Escapist Medicine


Fam Pract Manag. 2002 Oct;9(9):12.

“I just want to practice medicine.” I can’t begin to count the number of times I’ve heard that comment over the years – often enough from doctors who say it in an injured tone, with the implied follow-up, “Is that too much to ask?” They actually seem to think it is a reasonable expectation.

If what they meant was, “I just want to be able to run my own medical practice,” I might think differently. But they don’t. The physician who utters this statement in all seriousness really means, “I just want to be left alone to take care of patients. I want the boundaries of my professional life to be the walls of the exam room, and I don’t want to have to worry about making money, paying bills, managing staff, following regulations or dealing with insurance hassles.” Is that too much to ask? Yes. In fact, it is fatuously unrealistic.

Escape attempts

One major theme of the 1990s in medicine was escapism. Think back to the early part of the decade, when integration was the big thing. “If I join a [PHO, IPA or any other three-letter acronym of your choice], I’ll be free to just practice medicine, and I’ll have someone else take care of the rest.” That worked well, didn’t it?

Move on to the latter part of the decade, when the same hope for nirvana led hundreds and hundreds of doctors to help build pyramids for the physician practice management companies. “If I sell my practice to a PPMC, I’ll be free to just practice medicine, and I’ll have real pros to take care of the rest.” Sure.

The lesson these experiences should teach us is this: Managing your own practice is difficult, but having someone else manage it is worse.

I am not saying that every family physician should be chief in charge of managing his or her practice. That would imply universal solo practice, and not everyone is cut out for solo practice – although Sanford Brown, MD, makes an appealing case for it in this issue (“Ten Reasons to Be a Self-Employed Family Physician and Ten Ways to Do It,” page 41). What I am saying is that the physician who abdicates responsibility for everything outside the realm of the clinical encounter is living in a fool’s paradise. Correction: Nothing in medicine today is anyone’s paradise. He or she has a foolish vision of paradise – the equivalent of a little boy’s dream of being able to live exclusively on ice cream.

But the ice cream diet doesn’t work, and not just because your mother told you that you had to finish your vegetables before dessert. Actually, I suspect that there’s a law of nature lying deep under here – one that says eating brussels sprouts is what makes eating ice cream possible. But we don’t have to dig that deep. Just think of the most successful, productive, smooth-running, well-liked family practice you know of – one with satisfied physicians, staff and patients – and ask whether the physicians in the practice manage to escape responsibility for management.

Digging in

Of course, your getting involved in management is not a sure-fire cure for all that ails your practice. For one thing we’re a long way from Eden now, and the health care system may be farther away from the Garden than much of the rest of life. For another, getting involved in management without knowing what you’re doing is a recipe for disaster. There’s not much we can do about the first problem beyond recognizing that it’s better to be engaged with the world than to attempt escape. But you can do something about the second problem.

Learn how to manage, and learn to at least appreciate the managerial viewpoint. Read books. Read journals (yes, including FPM). Take courses, such as the AAFP’s “Fundamentals of Management.” Get an MBA, if you want to go that far. Whatever it takes, you need to know management. And if you’ve never met a manager you didn’t dislike; if the whole idea of management leaves you cold, don’t just thank God you’re a physician rather than a manager. Think seriously about the possibility that the problem may lie within you.

Whether you are employed or self-employed, you can be constructively involved in the way things run. If you’re not involved, things may run you over. The next time you find yourself thinking, “I just want to practice medicine,” think again: “I just want to do what I can to make sure my practice of medicine is successful for everyone involved.” That way, you’ll at least have a fighting chance.

Robert Edsall is editor-in-chief of Family Practice Management.

Conflicts of interest: none reported.

Send comments to fpmedit@aafp.org.


Copyright © 2002 by the American Academy of Family Physicians.
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