Saving Office Practice

This editorial is about the office practice of adult medicine. Office practice has been hurting for at least a decade. Medical students are taking notice, and more of them are choosing clinical specialties in which office practice plays a relatively small role. Leaders of internal medicine and family practice are concerned (1) but are uncertain about how to facilitate the change that must occur in individual practices scattered over a large and diverse country. An analysis of all of the problems confronting office practice isn't suitable for a brief essay, so I focus on a specific piece of the problem: administrative inefficiency and office expenses.

The doctors' chief complaint is diminished pleasure in daily practice. They say that the psychological and intellectual rewards of caring for patients are still there, but they have no time to savor them. The root causes of this chief complaint lie in the economics of practice.

Physicians' income fell during the latter part of the 1990s. The inflation-adjusted average income of physicians declined 5% from 1995 to 1999, while the income of other professionals and technical workers rose by 3.5%. Generalist physicians' income fell 6.4% to $138 000 (2). Recently, physicians have been working longer hours. They spent 46.6 hours per week in direct patient care in 2001, two more hours than in 1997 (3). Although physicians' personal income may now be increasing slightly, it has not kept up with …