Editor’s Note: Marc Lawrence, MD, is a member of Doximity’s Advisory

Last month, advisory board member Peter Alperin wrote an essay outlining
the strengths and advantages
of Kaiser and other integrated delivery
systems. Like Peter, I have worked for Kaiser, and I, too, have found it to
be a good place for doctors. While the pay isn’t overwhelmingly high, the
employee benefit program is excellent, and physicians certainly face a smaller
risk of litigation there than they would in independent practices. Patient
follow-up is exemplary, and standard procedures and courses of treatment are
carefully developed and researched. However, when it comes to issues of choice,
namely the freedom to pursue an untried or very tailored treatment plan, there
are significant compromises.

Kaiser has a certain way of delivering care, and the bottom line is that you
can’t just see any specialist you choose when you want to get a second opinion.
You first have to go through Kaiser’s own system. If you’re a patient with an
oddball disease–a rare cancer, for example–Kaiser is therefore a tough sell.
The bureaucracy can be frustrating, and the kind of deeply targeted care you
would get somewhere like MD Anderson or the Cleveland Clinic, while not
impossible, will be more challenging to pull off. It’s reasonable that
patients, empowered as they are with information resources, will resist having
to march through all the steps and go through all the Kaiser ropes when the end
result will be exactly what they already know–that they need to get care

Looking at this same issue from a physician’s perspective, one could argue that
Kaiser is getting considerable press for being the “right” system, but an
environment where there’s only one style of care is a limited one. Just as some
patients may not fit the Kaiser model, there are most certainly brilliant
doctors who don’t thrive in the kind of ultra-integrated environment.
Individuals whose personalities make them impatient to innovate, for instance,
will undoubtedly find the pace too slow. Because Kaiser is committed to proven
approaches, change does not come right away. In certain cases, there may be
other, more cutting-edge ways of delivering care that just haven’t yet made it
into the pipeline.

There are countless arguments for why Kaiser and other integrated care systems
are well-run and effective models, and I agree with the vast majority of them.
But as we continue to develop new approaches in healthcare, I want to make a
case for remembering to look outside of the box of what’s already working on a
broad scale, and continuing to make room for the small-scale and even the