Physician, manage thyself. Texas doctors form IPAs to gain control of health-care delivery.

Mention managed care to most physicians, and the first thing they think of is loss of independence. Specifically, they associate managed care with having to answer to someone they may not agree with over how to treat their patients and run their practices. As managed care plans penetrate ever deeper into Texas, more and more physicians are looking for ways to minimize that loss of autonomy. And in many cases, they are finding it in the form of physician-driven independent practice associations (IPAs). Such associations are growing rapidly in virtually every corner of the state. Texas physicians, fearful of what health-system reform may bring to them and their patients and determined to control their fates, are becoming allies in IPAs. Texas, in fact, is quickly catching up with many urban states in the formation of IPAs. However, to meet specific local needs, several groups are introducing some unique forms of practice associations to the mix.