Centennial Physician: Richard Perry, MD, Struggles with the Future

• Physician's practice patterns
• Internal medicine
• Quality of health care
• Knowledge, attitudes, practice

Richard Perry, MD, is a physician of the 20th century. Born before the advent of penicillin, schooled in the days when “imaging” meant x-rays and endoscopes were few, rigid, and of limited value, he has spent most of the century's latter decades as a devout practitioner of personal medical care, bringing increasingly powerful medical science to the lives of his patients. He loves his calling, but as he faces the 21st century, his practice and his medical values are in trouble.

Perry is a general internist (American Board of Internal Medicine, 1962)—an unapologetic primary care physician who cares efficiently for his patients over time and knows when to call for help. He is effective, self-effacing, much loved—and embattled. Managed care and the steady growth of the proprietary culture of medicine have made his medical career difficult in ways that he never anticipated. “After 35 years of work, my practice is probably two thirds of what it once was,” Perry reports. “My office is half empty some days, and overhead is a killer. For 7 of 9 months recently I had no income—zero—and one month I had to put money into the practice just to make the payroll for our office staff.”

Perry is 69 years old and something of an institution among Washington, D.C., physicians. His office overlooks the perpetual traffic snarl in a downtown neighborhood of low-rise office buildings that house law firms and trade associations. His examination-room walls salute a career in medicine with certificates from Georgetown University, D.C. General Hospital, and the Air Force. Family photographs and an unlikely picture of Perry hang-gliding, dated 1981, are also displayed. A prominent plaque attests to his selection as a laureate of the District of Columbia chapter of the American College of Physicians.