goog  leaving medicine

Friday, June 9, 2000
Frustrated doctors are leaving medicine behind
http://www.bizjournals.com/atlanta/stories/2000/06/12/story8.html

Socialists will tell you that "boom and bust" is a capitalist phenomenon, but if you want real "feast or famine" try central planning. After sucking in foreign doctors for years, the UK's
http://lastditch.typepad.com/lastditch/2008/01/nhs-blog-doctor.html

After the third month of my neurology residency in Chicago, I took a trip out to New Mexico and never came back.
http://travelingmedicineshow.wordpress.com/what-could-possibly-go-wrong-leaving-medicine-the-first-time/

Frustrated doctors are leaving medicine behind

Atlanta Business Chronicle - by Julie Bryant Staff Writer

Late on a hot afternoon in May, prominent Atlanta heart surgeon Dr. William R. Mayfield finished up a routine heart bypass operation on an 80-year-old woman, stripped off his scrubs and walked away from 20 years of medicine.

Lured by the promise of a new frontier for health care and frustrated by a profession which had become virtually unrecognizable to him, Mayfield traded in his white coat for a new career -- executive vice president of a start-up dot-com company.

Mayfield is not alone. Frustrated by constant feuding with managed care companies, ever-rising mountains of paperwork, less time for patients, deepening federal reimbursement cuts and workdays that typically stretch into nights, a growing number of doctors are leaving traditional medicine behind.

Many have taken up consulting careers or made lateral moves into administrative jobs. But a burgeoning group of doctors are finding a new home on the Internet where the entrepreneurial spirit reigns and the health-care industry stands ready to be reshaped and molded.

"Initially it was like falling off of a cliff," said Mayfield, who will take a substantial pay cut in his new position with a subsidiary of Atlanta-based MedAscend, a continuing medical education (CME) company. But when Mayfield thinks back on what he has left behind he has few regrets, if any, he said.

"As a young, enthusiastic surgeon you convince yourself that it's going to get better," he said. "At every stage in my career I would tell myself, `It's going to get better.' It never got better."

The Internet can offer doctors an opportunity to regain control over their careers and use their creativity, said Dr. Alfred Martin, who just launched MEDinterface.com, a one-stop-shopping ground for health-care professionals. To avoid bureaucratic hassles, many physicians have ended up in large group practices where their individuality is lost, he said.

"A lot of people think in medicine you can have your own business but a lot of us cowboys are being corralled into one big corral and it's not as much fun anymore," said Martin, who graduated from the Medical College of Georgia before attending the Harvard School of Business.

"Doctors see the Internet as a way to get back on their horse and do some stuff," he added.

Mayfield, unlike Martin, said he never considered another career until his own drastically changed. Born and raised in Smyrna, he fell in love with medicine on the back of an ambulance. At 15, he was an ambulance attendant who went on to become one of the fist emergency medical technicians (EMTs) in Georgia, he said.

He said he remembers being warned along the way that medicine was changing, and not for the better, but by then the goal of becoming a heart surgeon had been set. After graduating from the Medical College of Georgia, completing five years of general surgery work and two years of cardiac surgery studies, he finally achieved his goal.

In 1991, he joined Peachtree Cardiovascular & Thoracic Surgeons PA, one of the nation's largest medical groups in terms of patient volume. It was a prestigious accomplishment, but gradually the external constraints on the medical industry proved wearing for Mayfield.

There was less and less time for patients as federal reimbursement cuts forced physicians to see more patients and do more procedures. As Mayfield, 45, began hitting his peak earning years, he found he was making less money and doing more work. Over the past three years, Mayfield said, his salary has decreased by 40 percent.

Then there were his side ventures.

"It wasn't just that medicine had become so negative, it was my experience with business that became so positive," he said.

Mayfield developed an innovative line of surgical instruments designed to help surgeons perform minimally invasive cardiac surgery. Eventually, he sold the instrument line to a publicly traded surgical products company.

Suddenly, he had a life outside of medicine. He was using new skills, being an entrepreneur and building up a new list of contacts in the business world, he said. The experience left Mayfield wanting more.

"About 95 percent of the doctors who stop me in the hall say they wish they could do something like this," Mayfield said of his new job. "But either their financial situation won't allow for it or they don't have a business idea."

Tom Callaway, who heads the national e-health practice for Korn/Ferry International, one of the world's leading executive search firms, is busy these days fielding calls from doctors like Mayfield and Martin.

In the last two years the number of calls has markedly increased, he said. Many doctors searching for work outside their profession are hopeful that there is a place for them in the dot-com world. Some come with specific career moves in mind or a specific business they want to join.

Others come nearly at their wits' end, he said.

Nationally signs that the physician industry is troubled come in the form of high turnover rates within medical groups, and declining enrollment numbers at medical schools.

