Golden Age of Medicine

Excerpted from George D. Wolf, M. D., The Physician’s Business: Practical and Economic Aspects of Medicine (Philadelphia: J. B. Lippincott, 1938), Chapter Four, "Location," pp. 30-34.

RURAL OR URBAN

There is some need for physicians in rural areas. The inducements offered are that expenses are at a minimum, and collections better than in the city, where the population is so largely shifting. If these advantages outweigh the allure of the city in the eyes of the young doctor, he will do well to equip himself with a good road map, listing towns and their populations. This list, if checked against Polk's Medical Directory or the Directory of the American Medical Association, which lists the number of practicing physicians in each town, will establish the ratio of doctors to the population. Another method of establishing the need of a community for an additional physician is the scanning of the death notices published in the journal of the American Medical Association. Frequently a town is left doctorless, and the young physician does the community a genuine service by establishing himself there.

Whether a rural or an urban location is selected, it is advisable to avoid the proximity of a large hospital or free clinic. The average physician, especially the young one, cannot possibly survive this type of competition. For obvious reasons, neighborhoods unable to support a physician should also be avoided, as should locations with inadequate transportation facilities, as inaccessibility is a serious handicap.

OFFICE

Central Section of City

A city locale having been selected, the next problem is the selection of a particular building within the city. Whether to choose an office building, an apartment office, a private house, or a combined home and office, depends of course upon the individual needs and the community habits.

In some sections of the country it is the custom of all doctors to establish their offices in professional buildings. In such a case, the problem is solved, since the newcomer has but to follow suit. For a practice chiefly devoted to the professional and business classes, who have time for treatment only during business hours, location in the business section of the city is an undoubted advantage, if not an out and out necessity. However, where personal following is an important consideration, an office building is not a particularly good choice.

An office building of the professional type offers the manifest advantage of having been planned for medical needs. Space is well divided, and rooms conveniently laid out, with provision made for dark rooms. The lighting arrangements and plumbing facilities are planned for the convenience of patients and attendants. Local telephone service, secretarial service, cleaning service, and occasionally linens are also provided. Such arrangements are usually not to be had without extensive alterations in apartments designed for other than professional purposes.

The professional building offers an opportunity for group practice, where patients can receive attention from specialists associated under one roof. Often there is a small hospital in the building, so that the doctors who have offices there are enabled to visit their hospitalized patients, and so conserve both the time and the energy otherwise expended in traveling.

The chief disadvantage of the office building as a base for the doctor (aside from the fact that a personal following will be difficult to achieve through it), is the coldness and impersonality of the scene in the patient's eyes. The regimented offices, elevators, attendants, create a factory-like impression.

For those who find that the disadvantages of the professional building outweigh the advantages, a residential district offers a better site for an office. Here again a choice may be made between an office established in the doctor's home, and an office located in an apartment building, but separated from the home.

Residential Section

A combined office-home makes possible economies of time and of money, since it eliminates traveling back and forth between office and home, and precludes a double payment of rent. At the same time it enables the wife of the doctor to act as secretary and nurse, to attend to telephone calls in the doctor's absence, and to help him during the time when it will be difficult for him to employ assistance. If his home is combined with his office, he will find it possible to have his meals punctually, even to the point of lunch in the midst of busy office hours. Also, when night calls have resulted in the loss of much sleep, it is a great advantage to be able to nap for a short time, with the assurance that should a call come for him, he is not beyond reach. He can have guests at home and enjoy his leisure, with the certainty that he is always available. Moreover, evening office hours are feasible at home, and patients who cannot visit the doctor in a downtown office during the day find it convenient and pleasant to walk to his home in the evening.

The other side of the picture offers certain disadvantages. While it is convenient to have the family present to answer the telephone, make excuses for the doctor’s non-appearance, and smooth over awkward situations, it is not conducive to the dignity of an office to have the doctor's children romping about, and to have all the familiar sounds of a busy household penetrate to the waiting room. Moreover, if patients know that the doctor is always at his home, they will straggle into his office at all times, and refuse to observe his stated office hours. Of course if the need for his attention is urgent, the physician will not mind the irregularity, but in many instances such visits out of hours are merely thoughtless and selfish disturbances of the doctor's hours of repose and relaxation, and it becomes difficult for him to lead a life independent of his work.

The alternative is an office in an apartment building—a complete entity in itself. Space is offered at a rate less expensive than in an office building, and the atmosphere is at once more congenial and less constrained. Parking space in the vicinity will be more readily available and will offer no problem either to the doctor or to his patients. The physician will be able to display a sign in his window, an obvious impossibility if he is situated in an office building many stories from the ground. In an apartment he will usually find useful bath and shower facilities. A very important additional factor is that in a residential neighborhood he will find the atmosphere quiet and conducive to work. In his free hours he may be able to do some constructive reading and writing, in surroundings determined by his own taste. His home can also be established in convenient proximity to his office.

Sharing offices

Sharing an office with one or more colleagues has many obvious advantages, both professional and economic. Not only does the per capita expense diminish, but the office is made more efficient by the combining of equipment and personnel. When there is a duplication of the type of practice, one doctor can substitute for the other in case of illness or during vacations, even when there is no definite partnership understanding. If the colleagues practice different specialties, a partial group practice is virtually established, and the patient can obtain the benefit of a consultation without going elsewhere. The disadvantages of this plan are, of course, the possibility of cramped quarters or incompatibility between the doctors.