The Academy Award winning movie, The Blind Side, tells the powerful story of Michael Oher, a kid from the wrong side of the tracks in Memphis. Michael's path fortunately and fortuitously intersects with Leanne Tuohy, brilliantly played by Sandra Bullock in the movie.

Growing up in the south and being married to a Memphis girl for going on 23 years now, I have a deep appreciation for the tough courage required by all of the characters in this story. It is no wonder that the book and the movie captured the attention that they did.

Yet lost in the personal story of Oher and the Tuohy family is the underlying story that Michael Lewis, the book's author, set out to tell in the first place. The full title of the book is, 'The Blind Side: Evolution of a Game.'

As he had done before with best sellers such as 'Liar's Poker, 'an insider's look at Wall Street, and 'Moneyball,' a brilliant exploration of how the financial imbalance between the 'haves' and 'have nots' affects Major League Baseball, Lewis began with a mission to look at how the game of football has changed. Oher was just intended as the illustration, but the illustration took on a life of its own.

This deep football story was really not in the movie, so in case you have not read the book, here is the point, and the idea I want to explore here...

For years, offensive linemen generally, and left tackles specifically, toiled in relative obscurity in football. Quarterbacks, running backs, receivers and even defensive players got the glory, the money and the girl. Offensive linemen were the grunts in the trenches that did a necessary, but unglamorous job.

Then the game began to evolve.

In the old days, those Vince Lombardi days now portrayed in grainy films narrated by the guy with that awesome baritone voice, it was all about running the ball in a smash mouth, hand to hand combat sort of way. That was the way football was supposed to be played.

Then some teams started this bizarre thing called passing.

Then passing teams began to win.

Then quarterbacks who could really pass became more valuable, and commanded insane contracts worth millions of dollars.

Then came Lawrence Taylor.

You see, Taylor was this seemingly inhuman species that was large and fast. And he played defensive end, a position intent on harming these high priced quarterbacks who could pass.

And on one play in 1985, Taylor came unseen from the quarterback's blind side and literally snapped in half the leg of quarterback Joe Thiesmann, ending his career.

Taylor, and those like him, changed the game, and in the process, changed life for the offensive left tackles.

These previously anonymous linemen are now the second highest paid position in the NFL, right behind the precious quarterbacks that they protect. Right handed quarterbacks, of which most are, can't see their left side when they are back to pass. Someone who can provide protection from the monster coming from the blind side is now worth millions of dollars per year. The evolution of the game turned left tackles into prized players.

A similar change has happened for physicians and it is becoming very obvious which practices have discovered the value of a good left tackle and which are still exposed to the hit from the blind side.

I am seeing a growing disparity in the quality of management talent, the left tackle of a physician practice, from practice to practice. Those with good left tackles are winning, and those with an old view of practice management don't even know what is hitting them.

The business of medicine has evolved at least as rapidly as football. This is no longer a cottage industry where Marcus Welby hangs his shingle and just provides good care to his patients. Managed care, flat and declining reimbursements, complex information technology and inter-organizational data exchanges, increasing rules and regulations, and growing government intervention are our Lawrence Taylor's -- threats coming from the blind side intent on doing damage to the independent physician.

Yet many practices, especially those that are small but even some that are bigger, seem to regard their need for management talent as no different than 30 years ago.

We have the chance to work with practices of all sizes, specialties and geographies. It gives us a front row seat to see the difference when there is good management talent and not. And the difference is dramatic.

It is not a stretch at all for me to say a typical five physician practice with marginal management could spend an extra $50,000 a year to upgrade the talent and make that investment back multiple times over.

Managerial leadership that is not up to the current, and future, task results in revenue leaks (bad managed care contracts, revenue cycle management problems), poor use of data (operational performance, strategic insight), wasted time for physicians (working on issues that distract from what the doctor should be doing, needless rework), wasted investments (poor decisions, poor implementation and execution), and lost opportunities (no strategic vision, inability to capitalize on relationships, inability to develop new revenue streams).Easily, practices lose much more than they 'save' by not paying up for the necessary talent.

We've written in this space before about the potential demise of the small practice (see: The Future of Small). There are multiple forces working against the small practice and this is just one more.If you are too small to afford the right managerial and administrative talent, you just might be too small.

Michael Oher and those new left tackles like him all posses a set of skills that merit their new millions. They are big, intelligent, have strong hands and quick feet. That combination is rare, and worth a lot because there is a $10 million a year guy that they are protecting.

We're not the NFL, so we can drop a couple of zeros, but the rest of the analogy holds.

Doc, if you are the quarterback of your team, what is a good left tackle worth to guard your blind side?