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This article presents an analysis of the effects restructuring in the health care sector is likely to have on the economic conditions of black physicians. The model presented of the physicians’ services market is one in which black physicians, because of perceived quality differences and patient preferences, are relegated to servicing the lowest income clients and those with the lowest quality insurance. It is argued that the physician surplus, the growth in the uninsured, and the increasing competition by large group practices, outpatient-care facilities, and HMOs will place additional pressure on black physicians.

By examining the records of 101 admissions (86 patients) undergoing total hip replacement for osteoarthritis, we studied the impact of 24 preoperative laboratory assessments on the postoperative course. Four patients had their procedures postponed or canceled because of laboratory abnormalities; three of these patients had abnormal urinalyses and one had abnormal liver function tests. No other patients had alterations In their perioperative course as a result of the tests. No subsequent postoperative complications were attributable to either an abnormal or deficient preoperative assessment. Two patients with postoperative hepatitis had normal preoperative liver function studies. One patient had a postoperative bleeding episode but had had normal preoperative PT and PTT values. The economic implications are discussed in a costeffectiveness model. On the basis of these results, we recommend that only a minimal set of preoperative laboratory tests be added to the detailed medical history and physical examination in otherwise healthy patients about to undergo total hip replacement surgery.