Abstract
The American health care system is undergoing a profound reorganization and realignment that is primarily driven by a free-market corporatization of health care.1 Physicians are extremely concerned that these changes will affect their ability to be autonomous, to retain the free use of their clinical judgment, and finally to be paid adequately.2 In some instances the changes are already affecting the free choice of ancillary specialties such as dermatopathologists.3 Indeed, in many areas of the country, managed care is quickly becoming the dominant vehicle for health care delivery and appears in many ways to be affecting physician autonomy for both private practice and academic physicians.4 Independent practice associations (IPAs) have been developed across the country to meet the needs of managed care costeffectiveness while attempting to preserve both clinical and financial physician autonomy.5 This article focuses on dermatology-specific IPAs, including functional models, the potential advantages and disadvantages for individual physicians, and for the specialty, antitrust implications, and finally introduces an IPA model that may benefit dermatologists and the dermatologic community as a whole.
