May 1999 Table of Contents

Editorial

Flying Solo

Fam Pract Manag. 1999 May;6(5):8.

To some, the term “solo” evokes heroic images, such as Lindbergh winging across the Atlantic in the Spirit of St. Louis. In the medical profession, the term once had heroic connotations as well. The solo physician could accomplish successful deliveries by kerosene lamp, sit all night at the bedside of a febrile child, provide comfort to a dying patient — and then get up the next day and do it all again. Sadly, though, the contemporary image of the solo physician is no longer a heroic aviator, but a dinosaur.

On the surface, it is hard to fault a colleague who forgoes solo practice and joins a group for financial security. But for some soloists, joining with an omnivorous group practice is akin to selling one's professional soul to the devil. The temptation, it seems, is too strong to resist.

I must confess that I once succumbed to this temptation after a dozen years in solo practice. In a moment of weakness, after being on call nearly every night for 18 months, I became desperate. I finally took an administrator's advice and applied to one of the big group practices in my area. Fortunately for us all, I was promptly rejected.

Out of curiosity, I later questioned a colleague who had information about my application. “Well, Joe, it seems you aren't a team player,” he said. I thought this over and realized that the groupies, as I affectionately call them, were exactly right. I had never been a good team player because I liked being the captain of the team. I did not want to answer to some guy in a pin-striped suit reviewing my “production.” In my moment of weakness, I had forgotten the sound admonition of Groucho Marx, “I don't care to belong to any club that will accept me as a member.”

This episode reminds me of a passage in one of the most poignantly amusing books I've read about medical practice, Kill as Few Patients as Possible: And 56 Other Essays on How to Be the World's Best Doctor, by Oscar London, MD.1 London is the pseudonym of an internist who practices in Berkeley, Calif., and unashamedly lays claim to the title “World's Best Doctor.” Chapter 12, titled “Join a Partnership and Die Rich, Young and Anonymous,” is a particular favorite of mine. If you could pass this on to some young physician who is a soloist at heart, you just might save a life.

London writes, “In primary care medicine, solo practice is the only way to fly. Young physicians flock to group practice out of a misguided need for self-protection. ... As members of a group, they proceed to blur their identities and work twice as hard as soloists. Members of a group make a lot of money, lose a lot of friends (their partners) and die young. When news of the death hits the medical community, the departed is eulogized with a poignant ‘Who's he?’ — or with the more personal remembrance, ‘Wasn't he with Sol's group?’”

London concludes, “The best-kept secrets of private practice are that patients don't die very often during the span of your career and that almost all the illnesses would go away without you. At least 90 percent of my patients are lovely people. Why would I want a group practice to keep me away from all these wonderful folks?”

Well put, Dr. London. I will always treasure my years as a solo physician.

Dr. Haines is a solo family physician in Stillwater, Okla.

1. London O. Kill as Few Patients as Possible: And 56 Other Essays on How to Be the World's Best Doctor. Berkeley, Calif: Ten Speed Press; 1987.

Editor's note: For a very different perspective on group practice, see the special section “Harnessing the Power of Physician-Led Groups.”

 

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