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!)

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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