The Solo Shuffle

11N.

Private
practitioners
holdfast to
their
independence,
despite the
headaches
of managed
care.

JULIE EDGAR STAFF WRITER

Above: Dr. James Bragman: No
`doc-in-the-box.'

Left: Dr. Alan Mindlin: "Poster
child" of solo practitioners.

home. It's hard to quanti-
fy how many hours I'm
working," he said.
Saving money to launch
the practice, which is out
of the Beaumont Medical
Building in West Bloom-
field, meant living at home
until he was 33 and
putting up with his
friends' "guff and crap"
about it, Dr. Bragman
laughed.
"No one laughs any-
more, because I saved a
tremendous amount of
money and I had a long-
range vision. I knew I was
going to be in an upscale
neighborhood. Machinery was
paid off in the first year. I had zero
debt," he said.
What wasn't funny was learn-
ing how to run a business, he said.
Medical school doesn't provide
clues, so it was a seat-of-his-pants

OTO BY GLE NN T

orman Rock-
well's image
of the kindly
physician,
pinching a
little girl's
cheek or ban-
daging the
scraped knee of a Little Leaguer,
was an idealization back then.
Today, it's nearly unrecogniz-
able.
The number of doctors who
hang up a shingle, put on their
white coats and post an "Open"
sign on the door has dwindled to
a fraction of what it was 10 years
ago.
The enemies of the solo practi-
tioner are myriad: long hours; re-
duced fees from managed care
organizations, traditional insur-
ance companies and the federal
government; higher overhead
costs; exorbitant malpractice in-
surance premiums; and for the
recent graduate, heavy debt from
student loans.
According to the Ameri-
can Medical Association,
the number of doctors prac-
ticing on their own dropped
from 46 percent in 1982 to
29 percent last year. The
numbers are based on year-
ly surveys of 4,000 member
doctors.
The Michigan State
Medical Society reports
that in 1994, 33.2 percent
of its 12,000 members were
in private practice — down
from 48 percent in late
1992. Another 6.5 percent
said they practice alone,
but share office expenses
with other doctors. Rough-
ly 19,000 doctors practice
in Michigan.
Still, there are the few
and the brave who value
their independence. Some
of them do pretty well, con-
sidering the obstacles.
Dr. James Bragman, an
internist with a specialty in sports
medicine, chose to be on his own
six years ago after practicing for
a few years out of two multi-spe-
cialty clinics.
"I really wanted my own pa-
tient population rather than a

free-standing edifice, a doc-in-the-
box operation, which is part, of a
clinic structure. That was an ab-
horrent way to practice medicine.
You like to stay with patients for
the long haul," he said.
In the beginning, he worked 80

to 90 hours a week; today, it's be-
tween 60 and 70, partly because
he's cut back on pre-operative con-
sultations.
"There's a tremendous price to
be paid. I may not be in the office,
but I'm taking phone calls at

education. Dr. Bragman admit-
ted he made mistakes in the be-
ginning.
Today, his practice is thriving,
with patient records in the thou-
sands, he said. Dr. Bragman, 39,
is also medical director of Samar-
itan Care Hospice in Southfield
and a clinical assistant at Wayne
State's medical school.
And when he is out of town or
otherwise indisposed — an obvi-
ous drawback for the solo prac-
titioner — colleagues will cover
for him.
Dr. Bragman is quite happy
with the way things have turned
out.
"You are your own boss and you
are in charge of your own destiny.
You take responsibility for the fail-
ures. It's on a smaller scale, so you
don't run into the corporate or bu-
reaucratic politics like one would
in a clinical group or multi-physi-
cian specialty group," he said.
Dr. Mark Schare, an obstetri-
cian-gynecologist, left Henry Ford
Hospital five years ago to set up
a practice in the Beaumont Med-

SOLO SHUFFLE page 4

