The solo family doc isn’t extinct: I’m proof of that

An excerpt from Pet Goats and Pap Smears.

My dad is eighty-eight years old. He finally retired from medicine at eighty-six. I call to check on him. “What are you up to, Dad?”

“I just returned from synagogue a few hours ago. Right now I’m catching up on my reading. I’m finishing up the fiftieth anniversary issue of Medical Economics.

That’s Dad living it up on a Saturday night.

“It came out in 1973,” he continues. “It’s a nostalgic look at the U.S. physician from 1923—the year I was born—through 1973. I’ll mail it to you when I’m done.”

One week later, I read all 302 pages on Saturday evening. In a partial reprint of the first article from October 1923, Dr. Royal S. Copeland—then junior U.S. Senator from New York—suggests America would be better off if more doctors entered politics. He writes:

Most of the government’s vital problems have to do with things more familiar to the physician than to anybody else in society. . . . The doctor is better qualified to know the desires and necessities of the human family than the lawyer, the engineer, and even the priest. . . . He is an eyewitness to the suffering of the poor. . . . In consequence his soul is moved and he becomes an advocate of social justice.

I agree with Copeland’s sentiment. It is the physician who is in the best position to heal the wounds of a nation. But the mission of Medical Economics is not to turn every physician into a social activist. Its mission is to educate physicians on the business of medicine.

Nearly ninety years after the journal’s debut, physicians have the same concerns they had in the 1920s. Doctors still fear an imminent doctor shortage. They still suffer from a lack of business education. They still believe high-paying specialties will force the solo family doc into extinction.

In the 1920s came the group practice, and the 1930s brought a trend toward salaried jobs. In the 1940s, government, labor, and business groups continued to erode solo doctors’ “rugged individualism.” Over the decades, physicians have been pressured to see more and more patients. Even house calls were nixed as financially unwise.

Many doctors miss the good old days. In 1973, one old doc lamented, “Medical offices are just mills.” Oh no! I wonder what he’d say today!

Physicians across the country are now contacting me for business advice: “Is it really possible to go solo? How can you do house calls? And your own billing? Is it hard? Can you serve the poor and not go out of business? How do you work without staff? And be available 24/7?”

Yes, I accept insurance and I never turn anyone away for lack of money. I love doing house calls. With low overhead, I can work less and earn more than I ever made as an employed physician. Technology makes it easy to do my own billing. Maintaining clear boundaries with patients, I don’t need staff to protect me from patients.

One evening, I ask my mom for her advice on why doctors keep asking me for advice.

Mom is seventy-one years old. She’s a retired psychiatrist. She had a thriving private practice in the 1970s and ’80s in Dallas.

“Mom, how did you do it?”

“My entire philosophy is self-sufficiency. I gather information and figure things out on my own.”

I recite a list of questions doctors keep asking me.

She says, “What’s wrong with them? It’s common sense. They need to go off by themselves, spend a few hours thinking about these problems, and come up with a solution.”

“What’s your best business advice?”

“Have a patient base. Don’t be fearful. Figure out how to do your own billing. Immediately incorporate to save on taxes. Get a good CPA—preferably Jewish. I’ve had the best luck with Jewish CPAs. They perform miracles.”

“In solo practice,” she continues, “I earned twice as much as the guys. Most doctors are risk-averse and afraid. They want to be taken care of by a hospital system.”

“Mom, how come smart people can be taken advantage of so easily? Docs still believe they can’t succeed in solo practice. Why?”

“Well, in psychiatry, most doctors had psychiatric reasons for not succeeding. They were fearful. They didn’t believe in themselves. Seemed like they had no confidence in their ability to succeed. I found psychiatrists to be anxious, scared, and lacking self-confidence.”

“How did medicine change in the 1980s?”

“In the ’80s, corporations brainwashed us. They overtook us. I blame doctors. Doctors don’t think for themselves. They just follow along. I saw what corporations were doing and I didn’t want to play their game, so I went into solo practice. And my CPA and I did really well.”

“Any other advice for doctors today?”

“Have confidence. Ask yourself: Do I believe in myself? Okay. Then find an office and hire a CPA.”

The solo family doc isn’t extinct. I’m proof of that. I believe the good old days are here now. And the best days in medicine are yet to come.

