A Family Doctor Looks to Retire, but Finds No One to Take Over - NYTimes.com

"So there we are, miles from shore, fishing since 11 o'clock at night, and we haven't gotten one single bite until finally we gaff one that's about this big."

Dr. Ronald Sroka held his hands about three feet apart, and John Mayer — fishing buddy and patient — smiled from the examination table. Dr. Sroka shook his head, glanced at a wall clock and quickly put his stethoscope to his ears.

"All right, deep breaths," Dr. Sroka said. It was only 10 a.m., but Dr. Sroka was already behind schedule, with patients backed up in the waiting room like planes waiting to take off at La Guardia Airport. Too many stories; too little time.

"Talking too much is the kind of thing that gets me behind," Dr. Sroka said with a shrug. "But it's the only part of the job I like."

A former president of the Maryland State Medical Society, Dr. Sroka has practiced family medicine for 32 years in a small, red-brick building just six miles from his childhood home, treating fishing buddies, neighbors and even his elementary school principal much the way doctors have practiced medicine for centuries. He likes to chat, but with costs going up and reimbursements down, that extra time has hurt his income. So Dr. Sroka, 62, thought about retiring.

He tried to sell his once highly profitable practice. No luck. He tried giving it away. No luck.

Dr. Sroka's fate is emblematic of a transformation in American medicine. He once provided for nearly all of his patients' medical needs — stitching up the injured, directing care for the hospitalized and keeping vigil for the dying. But doctors like him are increasingly being replaced by teams of rotating doctors and nurses who do not know their patients nearly as well. A centuries-old intimacy between doctor and patient is being lost, and patients who visit the doctor are often kept guessing about who will appear in the white coat.

The share of solo practices among members of theAmerican Academy of Family Physicians fell to 18 percent by 2008 from 44 percent in 1986. And census figures show that in 2007, just 28 percent of doctors described themselves as self-employed, compared with 58 percent in 1970. Many of the provisions of the new health care law are likely to accelerate these trends.

"There's not going to be any of us left," Dr. Sroka said.

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http://www.nytimes.com/2011/04/23/health/23doctor.html?nl=todaysheadlines&emc=tha23&pagewanted=all