The doctrine of medical practice is undergoing radical change. Community Hospital’s time belonged to the old medical doctrine of fragmentation, inefficiency, idiosyncrasy, uneven quality and high cost. The old doctrine was also highly personal and almost entirely dependent on individual professionalism. The replacement doctrine is systematic and corporate, driven from the top down based on big data and big margins. The defects of the old doctrine were manifold and obvious. Its virtues were subtle and subjective. The defects in the new doctrine are yet unclear, but troublesome.