Lonely... I'm Mr. Lonely


An inherent risk of hosting a convention in San Diego played out a few minutes ago, when one physician attending the AAFP 2008 Scientific Sessions said to another physician, “Look at this weather. Why are we indoors right now?”

One reason to come indoors is the quality of the presentations and the presenters thus far at this year’s conference. The first session I attended this morning, “Returning to Our Roots: How to Go Solo,” by John F. Brady, MD, FAAFP, brought some unique insights into the advantage of abandoning the large group practices that have become so common today for the old-school, “Norman Rockwell-style” practice of yesteryear. Brady’s words—not mine. Brady runs his own solo practice, The Village Doctor, in Newport News, Virginia.

Brady first made a compelling case for going solo, citing many statistics that reflect declines in job satisfaction and quality of care among family physicians over the past decade. (Perhaps the only misstep of the presentation was Brady’s use of the now crusty 2001 Institute of Medicine report, “Crossing the Quality Chasm.” Fortunately, many of the other statistics Brady cited were more recent.)

Among the pros of moving to a solo practice, Brady cited the ability to “follow the American dream,” and he pointed out several surveys that show for most physicians, salary is less a driver of job satisfaction than is autonomy. The ability to make quick decisions (as opposed to the committee approach) and determine your own office hours, vacation schedule, and practice structure are also big advantages.

The cons of running a solo practice include concerns about being on-call 24 hours a day, 7 days a week, managing vacations, financial concerns, and not least, the social isolation that can result if you strike out on your own. To solve this last problem, Brady has joined a consortium of other doctors who also practice solo.

To be sure, the decision to move to a solo practice is not an easy one. Technology has played a big role in Brady and others’ ability to go it alone. (Brady has a nurse who works alongside him, but he mentioned several other physicians who have gone the “completely solo” route, without a receptionist, nurse, or physician assistant).

What struck me most about the hour-long discussion was just how many issues a physician must work through in order to run a successful practice. So many decisions, so little time. But for Brady, the decision to go solo came down to simplicity: he wanted to focus exclusively on his patients’ wants and needs. Now, he sees an average of 11 patients per day, and his ability to give each one the attention he or she deserves has been the most rewarding aspect of going it alone. Doesn’t sound so lonely after all.

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