21 November 2016

General Practitioner

In the hoary days of my youth in a modestly sized town (about 6,000 people) in Iowa, before I moved to Ames...

When we needed to go to the doctor, it was a small office with a single doctor.

This doctor was not the only such practice in this smallish town.

The staff was his secretary/receptionist and a physician's assistant.

That's it.  Three people and a clientele of about 1,000 patients of all ages.

My mom's income was just slightly above the point where a (newly) single mom with two kids would get government assistance, and we didn't have health insurance.

Yet we were able to afford to go to the doctor.

I've looked around and this sort of practice is gone.

The smallest I've been able to find still has 15 people working there.

This leads to some sickening comparisons.

The 15 person staff is servicing the same number of patients as the 3 person.

The secretary/receptionist at the GP way back had no medical training or certifications.

All 12 of the non-doctor positions at the 15 person practice have at least a medical assistant degree and certification, and you cannot work at an office without it.  Most of them also have a specialized certificate/degree in medical billing and encoding.

What changed?

Laws and regulations mostly.  Thanks to all that increased regulatory overhead, you need five times the personnel and three times the doctors to treat the same number of people.  On top of that, the front office people need to be trained in skills they will never use.

This is akin to requiring the receptionist at a law firm to pass the bar so they can be hired to answer the phone.


  1. Oh... you're just scratching the surface. You should start poking around in to what medical malpractice and office liability insurance cost a small doctor's practice back in the 1970s vs. today. And then what the cost of rent (because they need more specialized space now and more of it), the cost of supplies (again, more of it, and the specs are higher) and equipment (way more than what they used to need).

    Small practices, especially in rural areas have been and are being squeezed out of business.

  2. My 'good' doctor I had for 8 years in NOVA just quit. He wasn't going to deal with the BS... My dentist stopped taking insurance, dropped his office staff by five, and it was cheaper than when I used insurance to go see him. I could file on my own, which was fine by me.


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