My parents used to try to encourage me to go abroad to donate medical care to 3rd world countries through programs such as Doctors Without Borders or Peace Corps or similar. Back in my "wise" 20's I would tell them that I thought there was just as much need here in the USA. Little did I know just how true that was!

In med school there was a program where underserved areas would pay for school in return for 3-4 years of medical service past residency.

I do agree with you that there ARE doctors out there who would freely choose to provide care in indigent clinics for less pay, but there aren't enough established opportunities from which to choose. And it is too daunting and expensive and difficult (from a business point of view) to establish such a clinic on a small scale.

Anyone know Bill Gates? Maybe we could convince him to do something like this.

I know a physician who is currently running a "boutique" clinic (ie, you pay a yearly subscription cost, not covered by insurance, and it covers everything the office can provide - including 1 hour, same day appointments for pretty much anything). He tries to set the cost at ~the cost of basic cable (although it may be more than that, really? I don't have cable to know...), and a significant fraction of his clientel is made of people who don't have insurance through work and have some chronic medical condition that would make private insurance prohibitive on their not-particularly-high salary. So, they pay for this service and, if they can afford it, some catastrophic insurance on top. There are a number of wealthy people who just want the convenience and personalized attention as well. And he does some pro bono work on top of it all. It's an AMAZING practice. He doesn't make a lot of income compared to what I'm sure he could in another setting, but it's flexible and he loves it. And, for what it's worth, this is not in a particularly well-to-do part of the country. Just to say... it's possible!

I have a private practice which is about 85% medicaid. I feel the same way about quality vs. quantity. Medicine today has become a numbers game. The only way to make a living is by increasing the number of patients you see.

I am in a somewhat different situation, as I don't have a boss to report to. On the other hand, if I don't see enough patients, I don't make enough money to live on!

I refuse to compromise on the quality of care I give my patients. However, in Pediatrics, not everything has to be done by me! I have learned to delegate a lot. Nearly all bloodwork and throat cultures are done by staff. I have a medical assistant prep the patients for me before I come in (vitals, height and weight, set out equipment needed, etc.). I use an EMR with templates which really speeds up my charting.

I try to balance giving my patients the time they need, and moving quickly. For the most part, it works. Some patients need a lot of time, some are happy to just be seen quickly and be on their way.

Most days I can see between 30 and 40 patients between 10:30 and 6, but I do not have any breaks. Sometimes I return patient calls at night, after my kids are in bed.

I don't make a huge amount of money working this way. I could probably make more money if I treated my patients like "numbers" like some practices in this area do, but I will not do that. I would rather make less and give my patients quality care because that is what I went into medicine for.

good for you! I'm glad that you have made the conscious choice to limit quantity so that you can continue to provide quality care.

Unfortunately my specialty is so expensive to start (the equipment, and if I want to delegate, the cost of a trained staff member) that I can't create my own practice. I did consider the boutique medicine route but after cruching the numbers it just isn't feasible. It's a little late now to switch to primary care, especially since I really love ophthalmology. So I've made some changes to my hours to try to keep my burn-out low and we'll see where it goes.