Demystifying Medicine One Month at a Time

The Sad Demise of the Yeoman Doctor

The corporate takeover of medicine.

In American History we studied the yeoman farmer as the Jeffersonian ideal. The rugged individualist clearing the land, building his home, and creating fertile growing space in the hinterland to feed his family and eventually the community.

Heroic; now historic.

The yeoman farmer was almost entirely supplanted by agribusiness, as economies of scale were created by the efficiencies of amalgamating resources (land) and using technology to efficiently specialize (mono-crop culture).

[The counterweight to this has been the rise of organic farming, but even in that story there is a familiar pattern of big business leveraging itself in the newer market.]

Also being relegated to mythic status is the yeoman doctor, out there by himself (almost always him), caring for generations of family members in the same location. He would attend to his patients in the office, in the hospital, and after hours.

Now comes a wonderfully reported portrait of the last of this dying breed. The Times ran a front page story about Dr. Ronald Sroka, a family doctor who’s now taking care of his third generation of families in Crofton, Maryland.

Dr. Sroka has no partner. He doesn’t have an electronic medical record. He eschews unnecessary testing since a) he knows his patients so well and b) he’s very skilled at diagnosing things with a history and physical examination.

He owns his practice, in the time-honored tradition of doctors hanging out a shingle and making things work by the sweat of their brow. His wife (of course) helps run the business end of the practice.

Now that Dr. Sroka is nearing retirement age, he can’t sell his practice. He can’t even give it away.

Younger docs (I am one) don’t want to work as hard as Dr. Sroka does. We want doctoring to be part of our lives, not the whole thing.

We trade the risk (and reward) of owning a practice for the security (and loss of freedom) of a salaried job in a larger organization.

The same kinds of issues are in play as with agribusiness: Consolidation brings leverage in negotiating contract prices; working for a large organization means economies of scale. The corporate entity takes care of overhead like malpractice, computer systems, even paying the nurses and medical assistants.

The Health Care Reform legislation (PPACA) passed by Congress in 2010 will only accelerate this process. Organizations that integrate care to provide high quality mean that the little guy will be left out in the cold. The sheer bureaucracy of the new changes (e.g. building “accountable care organizations” and “gainsharing risk”) will make it harder and harder for solo practitioners and even small groups to survive on their own.

There will obviously be a few holdouts:

  1. Psychiatrists in Manhattan.
  2. Cosmetic surgeons.
  3. Concierge doctors, the model of which I think will lead to the rise of the
  4. Boutique practice. You want to go where everyone knows your name. Where you’re treated like an individual. And you’re willing to pay out of pocket for the privilege, avoiding the hassles of insurance altogether.
  5. “Diet” doctors, purveying their own “special” elixirs and potions.

If health care reform means more accessibility and better quality of care, then the changes will be welcome. Yet there will be major disruptions in our current practices and patterns for some time to come.


  1. Paul Dorio

    Here’s the sad thing about the Yeoman’s comments:

    Younger doctors, to generalize ridiculously, don’t want to work as hard as Older doctors. So the Older doctors are becoming anachronisms. Fine. What happens to the increasing numbers of aging people – Remember, 80 million Baby Boomers are just starting to turn 65 – if droves of doctors no longer want to actually work for a living and are satisfied merely working as a salaried individual in a “larger organization.” As if working in that larger organization implies that they will all work less hard.

    The reality is that, for the same amount of pay, doctors will work much harder than ever before. That’s where the real issue becomes apparent. And by then it will be too late for these Younger doctors to find a job that is satisfying and rewarding and pays well and involves patients that they actually can get to know well.

  2. Fred Kupchak

    Your blog is so informative … keep up the good work!!!!

  3. Dr. Dalton

    PERFECT articles. I AM a woman doctor in a solo indie practice who had hung a shingle for the last 10 years. I LOVE the independence and being in a “boutique” neighborhood office. We DO take insurance, but in order to do so, we have to run a tight ship. My husband has another FT job but helps on the tech and claims end of things. I do all the billing and a lot of delegation to my two phenomonally talented employees. We are high tech and old-fashioned at the same time. I am the last of a dying breed. Even with insurance hassles and headaches, I’d never trade this for anything, though. I am able to work part-time, be a mom and do a lot of work on-line from anywhere in the world. It’s a good life.

  4. Heidi Weispfenning

    I know this entry is rather old, but I just came in from the NYTimes.

    Here’s a small-town newspaper article about the retirement of one of these yeoman doctors (who happens to be my father): After 36 years, a beloved ‘doc’ retires

    The story only covers the years of his private practice, not the years before that he spent as the only doctor at the local Health Center, or the several months he spent working entirely by house call while his practice was being built. But it certainly goes into the problems of the independent Family Practitioner.

    • glasshospital

      Thanks so much for sending this link. Your father sounds great.–JS

  5. Robin

    Love the concept of Yeomen Doctor. As my husband and I have been trying to create a “new” model of practice, we’re finding that much of what we’re doing is pretty old. I think that in order to create that level of individualized care while providing a quality of life for the physician, we’re going to have to get creative. While I totally agree that the current (lack of) system has to be fixed, I worry that many of the rules and regulations will prevent people from coming up with creative, individualized and locally applicable solutions.

    • glasshospital

      Looked up your practice website. Love the idea of “Community Supported FP.” Congrats on being different and in touch with what matters most to you.

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