Quietly, this article has remained on the Top 10 Most Emailed list at NYTimes.com for 5 days since it was first posted on the 24th. It appeared in the print edition on the 25th. However, before it arrived on doorsteps, it had already run up the list of most emailed articles. Here is the opening paragraph, setting the context for the story.

A quiet revolution is transforming how medical care is delivered in this country, and it has very little to do with the sweeping health care legislation that President Obama just signed into law.

In short, new physicians coming out of medical school are far less interested in running their own practices than they used to be. The are choosing the route of working for larger, integrated multi-specialty groups, like the Everett Clinic, for HMO models like Group Health, or for hospital systems like Swedish Medical Center. (Worth noting is that in many states it is illegal for hospitals to employ physicians, but not in Washington State.)

“When I was young, you didn’t blink an eye at being on call all the time, going to the hospital, being up all night,” said Dr. Gordon Hughes, chairman of the board of trustees for the Indiana State Medical Association. “But the young people coming out of training now don’t want to do much call and don’t want the risk of buying into a practice, but they still want a good lifestyle and a big salary. You can’t have it both ways.”

Admittedly, that line reads a bit like “when I was your age… both ways uphill… young whippersnapper…” However, to the extent that is the case nationwide, it is even more pronounced in the Puget Sound area.

The American Medical Association states that about 70% of all physicians in the United States practice in groups of 9 physicians or fewer. In other words, the vast majority of care is provided in settings where physicians can take the time to develop strong patient-physician relationships.

In Western Washington, according to the Puget Sound Health Alliance, that number is far closer to 40%. Hospitals purchasing physician practices to build a referral base for tertiary services appears to be the primary driver for this decrease, but there is also the prevalence of multi-specialty groups like the Polyclinic. There are a number of reasons this is the case here, but those are a few.

So what does this mean for health care in the US?

For patients, the transformation in medicine is a mixed blessing. Ideally, bigger health care organizations can provide better, more coordinated care. But the intimacy of longstanding doctor-patient relationships may be going the way of the house call.

Again, to the extent that is occurring in the US is the extent to which Washington State is already well down this path. How is your relationship with your physician? Better hold on to it.

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