The father of the industrial revolution would recognize the trend.

More and more physicians are foregoing the Marcus Welby business model of delivering all of the care for their patients.  The hours stink and they pay is not worth it.  Though there is a lot of psychological reward in knowing your patients for years, knowing their kids, and really feeling like the trusted advisor to which they turn in times of concern, that doesn't pay the bills.  And more than just the bills, the new generation of physicians is not willing to provide that type of care for the families they serve if it comes at the expense of their own spouse and kids.

Increasingly, new physicians are taking employee jobs, migrating to a hospitalist or ED type role.

There is an interesting dynamic at play as it relates to the delivery of care.

This new model has a few consequences for patients, be they intentionally designed or not.

Care is broken down into smaller and smaller parts, a la the idea of Mr. Taylor, allowing specialization and focus.  That is good in one regard.  The idea that the old family doc could know everything about every condition he faced was probably a fallacy, even when black bags were common.  There is a team approach.  Knowledge is more dispersed.  It is easier to implement processes and systems that make things like clinical protocols and evidenced-based medicine a reality. 

As was Mr. Taylor's preeminent goal, care is now 'more efficient.'

But as all Wal-Mart shoppers know, more efficient necessarily means less personal.

Patients, maybe without thinking about it, will be trading a personal relationship with their physician for what should be higher quality and lower cost care.

It is a swap in what we provide to our customers.  I hope they like the switch.