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Some Pursuing
Alternative Careers
December
15 2002 While in medical school, Edward Schneider, MD, 56, dreamed of being an
old-style country doctor. After 28 years as a family physician in
Stockton, Calif., he sold his practice last summer to teach science at a
community college. “I absolutely don’t ever expect to go back to the
practice of medicine,” he says.
Lorne Weeks, MD, 50, practiced orthopedic surgery for 17 years in
Colorado and Kentucky until four years ago. That’s when he left medicine
to become a consultant for CareerLab in Englewood, Colo., helping
physicians transition into new occupations as he did. “Medicine is a
different game than the one I contracted for,” he says. “There’s a sense
of betrayal. The bases have been moved.”
Costs and Regulation Physicians who spent an average in today’s dollars of $136,000 on a
medical school education and seven or more years of their lives
intensively studying medicine are leaving in the prime of their careers,
when their benefit to society is arguably the greatest. Do self-exiled physicians feel a societal obligation to practice under
any circumstances? “I gave away $120,000 in charitable care every year for
15 years to patients who couldn’t pay me,” answers Hendrix, the South
Florida farmer. “That’s $1.8 million. I paid my dues.”
Orthopedist-turned-career consultant Weeks says, “I don’t remember
promising anyone I would practice until I die.”
While physicians are leaving, applications to medical schools also are
declining. The Association of American Medical Colleges in Washington,
D.C., which represents the nation’s 125 allopathic medical schools, says
medical school applications declined by 29% since 1996.
“All of us, medical educators and the public alike, should worry if a
career in medicine ceases to be attractive to prospective applicants,”
says AAMC President Jordan Cohen, MD. Today, one out of every two students
who applies is accepted, compared with one in three in 1995.
“The real issue with medical schools is that the number of student
slots has remained constant for the last two decades while the U.S.
population has grown; so the schools have not kept pace with the
population,” says Edward Salsberg, PhD, director of the Center for Health
Workforce Studies at the State University of New York at Albany.
Disappearing Doctors Health Professions. The AMA’s outgoing president, Richard Corlin, MD, addressed the issue
at the organization’s annual meeting in June, saying, “Doctors are
disappearing from America’s communities because of skyrocketing medical
liability insurance premiums and an out-of-control legal system.”
Also, the Massachusetts Medical Society released findings in June from
a study that showed the Bay State is facing a crisis in the number of
physicians available to deliver patient care. “Many physician practices
are already overwhelmed and unable to handle additional volume,” the
society said. Last year, a report by the California Medical Association,
And Then There Were None, said that by 2004, 43% of physicians planned to
leave patient care in One of the most frequently cited national reports was done in 2000 by
Merritt Hawkins, a physician recruiting firm in Irving, Texas. In a survey
of 300 doctors age 50 and older, about 40% said they planned to retire
from medicine by 2003, and 10% said they expected to change careers.
Some have extrapolated from the Hawkins study that based on the total
number of U.S. physicians age 50 and older, an astonishing 100,000 could
be retiring by next year, a “gray out” of one in seven doctors.
“Admittedly, our survey size was small, and the results more likely
reflect dissatisfaction than actual plans,” says Hawkins spokesperson
Phillip Miller. “Plus, since it was completed, the stock market has gone
south, which may inhibit some physician retirements. That said, we are
nonetheless continuing to see a lot of doctors retiring prematurely.”
The problem may be larger still because exiting physicians do not
report their departures to any central information agency and do not
cancel their licenses. They simply don’t renew, which doesn’t show up in
state or AMA records for several years. Also, many former physicians
maintain multiple licenses so they can write prescriptions for family
members but no longer see patients, which tends to skew the data.
White Coat Blues “It’s not the long hours,” says Cooper about the practice of medicine.
“It’s getting beaten up and the fear of getting audited or sued that
demoralizes physicians. Doctors don’t want to retire. They love medicine.
They hate the practice.”
Karen Engberg, MD, an internist in Santa Barbara, Calif., agrees. “Why
would someone want to work 80 to 100 hours per week when they can support
themselves just as well in almost any other profession and with many fewer
regulatory headaches, much less liability, and a forest less of
paperwork?” she asks. “This year our reimbursements have shrunk by 5%
while our overhead has gone up about 20%. It’s a losing battle.”
Not only have reimbursements declined, but what doctors call the hassle
factor has risen considerably as well. In some markets, obstetricians have
stopped delivering babies and surgeons have stopped performing risky
procedures—both out of fear of malpractice suits. A patient on crutches is
sent to a radiology center miles away instead of using his physician’s own
x-ray room because an HMO has negotiated a lower rate with a cross-town
center or because of liability concerns. Pap smears that once took three
days for results get shipped out of state as a cost-cutting measure and
take 10 days to get back.
Rita Robinson, MD, 54, an internist and oncologist in Akron, Ohio, used
to do 80% oncology and 20% internal medicine but had to flip those two
because insurers would not pay her for the time she needed to spend with
cancer patients or for administering chemotherapy in her office. Now,
because her annual malpractice rate tripled this year to nearly $25,000,
she is considering leaving practice to sell cosmetics full time.
For Hendrix, the former South Florida surgeon, several situations
precipitated his exit from medicine. He became angry and despondent when
an anesthesiologist he worked with committed suicide over a malpractice
suit. Hendrix himself had been sued twice, though in each case the charges
were dismissed.
A Silver Lining What’s more, many physicians who remain in medicine are leaving heavily
populated cities for rural areas where malpractice premiums are lower.
Still others are shifting from one field of medicine to another, from
direct patient care to academic or administrative work. Nonetheless, once doctors retire, they typically do not return to
patient care, Weeks adds. Recent job titles physicians have assumed
include securities analyst, actuary, quality assurance officer for a
medical device manufacturer, and founder of a medical Web site, he says.
“Careers were once a lifetime investment,” Weeks continues. “Now they
are amenable to tweaking, redirection, and a midcourse correction.”
Doctors are discovering their value with the help of career counselors;
some of these counselors are like Weeks: disheartened physicians who saw a
new opportunity in medicine. Gigi Hirsch, MD, once worked as a
psychiatrist and now is the CEO of MD IntelliNet, LLC, a research,
consulting, and physician placement firm in Of course, most physicians will remain in practice, particularly those
who believe medicine is still the most exciting and rewarding profession,
even with all of the hassles common today. “I am a doctor through and
through, and I will die a doctor,” says William Harris, MD, 52, family
practitioner and geriatrician in Charleston, W. Va., who has been in
medicine for 25 years. “Regardless of how much pressure and heat are put
on us, my colleagues and I plan to stick it out and stay in practice.
We’ll be the ones to turn out the lights. We’re not leaving.”--Reported
and written by Maureen Glabman, in
Miami. |
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