目的由于美国医疗环境不稳定,很多初级医疗医生寻求医院工作。医生所有的大型初级医疗团体成为一种选择,但是医生和政策制定者很少注意到这种团体的存在。本文旨在对此类团体进行描述,对其优点和挑战进行介绍。方法选取21个团体,将5个规模和地点相异的团体纳入研究。对团体领导者进行采访,随机选取团体医生进行调查,并采访外围观察者——与此类团体服务共同患者的健康项目、医院和专业医疗团体的领导者。对团体领导者、团体医生和外围观察者的反馈进行三角法处理,找到关键主题。结果此类团体医生在小型诊所中工作,团体为发展实验室和影像学服务、健康信息科技和基础设施提供必要的规模经济扶持。各个团体的规模与有价值合同的参与程度不同,但是所有团体的质量和成本效应的财务风险都在增加。与医院雇佣的多专业团体不同,独立初级医疗团体的目标是降低医疗成本,而同时不影响医院病床的入住率和专业医生的高收入。每个团体都被外围观察者给予积极的关注。然而,这些团体都面临被其他有能力投资额外基础设施的组织收购的压力,因为基础设施有助于获得有价值的合同,并为医生提供更为丰厚的薪水。结论大型独立的初级医疗团体有潜力吸引医生并提高患者护理水平,途径是结合医生自主权的人力规模优势、利用小型诊所的资源赢得有价值的合同。 Purpose Due to the unstable medical environment in the United States, many primary medical doctors seek hospital work. Large-scale primary care groups owned by doctors are an option, but doctors and policymakers rarely notice the existence of such groups. This article aims to describe such groups and describe their strengths and challenges. Methods Twenty-one groups were selected, and five groups with different scales and locations were included in the study. Interviews with group leaders, random selection of group doctors for investigation, and interviews with outside observers - health programs, hospitals, and professional medical community leaders who work with such groups. Triangulate feedback on group leaders, group physicians and outside observers to find key topics. As a result, these group physicians work in small clinics that provide the necessary economies of scale for developing laboratory and imaging services, health information technology and infrastructure. The size of individual groups is different from the value contracts, but the financial risks of quality and cost-effectiveness for all groups are increasing. Unlike multidisciplinary teams employed by hospitals, the goal of an independent primary care community is to reduce the cost of health care without affecting the occupancy rate of hospital beds and the high income of professional doctors. Every group is given positive attention by outside observers. However, these groups are under pressure to be acquired by other organizations that have the capacity to invest in additional infrastructure, as infrastructure helps to secure valuable contracts and provide doctors with more lucrative salaries. Conclusion Large independent primary care groups have the potential to attract physicians and improve patient care by combining the manpower advantage of physician autonomy with winning valuable contracts with the resources of small clinics.