Leaving Practice in the Era of Independence

Abstract

From 35 years of interviews and autobiographies, the author reflects on retirement and relationships in general practice in the mid-twentieth century. General practitioners (GPs) in the United States in the 1950s–1960s functioned as small business owners with all the challenges and rewards of owning one’s own practice. Their practices were neighborhood-based, and the physicians and their families lived among their patients near the closest hospital. GPs were part of the post-war middle class, drove station wagons, and were known and respected for what they did. Their retirement income came from the value of their practice and whatever investments they had made. Emotional ties to practice, patients, and colleagues were a factor in keeping many family physicians working longer than they intended. Then came the growth of graduate training programs in family medicine in the 1970s. The merging of private offices into large systems compromised the scope of care. Moving family doctors into corporate buildings and systems reduced the neighborhood quality of family medicine. The corporatization of medicine has limited physicians’ direct responsibility for patients and communities. Physicians are able to retire more comfortably, but the organizational compromises necessary to make that happen have exacted a toll on physician agency that will affect the discipline going forward.