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In the article “Statistical research: lost in translation?” Drs Hogg, Wong, and Burge1 clearly describe an important issue. Language influences our perception of reality.
They describe independent practice as each doctor being in a full “stand-alone” operation with independent space, independent staff, independent records, and independent finances, and suggest the practitioner does not interact in his or her regular day-to-day work with others doing the same type of work. Using their criteria, no family medicine practice qualifies as an independent practice because all practitioners “influence each other, however minimally.”1 Solo general practitioners do not operate in isolation. They routinely collaborate with other health professionals. Every practitioner works and collaborates with medical and nonmedical experts who are also trying to help patients.
Solo practitioners might not share office space, but they do share overall resources and spaces for care, including access to laboratory tests, emergency departments, hospital beds, and common areas in medical buildings. Each day, staff in solo practice relate by e-mail, telephone, or fax with staff in the offices of other general practitioners or specialists. Patient information, including health records, is often shared with other doctors using common standards.
In all provinces, the incomes of all primary care practitioners are related. Government decides on the pool of money available for primary care. The payments per visit or salaries for each doctor relate to the total number of clinicians and the services they provide.
The authors use the term independent practice, but the term solo practice might be a better descriptor. Hardly anyone, including medical professionals, fulfils the criteria outlined by Donner and Klar2 for independent practice. Solo practitioners have never been independent; they have always collaborated with and been influenced by the people around them and the government who pays them.