I have always looked forward to Dr. Sanford Brown’s “Practice Diary,” but the final chapter was disappointing. As a physician who is employed by a hospital-owned group, I was irritated by his description of “physician employees” as “homogenized lemmings.” My position allows me to focus my energies on patient care rather than spending time balancing the books. This vision of family medicine is no less valuable than Dr. Brown’s.

Many medical students see overworked physicians in primary care and choose specialties that seem to be more conducive to a balanced life. In family medicine, we should support a diversity of choices and provide training that helps residents decide on the type of practice that suits their lifestyle. But just as some doctors choose not to deliver babies, some of us choose not to run a business. Please respect our choices.

Author’s response:

I meant no disrespect. I just do not feel that your model is the direction that family medicine needs to go. I am disturbed by the large numbers of family physicians who claim they are unhappy practicing family medicine and would not do it again if they could choose over. I’m also disturbed by the paucity of physicians choosing independent practice as a model. I feel that, in general, the economics of being employed dictate against optimal patient care and physician satisfaction. You might feel differently if you were overworked and underpaid in a hospital-owned group that wasn’t being managed efficiently. But a medical practice is a business, and if you’re not running it, then someone else has to be, for better or for worse.

I feel more physicians would opt for independence if they had the requisite training. I can hardly blame new family physicians for choosing a salaried position when they don’t know anything about running a practice. Independent practice, incidentally, doesn’t mean having to be a solo physician. Belonging to a small group in which all the physicians participate in practice management decisions qualifies.