Horizontal and vertical integration of physicians: A tale of two tails

Lawton Robert Burns, Jeff C. Goldsmith, Aditi Sen

Research output: Chapter in Book/Report/Conference proceedingChapter

64 Scopus citations


Purpose - Researchers recommend a reorganization of the medical profession into larger groups with a multispecialty mix. We analyze whether there is evidence for the superiority of these models and if this organizational transformation is underway. Design/methodology approach - We summarize the evidence on scale and scope economies in physician group practice, and then review the trends in physician group size and specialty mix to conduct survivorship tests of the most efficient models. Findings - The distribution of physician groups exhibits two interesting tails. In the lower tail, a large percentage of physicians continue to practice in small, physician-owned practices. In the upper tail, there is a small but rapidly growing percentage of large groups that have been organized primarily by non-physician owners.

Original languageEnglish (US)
Title of host publicationAnnual Review of Health Care Management
Subtitle of host publicationRevisiting the Evolution of Health Systems Organization
PublisherJAI Press
Number of pages79
ISBN (Print)9781783507153
StatePublished - 2013
Externally publishedYes

Publication series

NameAdvances in Health Care Management
ISSN (Print)1474-8231


  • Group practice
  • Horizontal integration
  • Physicians
  • Vertical integration

ASJC Scopus subject areas

  • Health Policy


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