Building Your Practice by Demonstrating Quality Performance

Some Pursuing Alternative Careers

December 15 2002
Cover Story
Maureen Glabman

James Noble Hendrix, MD, was one of the most respected general surgeons in South Florida in 1990 when, at age 46, he stunned his partners by announcing his intention to stop practicing. The former physician now operates Hendrix Farms on 20 acres south of Miami where he grows lychees, a tropical fruit, that he ships all over the world.

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
If you began practicing in the 1960s, chances are you expected to be wearing a lab coat well past age 60. But those expectations are changing due in part to an evolutionary and escalating exodus from medicine brought on by managed care, regulation, rising malpractice rates and lawsuits, and economic and general dissatisfaction, verified by studies of doctors conducted in the last five years. As a result, researchers expect a dramatic shortage of 200,000 physicians by 2020, a time when the country’s aging population may require more medical care.

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.
The financial ramifications are enormous for America, which pays roughly $2.7 billion in tax dollars to train approximately 100,000 residents annually. About $300,000 is lost when a physician changes careers, estimates Richard Cooper, MD, 66, a former practicing hematologist and medical school dean who directs the Health Policy Institute at the Medical College of Wisconsin in Milwaukee.

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
But perhaps the most serious repercussion of physician dissatisfaction is access to care. “We are already seeing the early signs of shortages and of public unrest,” says Wisconsin’s Cooper. He was one of only a few experts who challenged predictions of an oversupply of physicians that were made in the 1990s by the AAMC, the Council on Graduate Medical Education, and the U.S. Bureau of

Health Professions.
In a report this year by the Pennsylvania Medical Society, Pennsylvania’s Disappearing Doctors, researchers reported that the high cost of malpractice insurance had resulted in the closing of medical clinics and had caused hundreds of hospital employees to be laid off.

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
California, move out of state to a better practice environment, retire earlier than planned, or change to a career that did not involve patient care. In a report last year, Keeping the Doctor Away: What Makes
Arizona Unattractive to Physicians? the Goldwater Institute in Phoenix drew conclusions about the supply of physicians in Arizona that were similar to those drawn about physicians in California.

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
Some speculate that physicians may be leaving practice because there are more opportunities for those with a medical degree than there were years ago. While it is true that physicians today practice in a wide variety of management and executive roles that were unheard of before managed care, the fact remains that practicing physicians today are no longer autonomous as they once were. In the past, physicians made medical decisions without answering to insurers.
They enjoyed the loyalty of lifelong patients who did not switch doctors because their employers changed health plans. They set their own fees and usually were paid in full. And, typically, they worked into their late 60s or 70s.

“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
But if physicians are leaving medical practice, the law of supply and demand may favor those who remain. “Doctors can be more selective,” Cooper explains. “They can have boutique practices, turn down Medicaid patients, and say no to HMOs.” Recruiters are reporting soaring starting salaries and offers of nontraditional working agreements, like job sharing. But a shortage of physicians means longer wait times for patients to get an appointment and longer search times for groups seeking new physicians for practices.

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.
The most difficult shifts are to totally different fields. “It’s much harder for doctors to move into new industries because they spend years training with a very narrow focus,” says career counselor Weeks. “Then they spend more years interacting primarily with other doctors. It can be hard to imagine what else is out there.”

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
Brookline, Mass. Peter Moskowitz, MD, once worked as a radiologist before he founded the Center for Personal and Professional
Renewal in Palo Alto, Calif. Todd Pearson, MD, is a pediatrician who founded the Center for Physician Renewal, in Bellevue, Wash.

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.

Privacy Policy | Advertising Information | Copyright
Published by
Premier Healthcare Resource Inc. 1996-2002. All Rights Reserved