Dr. Melos is a gastroenterologist in solo practice in a medium-sized Midwestern city. One day she hears a knock on her door. When she answers, she finds two representatives of Athenian Health System, who request a few minutes of her time. She invites them to take a seat in her office.
After exchanging pleasantries, the visitors get down to business. They extend Dr. Melos an offer to join the ranks of Athenian’s employed physicians. If she declines, they say, they will hire their own gastroenterologist, whose practice will grow rapidly on referrals from their large network.
The representatives of the health system are remarkably candid. “We will not take up your time with arguments about the appropriateness of what we are doing. What we have here is a large imbalance of power, and as a business matter, you really have no choice.”
Dr. Melos replies that she has always worked amicably with Athenian Health, using many of its diagnostic testing services and admitting her patients to its facilities, so the health system has no need to deliver such an ultimatum.
The representatives respond that, if they allowed Dr. Melos to maintain her practice in the form she is accustomed to, it would make Athenian Health, which is seeking to consolidate its market position in the area, look weak.
