The environment of medicine today will eventually force physicians to choose sides. To choose, they will need access to additional reserves and skills to manage medicine. An MSO can provide access to these reserves and these skills.

It is a strategic solution to maintain physicians' influence and autonomy. The writers explore the use of the Physician Practice Management Company strategy and the MSO strategy by physicians to address change in their marketplace. There is common ground between MSO's and PPM's with regard to capabilities, strategies, and functions. The motivation behind the use of the MSO strategy is very different than the motivation behind the PPM strategy.

This monograph distinguishes the differences between the two strategies and then focuses on the anatomy of an MSO presenting structure; design; services; finances; information systems; and success criteria. Six different strategic models of MSOs are presented with examples of how these models have been used in particular market circumstances. The discussion in the monograph concludes with risk and reward considerations for those physicians contemplating the development of their MSO including MSO disasters: barriers to development, as well as events that are bolstering MSO growth with physicians and hospitals to share the risk of managing the health care of Medicare eligible baby boomers and move away from payroll tax increases to fund Medicare.