I’m with Senator Copeland. I believe it is the physician who is best qualified to heal the individual patient and the entire community. It is still the physician who is eyewitness to the suffering of the poor. And it is still the physician whose soul is moved to be an advocate for social justice. Now is the perfect time for doctors to start community clinics, to work as social activists, and to become political leaders. America is waiting.

I think doctors need to believe in themselves a little more and maybe follow my mom’s advice—find a good CPA.

Back in the good old days, Dad smoked at his desk. (So did all the doctors!)
The solo family doc isn’t extinct: I’m proof of that

Pamela Wible pioneered the community-designed ideal medical clinic and blogs at Ideal Medical Care. She is the author of Pet Goats and Pap Smears.

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  • ninguem

    OK fine, your dad smoked, but those Circus Peanuts still give me nightmares.

    • PamelaWibleMD

      I know. Circus Peanuts may be worse for your health than tobacco.

      • ninguem

        “…..Most of the government’s vital problems have to do with things more familiar to the physician than to anybody else in society…..”

        Gotta figure in a year, rectal exams alone, you encounter enough assholes to populate Congress ten times over.

        • drg

          ninguem your joke reminds me of the old joke of a doctor looking for a pen in all their jacket pockets but they keep pulling out thermometers instead. Finally they yell out in frustration–some asshole has my pen!
          Anyway bad joke and antiquated. I mean who uses pens anymore when we have EHR?

  • Suzi Q 38

    Cool picture….My husband’s family doctor smoked too, and my MIL joined him. She was his friend and patient. Too bad she died prematurely of lung cancer at the age of 61.
    Back then, smoking was considered O.K…besides, who owns the office and the air?
    I still have a phone like that. I use it as a decoration in my family room.

    I like your parent’s style and business savvy.
    You can either work for someone else and do as you are told, or you can forge on for yourself and be confident and happy with what you do everyday.
    Good message.

  • LastoftheZucchiniFlowers

    Wonderful look back to a time when it was simpler to make those choices. One question for you: Please define:

    “Maintaining clear boundaries with patients, I don’t need staff to protect me from patients”

    Do you live in your service area? My dad and grandfather were surgeons, both long deceased and I learned at their knee(s) much of what I valued in my own practice (am almost fully retired after 40 years) But sadly I must maintain that THEIR way of doing things, despite my nostalgia, was O-V-E-R long ago. In the 80s when DRG came down the pike, I began to see the beginning of the end for Dad and Grandpa’s way of life. And while I would not have chosen differently I miss the ‘golden age’ very much. Just LOOK at the cavorting required only to offer a professional courtesy today! Your parents (and my father/gf) had power because they were their own bosses and their consumers were their patients. Today, the boss is the group/medical corporation and our consumers are the 3rd party payers. When physicians abrogated power away from themselves (ostensibly to have ‘more time off’) they unwittingly handed off the reins to non-physician bean counters; many whom of which are the CPA’s you wrote about.

  • ude

    “What’s your best business advice?”

    “Get a good CPA—preferably Jewish. I’ve had the best luck with Jewish CPAs. They perform miracles.”

    That’s pretty racist and offensive, but you will probably get away with it because Jews seem to get a free pass to express ethnic preference for their own kind. I fear I may be labeled an “anti-semite” for pointing that out.

    • Docbart

      How is that worse than when someone is praised for their Christian values? How often does that get condemned in the press?

      • ude

        You are pretending not to understand and trying to obfuscate the issue.

        The term “Christian,” as used by Christians, encompasses religion only, not ethnicity/race. The term “Jew,” as used by 95% of Jews, generally encompasses a specific ethnicity/race (as verified by numerous DNA studies) that originated from the Middle East, whose members may or may not actively practice the Judaic religion.

        Let’s just say when her mama advised her to get a “good Jewish CPA”, it’s safe to say she sure wasn’t referring to Jews who look like Whoopi Goldberg.

        Her mother’s statement is patently offensive and racist, and your use of religion to mask her racist remark is underhanded.

        • Docbart

          Oh, I see. The Jews are a race in the eyes of antisemites, but not when it comes to being considered as a racial minority when it could help them. And, of course we all know that the Jews control all the media? Right? That’s why an ethnically stereotypical comment by an old woman doesn’t get called out as racist. Did you read that in “Protocols of the Elders of Zion” or some more modern antisemitic claptrap?

  • Docbart

    Unfortunately, not all physicians are socially progressive. Having them in political office is not such a blessing. Think about Tom Coburn and Bill Frist.