In the wake of the recent news of esteemed architecture firm Karlsberger shutting its doors forever, I have been re-evaluating my thinking. Given a number of indicators, I was under the impression that things were looking up a bit out there on the front lines.

At a session titled “Research on the Future of Health Care Construction: An FM Perspective” at the recent ASHE PDC 2011 conference in Tampa, Florida, Jeffery Campbell, PhD, of Brigham Young University, and two of his students--Brian Sorensen and Kimberly Mendez--shared results from an independent study that sought to establish a baseline of the perspective of owners and facility managers for the next five years. The good news is that the group forecasted steady growth, stating that after the all-time low in 2008-09 (the largest industry decline in 50 years), healthcare construction has actually seen a steady rise.

Between those findings and lots of anecdotal evidence gathered by talking with various industry folks, you'd think that things were starting that slow walk uphill toward recovery. But now comes the Karlsberger closing, as well as continued reports from the construction industry to the contrary. I wonder, are things just as bad as they have been? Are they worse?

One of the things that I had predicted around this time last year was that we would start to see some of the larger firms swallowing up some of the smaller firms. While we have seen some of that already, I look for that trend to continue both in the A/E world, but in the healthcare systems as well. But to what end for the industry? Or for the public? Are we headed toward a handful of mega-firms and uber-systems? Are the days of the large independent numbered?

With all that in mind, where do you see the healthcare design industry today? Is it healthy or hurting? Is there an end in sight? I am deeply curious to hear the thoughts of those in the field, so please do respond here or e-mail me if you prefer not to have your comments be made public.