The era of the small medical practice is over. How many times have we heard that? It was widely proclaimed back in the 90s, in the wake of the Clinton administration's healthcare reform proposal. But 15 years have passed, and there are stillplenty of physicians working in solo and small group practices. Despite all the predictions that small practices could not survive in an environment of "big healthcare," they persist. A report published recently by the U.S. Centers for Disease Control and Prevention estimated that as of 2003-2004 more than 35% of office-based physicians were in solo practice, and roughly 66% practiced in groups of five or fewer. This article examines why, in spite of the challenges of being in solo and small group practices, many physicians still prefer the status quo and resist forming or joining larger groups.