I hear you. Although it has its frustrations, I work at an underserved clinic I must say that our patient population is for the most part very respectful and appreciative. Most of our patients are new imigrants or cant speak english. In this light it is very rewarding.

Thanx for the great posts and honest sharing of angst and hope.

I agree with DrSleep - small communities may have more to offer. An oncologist friend just moved from NV to Peoria (2 hours S. of Chicago) specifically for the better lifestyle, hours, small-town values (respect, less litiginous, people actually see their health as THEIR personal responsibility and a commodity worth paying for) in addition to the very low (5%?!) managed care market share. Worth a look!

I'm 10 years out from medical school and escaped from a very inequitable male-dominated Neurology practice (in Philadelphia suburbs) 1.5 yrs ago to open my own dream solo practice of doing mobile outpatient neurology (low overhead, no secretary, +billing service, +home business office, +electronic medical records). Can't say that it's profitable yet (thank goodness for my husband's job and benefits) but I do have more flexibility to be there for my children on sick days, special days, etc (tho' clearly I have other stresses about trying run a solo practice and learn the business of medicine - like trying to hit a constantly moving target). I see an awesome need and potential for the patients I serve - elderly, homebound, rehab/skilled nursing facilities. Unfortunately I'm not sure that I'll be able to keep this practice open amidst reimbursement cuts and increasing medical malpractice insurance costs in PA.

I agree that those in most need in our society (immigrants, elderly, poor, etc) seem in general to form the most respectful and productive doctor-patient relationships. I feel that with the introduction of managed care and the "copay mentality" many patients started to become more demanding and disrespectful, and in turn, devalued their own health, denying their responsibilty in the dr-patient relationship. We are seen as health "vendors" who must supply a failsafe product (read lawsuit) at "below invoice pricing" (I've actually had patients in the past argue about paying a $5 copay!). My patients paid more for their plumber and to get their nails done than they do to control their seizures!

I would be interested to hear if anyone out there has any business pearls of wisdom to share!

DrT- I happened upon your post today. I am struggling with whether to saty home with the kids or keep working as a private practice neurologist. I was really interested in what you are doing. Mobile neurology? Many of my patients are pretty disabled and have a hard time getting to the office. It sounds like a good idea! Tell us more!