Wednesday, February 5, 2014


Part healer, part entrepreneur, and part "trapeze artist" trying to balance and wrestle with insurance companies, trial lawyers, hospital regulations, government red tape, patient demands and family pressures - this pretty much sums up the life of a solo practitioner.

"The self-employed physician straddles two worlds at once, responsible for tending to patients and keeping the lights on. Owning a practice means running a small business.  There is no end to the shift and no hour to clock out." 

The new breed of "physicians seem not to covet this life, and it's hard to blame them. After the long, hard slog of medical education and training which results in a tremendous debt burden, solo and small-group practice offers neither optimal work-life balance nor a guaranteed income level. This is to say nothing of the costs of malpractice insurance (as well as the constant worry about loosing everything in the "malpractice lottery"), the regulatory and administrative complexities of modern health care delivery, the expense of information technology, and the advent of new care and payment models.  Most self-employed physicians must invest thousands of dollars in office equipment and surgical instruments - oftentimes literally betting the house on the solvency of their practice."

 "The emerging model, featuring the physician as a labor unit, challenges the very notion of what it means to be a "good doctor."  In place of ingenuity, availability, and patient advocacy, the new philosophy is more likely to prize those who play well with others and meet quality improvement metrics.  Physicians who chafe at authority, pushing against bureaucratic hurdles as the champion of their patients, may find themselves in danger of being deemed relics at best, disruptive physicians at worst.  The men and women who run these small practices are, or at least were, the silent majority of the medical profession. They tend not to be found on the editorial boards of topflight journals, in charge of major professional organizations, or at the helm of blue-ribbon committees.  Frankly, they don't have time.   They are the "soldiers on the battleground" of medicine. 

The surgeon lives and dies by the labor of his two hands. It is an honorable profession and offers a comfortable income. I would not choose any other path in life - it has been, and continues to be, a joy and a blessing to me.  I want to continue on this path as long as my mind is sharp, my hand-eye coordination remains exceptional and patients continue to come to my door and offer me joy.

Insight and some commentary provided by Charles G. Kels, JD in the Office of Health Affairs, Dept. of Homeland Security and The Judge Advocate General's Corps, US Air Force Reserve.  Washington D.C.