The American Medical Group Association (AMGA) reports that the turnover rate within medical groups has jumped to around 10 percent. Three to five years ago it was far less than that, said Dr. Donald W. Fisher, long-standing CEO of AMGA.

A number of factors are driving physicians out of the business, not the least of which is pure, unrelenting bureaucracy, Fisher said. "There are 146,000 pages of Medicare regulations alone to comply with," Fisher said. "It's just become a nightmare."

Last year the Association of American Medical Colleges reported that the applicant pool for U.S. medical schools had declined for the third straight year to 38,534, a drop of 6 percent.

The American Medical Association says it has not tracked how many doctors are turning away from medicine. The Medical Association of Georgia, which represents 8,000 Georgia physicians, hasn't either. But MAG officials say they have noticed the trend.

"I wouldn't want to be a doctor today," said Paul Shaner, MAG executive director.

They are not getting paid for their work, he said. Sadly, many of these doctors love medicine, but the hassles and pay cuts are forcing them to consider other options. The Internet is offering them a place where they can still have a hand in medicine and feel somewhat autonomous again, he said.

Rheumatologist Dr. Charles Peck felt the sting of guilt when he left his patients behind to become medical director of Aetna U.S. Healthcare, he said.

"I felt bad about that, but I had always planned to have two careers," said Peck, who now heads physician and managed-care services for Arthur Andersen LLP.

Now he gets resumes from doctors who want to make similar moves.

"Three years ago when I started, I got a resume every month, then every couple of weeks, then [every] week," he said. "Now sometimes it's a couple a week. There's a lot of people running away from medicine."

Many young doctors entering the business have wised up to what lies ahead and are arming themselves with MBA degrees.

The Association of American Medical Colleges reports that in 1998, 28 U.S. medical schools offered MD/MBA combination degrees and 143 students were enrolled in those programs. That compares to 16 schools and 78 students in 1996.

Dr. Mark Braunstein, CEO of Atlanta-based Patient Care Technologies Inc., said a combination career track was not always a popular option.

"In the '70s, I went to medical school with a special interest in getting involved in computer technology," he said. "I was considered a real oddball."

Not anymore. Braunstein graduated from the Medical University of South Carolina and the Massachusetts Institute of Technology (MIT). He traded the chance to go into private practice for a chance to develop clinical software programs for health-care professionals.

In 1990, he started Patient Care Technologies, which develops software packages for the home-care industry.

MEDinterface.com's Martin said he, too, was chastised by his peers for double dipping into the medical and business worlds by obtaining dual degrees. "Back when I did it in 1986 it was like leaving the priesthood," he said. "Now my peers regret not doing it. The thinking has changed."

Dr. Andrea Pennington, 29, is evidence of that change. She left a background in performance art and television broadcasting behind to pursue medical college.

Pennington graduated from medical school at Washington University in 1998 intent on a career in pediatrics. It seemed a wise choice, but during an internship at a Washington, D.C., hospital reality struck.

The veteran chairman of the pediatrics program abruptly resigned just as Pennington's internship began. She quickly discovered why. The program was not a moneymaker for the hospital and so proper supplies and clinical support were not available, she said. Fellow residents seemed to be just going through the motions to get through training.

Pennington elected not to renew her contract with the hospital and began searching for a medical consulting job. Instead she found Helios Health Inc., an Atlanta-based dot-com company which provides doctor's offices with "e-stations" where patients can search for health-care information online in waiting rooms.

She now directs content for Helios, including animated graphics that appear on the site.

Working with an Internet company, her medical skills are put to use explaining hard-to-explain diseases and treatments. Her skills in television production are put to use directing animation and she now has time to pursue community theater and moonlight in emergency clinics so that her medical skills do not get rusty, she said.

"At first blush we in medical school were sort of corralled into that mentality of 40 years of medicine and that's it," she said. "More and more now no one raises an eyebrow when you want to pursue additional career paths."

That trend may in some ways be better for medicine, Pennington added.

"Salaries are not what they used to be and being a doctor is not so prestigious anymore, it's just a job," she said. "When I was in high school if you wanted to make money, becoming a doctor or lawyer or businessman were your choices. That may have attracted people into medicine who probably should not have been there."

Now people who pursue medicine are truly devoted to medicine and really interested in it for altruistic reasons, she said.

MAG'S Paul Shaner sees a bright future ahead for those who do elect to stick it out. Patients are equally fed up with today's health-care system, and eventually the pressure they put on legislators will provoke change, he said.

For Mayfield, the change did not come soon enough. Sitting in his new office, he glances up at the clock when asked what time he'll be heading home to spend time with his wife and two growing sons.

In about a half hour, he says. The clock reads 5:30 p.m.

Reach Bryant at [e-mail].