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Dick Rothman, an othopedic surgeon who has run the biggest practice of its kind in the United States, is taking his practice public. But the nation's oldest hospital -- Pennsylvania Hospital -- can't imagine letting him go. He's their most productive surgeon, bringing in millions of dollars annually for the institution. Rothman is the quintessential specialist physician who practiced in an era doctors, particularly specialists, were the center of the health care universe. Now, the federal government, insurance companies and health-maintenance organization tell doctors what to charge. This article explores the reasons why Rothman will have no part of it.

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