I never thought I would leave my solo practice in internal medicine. The fiercely independent cowboy on the vast American range had always been my inspiration, but in 1992 I joined the satellite clinic of a large multispecialty group. I was happy to gain colleagues and more time with my family, happy to shed some of the hassle of coping with Medicare rules. I also believed that being inside "Fort Clinic" would protect me from all the changes I saw coming in the practice of medicine. Little did I know that the attacks would come from within the fort.

I opened my solo practice in 1986 with the desire to make my practice different-set apart and dedicated to Christ. To this end I made Bibles available in the waiting room and placed a Focus on the Family physicians' literature rack in each exam room. I also held a Bible study in the office every Wednesday morning for my colleagues from the hospital and staff.

When I joined the clinic in 1992, 1 continued the same practices. At the clinic, the Bible study steadily grew until one particularly crowded meeting seemed to ignite trouble. one of the doctors gave his personal testimony and vividly described the dramatic change a personal relationship with Christ had made in him. It was inspiring-perhaps too inspiring.

Trouble in the Trenches

Over the next few days, I heard rumors some employees were complaining about the meetings. I was shocked. They were held early in the morning before the clinic opened, were completely voluntary and interfered with no one. Why would anyone complain? it turned out only two people complained. They felt the clinic was endorsing the study. Also, one wanted the clinic to support a study of religious cults.

Later that week, the group's executive committee put the matter on its agenda. I phoned the president, who told me he thought the Bible study was innocuous, but the clinic would probably move to ban it because of the controversy. He added, "Religious things of any type always fail in public hearings." Not wanting to sow discord, I promised to move the Bible study elsewhere. As I hung up the phone, I felt a rush of nostalgia for my old solo practice. A year earlier, I had been my own president and executive committee.

That might have been the end of it, but the president was busy at the hospital when the committee met. And I didn't know I could attend. No one on the committee knew that I had already agreed to discontinue the meeting on clinic premises, so they voted not only to ban the Bible study, but went even further. The committee decided the literature racks and Bibles would have to go as well.

One committee member told me that not a word was spoken about freedom of speech, freedom of religion or physician autonomy.

The next day the satellite administrator called and asked that I remove the Bibles and literature. She told me they could be kept in my personal office but not in the waiting area, hallway or exam rooms. My first inclination was to comply, figuring that this was the price one paid for leaving solo practice. I felt I had sold my autonomy, my rights and, even worse, my faith for a few dollars.

Stand Up or Sell Out

The story of Esau in the Bible selling his birthright for stew seemed suddenly relevant. "Fort Clinic" had become my prison.

As I pensively left the office that night. I noticed the various magazines lying in the clinic waiting room: Cosmopolitan had the usual buxom female on the cover proclaiming "The joys of Being a Mistress, " Newsweek had a cover showing two lesbians hugging and Time had a picture of a teenage prostitute in Asia. I thought to myself, What is more offensive, Bibles on a table or Cosmopolitan? Focus on the Family or Newsweek? I made up my mind.

That night I explained the situation to my wife and children, saying that I would leave the clinic if I couldn't keep the Bibles and literature in my waiting room. I reiterated the importance of the Bible to my practice. For me to not use the Bible during my workday would be tantamount to malpractice-like withholding a drug from a patient while knowing that it could help him.

The next morning I called the medical-group president to say I would not remove the Bibles or pamphlets. I mentioned that no patient had ever complained about them in the six years I had practiced on my own or during my year at the clinic.

Later that afternoon, the group president came to my office to tell me that the executive committee had reconsidered: I could keep my Bibles and other religious literature on display. They reasoned that since my waiting room is in a dead-end hallway, only my patients would be likely to encounter the Bibles, and patients who objected could always change doctors within the group.

A Change of Heart

A year after this episode I found myself before the same committee, but this time my status as a shareholder was being voted on. Before the vote was taken, I asked the executive committee if there would be any future problems over my choice to display religious materials in my waiting room. They assured me there would not, and the vote in favor of my partnership was unanimous.

Since then, the Bible study has moved from my office to the hospital, and then to our homes. My literature racks are full, and the Bibles are still available to patients who want them. I know I have gained many benefits by joining a large group practice, but I have also learned that group practices can take some autonomy away In my situation, however, I gained something special. I realized for the first time how valuable freedom is and how precious my faith is to me.

Although the group has been good to me, it makes me sad to see the solo practitioner, like the cowboy, disappearing from the American landscape. I believe, however, it would be even more tragic to see Christian physicians relinquish their beliefs and ride into the sunset like defeated gunslingers.

James Avery, MD, is an internist in Clearwater, FL. He's been married to his wife, Jan, for 15 years, and they have three children, Jonathan, Joseph, and Juli.