It is daunting to reflect on the fact that I have just a few quarterly columns left. In this one, I will share my observations on the major trends impacting the specialty and the society. In October, I will reflect on the major milestones of the last decade.

Years back, when I was first getting my start as a hospital administrator, I was told that the future was managed care, that fee-for-service would be a thing of the past. That prediction has largely not been realized. On the other hand, I was employed in a health system that was working to accumulate market share through the acquisition of primary care physician practices and to ensure future viability through preferred provider arrangements with health plans. I feel that we were early adopters of the trend toward vertical integration. Philadelphia was then home to six medical schools and over 30 hospitals; today,...

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