History of independent physicians

In the very early days of rural America, doctors often went to patients’ homes in a horse and buggy and took care of the entire family’s ailments and injuries. Doctors in the late 1700s and 1800s were generally not formally trained, but were expected to treat everything from a broken arm to contagious diseases. They probably learned their trade from the town doctor who was retiring and needed a replacement. Fees were direct pay and may have involved livestock or even baked goods.

These were the first independent physicians in the US. Many were dedicated and qualified, while some were considered “quacks.” By the mid-1800s, those physicians who were concerned with the path of their profession saw the need for formal training and regulation. In 1846, the American Medical Association (AMA) was formed and in 1900, the Journal of the American Medical Association (JAMA) was founded.

According to an American Academy of Family Physicians (AAFP) Foundation paper, by the turn of the 20th century, the AMA set objectives to:

  • Purify the profession from quackery
  • Establish an orthodox medical education based on natural science
  • Promote standards for public health (sanitation, food and drugs)
  • Standardize medical education

Subspecialties then began to be established, along with more formal education and tighter regulations. As providers began to align themselves with hospitals and other healthcare facilities, the number of truly independent physicians began to decline and is now less than half of all providers.

In 2016, an AMA study found that only 47.1% of physicians held ownership in their own medical practice. This number was down significantly from four years earlier, when 53.2% practiced independently. Many physicians cite burnout or financial considerations as their reasons for giving up their independent practice and seeking employment in a larger organization.

However, the independent physician is not close to being extinct. Autonomy and independence will continue to be important factors for this group of dedicated doctors and the independent physician is now and always will be a permanent fixture on the healthcare landscape.