To the Editor.
—The article by Drs Reed and Evans1 in the Dec 11, 1987, issue of JAMA accurately portrays the condition that the profession finds itself in, that is, a state of progressive loss of professional autonomy. The authors propose the development of physiciandriven organizations, primarily in the form of group practices, as a partial or temporary solution to deprofessionalization. Having spent a number of years in group practice as well as health maintenance organization management, I could not agree more. A number of barriers lie in the way, but they are the sort of problems that can be overcome.Capital formation is no problem for the medical profession due to its earning power. The problem is that in private practice the revenues above office expenses are typically retained as income. In industry it is not unusual for 10% to 15% of revenues to go to research, development,