Family Physician Can’t Give Away Solo Practice:

The share of solo practices among members of the American Academy of Family Physicians fell to 18 percent by 2008 from 44 percent in 1986. And census figures show that in 2007, just 28 percent of doctors described themselves as self-employed, compared with 58 percent in 1970. Many of the provisions of the new health care law are likely to accelerate these trends.

“There’s not going to be any of us left,” Dr. Sroka said.

Indeed, younger doctors — half of whom are now women — are refusing to take over these small practices. They want better lifestyles, shorter work days, and weekends free of the beepers, cellphones and patient emergencies that have long defined doctors’ lives. Weighed down with debt, they want regular paychecks instead of shopkeeper risks. And even if they wanted such practices, banks — attuned to the growing uncertainties — are far less likely to lend the money needed. {…}

Dr. Sroka has not taken a sick day in 32 years. After his latest partner left in September, he was unable for five months to schedule any time off until another local doctor volunteered to cover for him. His income and patients depend upon his daily presence. This resiliency is part of a tough-minded medical culture — forged in round-the-clock residency shifts, constant on-call schedules, and workplaces in which revered doctors made decisions and staff members followed orders — that is fast disappearing.

Had he left a decade ago, Dr. Sroka might have been able to persuade a doctor to pay $500,000 or more for his roster of 4,000 patients. That he cannot give his practice away results not only from the unattractiveness of its inflexible schedule but also because large group practices can negotiate higher fees from insurers, which translates into more money for doctors.

A lot of people talk about how doctors are overpaid because they limit the supply and there they are able to jack up their rates. There is some truth to this, but if only it were as simple as these basic market forces! Because if it were, my wife would be making a whole lot more than she does due to the overwhelming shortage of family practice docs - particularly those with her skillset. Instead, while she was aggressively recruited, there was really only so much they could pay due to stagnating (per-procedure) reimbursement levels unless she were to join a profiteering practice that makes it up in volume. Without being a part of a team - a hospital, a large consortium of docs - the working conditions of family practitioners (who aren’t mere clinicians, anyway) are bad and actually made worse by the shortage.

There was a job in Estacado that caught our interest before she took the job here in Callie. I was interested because it was in Estacado, which I’ve wanted to return to since the day we left. She was interested because it was the small-town-doc job she’d been training for. The only doc in the town with call nights shared with docs from the neighboring town. But having been in Callie for a year, if we leave the next job won’t be anything like that one. Even in places with limited populations, people get hurt or sick at three in the morning and when you’re in call every third or fourth night, that’s a lot of time spent hovering over patients (”hovering”, by the way, falls under the category of “required” but “not billable”). In Callie she is a hospital employee and does have something of a team, but she still can’t leave town two of every three weekends and can get called in every other night or so.

Of course, the money is good. However, I had the choice between this and her working an engineer’s hours at an engineer’s wages, I’d take the latter. I just can’t imagine going the route Dr. Sroka went for so long.