Dr. Susman’s editorial, “The rebirth of the solo family doc” (J Fam Pract. 2011;60:510), gave me tremendous satisfaction. I have had my own practice since the early 1970s, after being kicked out of a family practice teaching program and told to “go make a living.”
What a fabulous run I have had—and am still having. Of course, caring for patients also involves running a business, changing light bulbs (and, at times, even toilet paper), and handling whatever comes along.
A quick story: I was an attending physician at a now-defunct family practice program and suggested we initiate video feedback review. The administrators put in a request for the camera and equipment (approximate price, $240). After 9 months of waiting, I went across the street and bought a used camera ($75) that worked wonderfully, and we were able to get started.
Just an example of why a private (and solo) practice can work more efficiently.
Lawrence Silverberg, DO
Ellicott City, Md
As one of the few remaining independent solo family practitioners, I found Dr. Susman’s editorial of particular interest. Aside from nostalgia, I strongly believe solo practitioners are in a position to deliver the most personable, most affordable, and simply the best health care. This is true, in part, because of our in-depth knowledge of our patients and their families as they experience life’s joys, sorrows, and life-altering events.
I agree that our government seems to be forcing clinicians into “a homogenized practice model.” I also think that our demise is, in part, due to electronic health records and poor economics in rural communities, as well as “accountability” mandates. There is, however, a more significant factor.
When I graduated from medical school in 1977, I had a debt of $10,000. I chose a community where all the health care was provided by solo independent practitioners, with a supportive community hospital nearby. Today, a typical graduate of a family medicine program owes well into 6 figures and does not have the opportunity to “hang a shingle,” as I did. These new FPs can’t afford not to join a larger, established practice that offers debt payment, a bonus, and a guaranteed income. The practices are either subsidized by the government or are hospital-owned and have money flowing in from grants, donations, and referrals. They become, in effect, subsidized competitors, as opposed to colleagues.
I appreciate your acknowledgment and respect for the fine, and now unique, health care that solo FPs provide. At age 60, I have great job satisfaction and enjoy my relationships and place in the community more than ever. (How many “employees” can say that?) I would love to see a return to more private practice. But as this is very unlikely in our current climate, simply being permitted to practice medicine—instead of having to jump through hoops to comply with myriad mandates and compete on a non-level playing field—would be greatly appreciated
Paul Rogers, MD
Johnson, Vt