated (they only go through 2015) but still quite revealing.

The figure below illustrates the distribution of primary care physicians in the U.S., from June 2013 ...

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Health care reimbursement in the U.S. is frighteningly complex. We have federal payers, like Medicare; state/federal payers, like Medicaid; private, for-profit insurance companies, like Aetna; private, not for profit insurers, like many local Blue Cross Blue Shield networks. Oh yes, and we have private insurance companies managing reimbursement for many Medicare and Medicaid recipients. This complexity comes with costs. Doctors and hospitals need to hire armies of people to process bills ...

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Jill Ladkin was already having a terrible autumn. It began with a seizure that put her in the hospital with what seemed like scores of unfamiliar physicians attending to her state of health. The brain scan revealed a mass in the lining of her brain, a location usually signifying a benign tumor; but, given her seizure, the tumor was hardly what you would call a harmless growth. The surgeon had a theory of what ...

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The HPV vaccine saves lives. It does so by reducing a person’s chance of being infected by the human papilloma virus, a virus that causes a whole range of cancers including, most importantly, cervical cancer.  Vaccinate your teenage daughter against HPV, and you will increase the chance she will live to old age. Simple as that. Yet currently, the majority of American teenagers, boys and girls, are reaching adulthood without the full ...

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In recent years, it feels like we’ve been inundated by stories of greedy pharmaceutical companies jacking up the price of important generic medications. In 2015, “Pharma Bro” Martin Shkreli, recognized that no other generic companies were manufacturing Daraprim, a drug used to treat infections common among people with AIDS, from $13.50 a pill to $750, confident that no generic competitor was around to cut into his market 
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Most men diagnosed with prostate cancer don’t die of the disease. Between 2011 and 2015, 112.6 per 100,000 men per year were diagnosed with prostate cancer in the U.S., but only 19.5 per 100,000 men per year died of the disease over that same period of time. That is still far too many deaths. But the huge disparity between deaths and diagnoses arises in large part from overdiagnosis of prostate ...

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Here’s what most medical experts agree on: People 50 and older should be screened for colon cancer. Here’s what is more controversial: Whether that screening should start, routinely, at age 45. Recently, the American Cancer Society (ACS) recommended that colon cancer screenings start at age 45. Their recommendation was based in large part on an uptick in the number of people 45 to 50 years old who are being diagnosed with colon cancer ...

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Chemotherapy drugs have become ridiculously expensive. Many new drugs come to market costing more than $100,000 per patient for a full course of treatment. Often, patients have to pay a significant portion of these costs. For example, a 20% co-insurance rate, typical for basic Medicare coverage, leaves patients responsible for more than $20,000 of chemotherapy costs, an often crippling burden. Fortunately, many expensive cancer drugs are going ...

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Sometimes it is hard for hospitals to provide expensive care to poor patients. When a low-income patient needs $20,000 of chemotherapy, a hospital loses money if that patient cannot pay for the medicine, or pays through Medicaid, with its relatively stingy reimbursement. Fortunately, the federal government created a program for hospitals that care for a disproportionate share of low-income patients, whereby they can purchase those medicines at a discount. The program ...

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Quick quiz question: two people are diagnosed with melanoma -- Sarah Sunburn, an adamant sun-worshipper, and Paula Pale-All-The-Time, a fanatical sun-avoider. Who is more likely to die of the disease? The answer is pale-faced Paula. Surprised? Let me unpack this mystery and explain why sun exposure simultaneously kills people, while making the cancers they are diagnosed with appear to be less life-threatening. I will start with what you probably know already. Melanoma ...

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