Perspective: Private Practice

^ Above: Neil Patrick Harris as Doogie Howser in the famed early 90s sitcom.

"INDEPENDENT PRACTICE HAS LONG BEEN THE

BACKBONE OF AMERICAN MEDICINE."

It might not be an accurate representation of the medical field, but one of my sweet tooths for television is the show Doogie Howser, M.D. (I hope y'all aren't too old to hear this). For those of you who don't know about the show, Doogie was a 30 minute sitcom that aired from 1989-1992, starring Neil Patrick Harris (currently on How I Met Your Mother, CBS) as a 16- year old medical child prodigy and his adventures of being a teenager and dealing with the stresses of a career in medicine. Throughout the show, there were attempts to pull him from his niche at the hospital. At one time, his dad tries to convince him to join him in his family practice in the neighborhood, and at another, a local pediatrics group is trying to get Doogie to move in with them, luring him with higher pay. However, each time, a specific case, patient, or colleague he cares about leads him to stay where he is.

And what does a 16 year-old prodigy have to do with a 23 year-old typical medical student?

I FACE A SIMILAR BATTLE... Do I really want to work in a hospital environment or do I want to try to establish my own medical practice? Each one has their pros and cons. However, I was reading an article in the New England Journal of Medicine about the decline in the independent practices over time. The amount of costs (everything from getting electronic medical record keeping systems to the tradeoff for independence for declining incomes) has driven many independent physicians towards working in groups (usually as employers) or as a person who works salaried in the hospital.

Most americans get their care from private practices (about 9 out of 10 of us), the NEJM article above has shown. Some studies have showed that being a private consultant has given patients better and more flexible treatment and care, others don't. Independent practices also allow doctors to build the rapport to improve patient compliance, resulting in better results (remember, that although a doctor might give out a treatment, its really up to the patient to improve their lifestyle or take their medications appropriately).

In my case I value working in a hospital or a group, because there's that support network available. In case I or one of my colleagues come upon a case that's pretty darn complex, I can network with them towards a quick solution. However, independently, I would either have to refer my patient or take some time off to do some research on my own and make some phone calls. The negative part to all this is the backbone as to which hospitals have to allot their care: will it limit my decisions to provide treatment?

The independent practice releases me from that (don't get me wrong, I still have to work underneath limitations & restrictions imposed by law & insurance). According to the NEJM article, there is an increased amount of charity care that takes place among independent physicians, improving their role in underserved and poor populations. I'd like that extra freedom to have an option to treat these patients appropriately in this case. However, don't get me wrong, I still want to make an enjoyable living. The ratio of amount of work to amount made to make a living is pretty poor, compared to working in private groups or in the hospital.

I guess everything is a trade, right? I haven't completely thought this out, but I hope that going through rotations and doing some more research can help me get a greater understanding of what's right for me: to play a role on ER or Private Practice?

Stay tuned... :P

Source: Isaacs, Stephen L., Paul S. Jellinek, and Walter L. Ray. "The Independent Physician - Going, Going..." New England Journal of Medicine 360 (2009): 655-57.