Tribecan Vicki Porges, who opened Downtown Pediatrics in November 2006, will close the office at the end of the year and join NYU Langone Health‘s Washington Square location on Jan. 2. It was a difficult decision, she said, but one that allows her to spend more of her hours on patient care and fewer running a business. And it is, I think, a microcosmic example of what is making medicine so challenging in our world today, both for doctors and for patients. The small neighborhood practice is a “dying breed.”

“It was a very tough, long-thought-out decision and not made with ease, but I want to just be a doctor and do the doctoring part at this stage in my life,” Vicki said. “I didn’t go to business school — I went to medical school and wanted to see patients. The only way I can do that now is by working for someone else.”

A fourth generation doctor — Vicki’s father was an obstetrician and gynecologist who emigrated from Austria with his father in 1938 at age 8; her mother was a pediatric neurologist who specialized in familial dysautonomia, a neurological disorder; her grandfather an ob-gyn in Vienna and then Beth Israel; her great-grandfather a general surgeon in Vienna — Vicki grew up in a household where medicine was a fulfilling job. (That’s her with her parents, below.)

“That’s how it was for my parents. My father would come home and tell us stories about his patients. My mother changed the rate of progression of the disease she specialized in,” she said. “Medicine has just changed. There is so much more I have to do now to run the practice, and all the stuff that was stressing me out and weighing me down when I got home at night was the business side, not the patient side.”

One option, she said, would have been to convert to a concierge practice, where patients pay an annual fee to have access to the doctors. But she would have seen fewer patients and, she said, she doesn’t believe in it as a business model in medicine. Instead, there will be fewer practices like hers, she says, “it’s a dying breed.”

She hopes her patients will be able to make it way up north to NYU and Washington Square — it’s familiar territory for her since she went to med school there and did her residency there, and started her practice there. Her longtime office manager Karen McCormick will join her in the move and she hopes more of her staff will come as well. She’s starting immediately in the new location so her patients can have continued care.

“It’s a shift for everybody and its sad,” Vicki said. “I wasn’t just serving patients, I was also serving my community. I walk around the neighborhood and see my patients. And I love that.”