As we move to a consumer directed model of healthcare, healthcare consumers will evolve and prioritize the important aspects of their care. Also midlevel providers as nurse practicioners are increasing in popularity in primary care practices since they enhance profitibility of practices. So you see pediatricians and internist are at a crossroads. They may either hire midlevels and maintain a traditional practice accepting assignment for insurers. A movement is occuring with physicians who are leaving insurance contracts and providing "retainer-based" or " concierge" or "boutique" care. Simply put, these doctors have an agreement with their clients rather than the insurer. The market will dictate the extent of success of these practices. Consumers will ultimately decide whether they want an MD in charge of their care fully, or whether the emerging midlevel system is acceptible for their children. Also consider that in the traditional system utilizing midlevels you will also see high turnover of physicians due to poor profitability. The forces at work in medicine continue to worsen doctor-patient relationships and these practices will evolve into a new niche of healthcare. New services and products are bought initially by early adopters and them move into mainstream marketplace. Personal Pediatrics is the modern reinvention of lost art of pediatric house calls. Our pediatricians provide personalized house call care to a limited panel of clients. Pediatricians will have to adopt their practices in one way or another in order to stay in business. They may either adapt by adding midlevel providers or taking advantage of new administrative support systems which drastically reduce overhead and enable a return to a practice option highly sought after in the consumer marketplace, the pediatric housecall. Personal Pediatrics is an administrative support solution based in Saint Louis Missouri.