Internist Timothy G. McAvoy, MD, has been practicing independently in Waukesha, Wisconsin, for decades now with no plans to retire. But he’s happy to turn over the leadership reigns of the AMA Private Practice Physician Section (PPPS) to a younger generation of doctors.
A member of the AMA-PPPS Governing Council, serving as the section’s delegate to the AMA House of Delegates, Dr. McAvoy helped get the section launched and served as its first delegate. He says that being an independent physician allowed him to dedicate the time to get the section up and running.
The AMA-PPPS is a member interest group within the AMA for physicians in private practice. The section governing council is responsible for directing AMA-PPPS efforts to preserve the freedom, independence and integrity of private practice.
“I've been a doctor for 52 years, since I got my medical degree in 1973,” Dr. McAvoy said. “What I like most about private practice is the autonomy. I can get up and leave. I don't have to ask for anybody's permission for anything I do.”
In addition to his role with AMA-PPPS and his private practice, Dr. McAvoy serves as medical director for the Rehabilitation Hospital of Wisconsin and as a representative of the Waukesha Elmbrook Healthcare independent physician association.
“I like to work,” he said. “So I'm working even at my advanced age of 77 because it rewards me and keeps me refreshed. If I take too much time off, I can feel myself getting a little stale.”
After finishing his residency in Wisconsin, Dr. McAvoy returned to Boston, where he found himself immersed in emergency medicine, serving both clinical and managerial roles.
“I worked as a 1099 independent contractor for an emergency medicine group, and I learned about the business part of medicine,” Dr. McAvoy recalled.
“I got to learn management skills, attended board meetings, and was given inordinate responsibility for someone of my tender years,” he added. “I was one of the directors of that company and was given a chance to invest in real estate, given a chance to work in other states and develop new skill sets—all of which was very entertaining and enjoyable.”
But, after six years, the physical demands of the long emergency-department shifts became onerous. Dr. McAvoy decided a change was needed. He looked into joining a large practice, but none seemed to offer the satisfaction he was looking for. Meanwhile, the idea of being a “throwback” grew more appealing, so he returned to Wisconsin, where he had family ties—including a namesake nephew.
He wanted “to try a different direction.”
“I decided I'd take a radical step and become Marcus Welby, and go out to Wisconsin and establish a solo practice,” Dr. McAvoy said.. “I knew what I was doing was anachronistic, but I wanted to do it anyway. I said, ‘If it didn't work, oh well, what the heck?’ I'd just go get a job.”
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Change of plans
Before hanging his shingle, Dr. McAvoy meticulously calculated how many patients he would see, how much revenue he would take in and how much he needed to be put back into his practice.
“I got the money part right, but I got everything else wrong,” Dr. McAvoy said.
“Instead of working primarily as a primary care doctor, I found myself as an internist in a family medicine hospital, providing consulting work and essentially doing the work of subspecialists,” he added. “I never really did stop doing that.”
This work was done at the 190-bed Waukesha Memorial Hospital, now ProHealth Waukesha Memorial Hospital.
“I spent four out every seven nights in the ICU putting in swans [Swan-Ganz or right-heart catheters], pacemakers and doing basic procedures, because we didn't have anyone else to do it,” Dr. McAvoy recalled. “They didn’t have hospitalists. Hospitalists weren't invented yet.”
In addition to his work at the hospital, Dr. McAvoy had a thriving outpatient primary care practice. But, despite scoring high on metrics used to assess the quality of care delivered to diabetic patients, he felt something was not right.
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“In 2009, I had the best diabetes metrics in the whole county of Waukesha, but by 2011, I'd given it up because I was chasing a mirage—a mirage of quality rather than real quality,” he said.
Dr. McAvoy explained that the metrics weren’t adapting to changing science and he thought they called for screenings more frequently than he felt were needed and they incentivized a hemoglobin A1c level for established diabetic patients that he thought was “a bridge too far” for many of them.
“I had superb diabetes outcomes, but I was spending as much as an endocrinologist,” he said. “And since I was chasing pseudo-quality, I stopped doing it once I saw the costs associated with it.”
Again, because he was independent, Dr. McAvoy said he had was able to follow his own path.
“In private practice, I make that decision, and I say, ‘I'll choose to do it the right way,’” he said. “If people want to audit me on it—which no one has so far—I would defend it at audit.”
Physician family
In addition to growing his practice, Dr. McAvoy and his wife Jacqueline built a family with five children, including daughter Kieran E. McAvoy, MD, a Waukesha-based geriatrician in private practice.
Dr. Kieran McAvoy is also on the AMA-PPPS Governing Council, serving as an alternate delegate to the AMA House of Delegates. In addition, she is the president of the Waukesha County Medical Society and is the recipient of the Wisconsin Medical Society’s 2025 Kenneth M. Viste Jr., MD, Young Physician Leadership Award.
Her father served on the Wisconsin Medical Society Board of Directors and was the organization’s 2013–2014 president.
He noted how another Wisconsin Medical Society past president, Barbara Hummel, MD, a solo family physician in the Milwaukee suburbs, was the first AMA-PPPS secretary. Its first chair was Arizona Medical Association Past President M. Zuhdi Jasser, MD, who graduated from the Medical College of Wisconsin in Milwaukee. AMA-PPPS Chair-Elect Keshni Lata Ramnanan, MD, is also based in Wisconsin.
Dr. McAvoy said he believes the reason for such heavy involvement from Wisconsin physicians is because, not too long ago, it seemed like private practices were on the verge of disappearing from the state.
“People wonder why so many Wisconsin doctors were on this,” he said. “We saw this problem firsthand, and that's why we were filled with evangelical zeal.”
Dr. McAvoy credits AMA past presidents David O. Barbe, MD, MHA, and Barbara McAneny, MD, with encouraging the initial AMA-PPPS organizers to follow through and get official recognition as an AMA section.
But he said it was Dr. Jasser who got the section established and continues to be instrumental in its growth. This includes recruiting AMA-PPPS chair Carolynn Francavilla Brown, MD, a Colorado-based family physician and obesity medicine specialist, and former governing council member Daniel E. Choi, MD, a New York-based orthopaedic spine surgeon.
“Carolynn has been a spectacular chair,” Dr. McAvoy said, adding that she and Dr. Choi have been doing the outreach and the education necessary to attract younger physicians to independent practice—too many of whom are skeptical about the prospects of life in private practice.
“What we've always strived to do is spread the message to the medical students and young physicians that this is a viable, rewarding and excellent lifestyle for practicing medicine,” Dr. McAvoy said.
“I don't know what the next step is going to be [for PPPS], but the right thing to do is turn it over to younger leadership who will have a completely different take than what I think the right next step is,” he added. “That's the beautiful thing about our AMA: Watching it grow and change to fit what it needs to be in the times.”
