Wednesday, February 11, 2009

NEJM article titled "The Independent Physician — Going, Going . . ."

Wow, what an article on the NEJM. I guess it's not anything we don't already know, but the authors (Stephen L. Isaacs, J.D., Paul S. Jellinek, Ph.D., and Walker L. Ray, M.D.) write about the reality of declining solo practices.

Medicine is a business and physicians are choosing options that provide them with flexibility and a reasonable work/life balance. After all, who wants to work more hours each week compared to residency? (and most of these physicians did not train in the era of the 80 hour work limit). More physicians are taking salaried positions to ensure financial security and shorter work hours (well, according to the authors they work shorter work hours but that may not always be the case with salaried positions).


  1. Very interesting article. It kind of contradicts what a survey in 2005 found - that the majority of patient visits occur in small offices (less than 4 doctors, often 2 or solo). It feels right, though, as the new trend.

    Certainly, it seems an understandable trend. If the intangibles of a career in medicine are less reliable than the struggles, it makes sense that newer providers - with more choice - would gravitate to career options that would decrease the headaches.

  2. Well, the majority of patients may still visit small offices if that's where doctors are seeing a very high volume to stay out of the red. When you're in private practice like that, your income correlates directly with your patient volume, so they try to squeeze as many patients as they can.

  3. Same, here, probably same for a majority of American physicians.

    It can lead to a tight convergence of some natural human tendencies...which make practicing medicine quite the constant juggling act.