Monday, April 4, 2011

Being a solo doc

Here's a fun article from the NYtimes. It made me think of the following.

Coming out of family medicine residency the last thing I ever thought I would do would be solo practice primary care. But since my wife matched for her residency at Geisinger, at 28, I ended up being a solo doc in a town of 950 about a half hour southwest of Wilkes Barre, PA. I never thought I'd love it as much as I did and I actually found the work easier. Instead of being on call for thousands of patients that were not mine, every patient that called at night I already knew. Knowing that they would reach me directly anytime and that they could see me the next day always, I found patients respected my time at night and I rarely got called. I also made sure I finished all my work each day so I wouldn't get called.

When patients showed up at the hospital, I already knew them. I didn't have to spend an hour getting a complete history and physical because I already knew them in the office. I rounded 7 days a week and always knew what was going on. When I took care of patients in the nursing home, I didn't have to wade through tons of medical records to find out what went wrong because I was the hospital doc too. I made home visits, went to the football games and went to deliveries. I didn't have to come in every morning spending time figuring out what happened over night or over the weekend because I had taken care of everything already.

Now I am at the University of Pennsylvania. When I'm on call, I get paged constantly. It takes me a lot longer to figure out what is going on. Patients are faceless on the other end of a phone line. When I'm not on call, I have to figure out what happened to all my patients. I'm only on call less however. Much less. My wife appreciates that. I do get weekends off.

I do miss taking care of patients that are all mine. I miss the relationships. Anonymous medicine is unlikely to produce higher quality medicine. There's no passing the buck when you're solo. You take care of things right the first time and you clean up your own mistakes. My salary was half to 1/3 of my ER buddies, derm, ophtho, anesthesiology, radiology friends. But my patients were better friends. (even on facebook!). The only thing I missed was having an opportunity to work with medical students and residents.

Solo practice is really enjoyable. It is sad to me to see that it is likely to go away.

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