In the mid-1990s I worked weekend shifts as a ‘moonlighting’ doctor in a suburban Chicago hospital. When I would show up on Friday evenings, the other doctors would always say: ‘Peter, remember, no roundtrips on weekends.’ Translated, that meant no patients admitted over the weekend should go home before Monday afternoon at the earliest. I soon understood the genesis of the ‘no roundtrip’ rule. At the crack of dawn on Monday mornings, before their regular office hours, the doctors would go from room to room, providing consultations and filling out billing cards. Over time I learned that most of the patients had never seen the physicians who woke them before breakfast and were under someone else’s care. [Illustration] This spring my colleagues and I published a study of Medicare in the New England Journal of Medicine, showing that what happened in the Chicago suburbs actually happens nationwide. Medicare patients bounce between many doctors, most of whom are unaffiliated with one another and, as a result, few patients have a single doctor who is central to the care they receive. The typical Medicare patient in one year sees seven different doctors, including five different specialists, working in four […]