My father and I often marvel at how much medical practice changed in
the four decades between the end of his orthopedic surgery training and the
end of my internal medicine residency. In 1950 he started as a solo practitioner.
In 1990 I joined a group of 13. He had a secretary who dressed in nurses'
whites and served him lunch at his desk. I have a secretary who wears what
she likes (and, OK, surprises me with a candy bar on days she triple-books
my schedule) but also an office manager, a business manager, and a managed
care manager. And unlike me, my father, I reflected recently as I finally
took down the holiday cards lining my office bookshelf, often received gifts
from his patients.