Many doctors calling it quits earlier than planned

By KATHERINE SPITZ

June 26, 2000 Web posted at: 2:21 PM EDT (1821 GMT)

In this story: White coat blues Income in perspective Paying their dues Other hopes for children Trading in old ideals RELATED STORIES

AKRON, Ohio (The Akron Beacon Journal) -- Sick of managed care and the medical malpractice climate, longtime Akron obstetrician-gynecologist Dr. Ted Robertson walked away from his practice two years ago.

Now 62, Robertson mows his yard, reads the classics and works on his hobbies, which include tinkering with a 1929 Mercedes SSK kit car.

He misses medicine. And he wants to volunteer at a medical clinic for the needy. But he definitely won't return to paid work as a doctor.

``If I hadn't saved the way I did, I imagine I would have had to practice another eight to 10 years -- miserable, totally miserable,'' said Robertson, who lives in Medina County's Sharon Township.

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As an older, disillusioned doctor, Robertson has plenty of company: A national survey of physicians 50 and older reported in April that nearly half plan to leave medicine within three years. Another 28 percent plan either to refuse new patients or to otherwise limit the amount of time they devote to medicine.

``Doctors no longer enjoy the control and autonomy they once did,'' said Joseph Hawkins, chief executive officer of Merritt, Hawkins & Associates, the Dallas-based health-care staffing firm that conducted the survey.

``Many of the things that attracted them to medicine in the first place are no longer there.''

Like making medical decisions without answering to an insurance company. Earning the loyalty of lifelong patients. Setting their own fees -- and usually getting them.

Today, a growing resentment among midcareer and older doctors against managed health care is feeding an epidemic of white-coat blues. More than half the doctors questioned in the national survey cited managed care as their single greatest source of professional frustration.

``There's a depression descending on the profession,'' said Dr. John Fink, 44, an Akron vascular surgeon who also serves as chairman of the Summa Health System hospitals board of trustees and is former chief of staff at Akron City Hospital.

``All of us, essentially, talk about retiring early. I'll be out at 59 1/2, if not sooner.''

Thanks to the long-running bull stock market, many disillusioned doctors likely will have the money they need to make a down payment on their dreams.

Older doctors -- and even some relatively young ones, such as Fink -- entered medicine when it was a very different profession. But the 1990s brought major changes, said J.B. Silvers, director of research at Case Western Reserve University's Health Systems Management Center in Cleveland. The government cut back on the fees Medicare pays to doctors, and managed health-care companies increasingly became involved in doctors' dealings with their patients.

While today's medical students and new doctors are getting more and more training in how to work in a managed-care environment, veteran physicians have had to adapt to the new rules well into their careers.

They don't like it.

Older doctors complain that they have had to steal time from patients to find time to handle the paperwork that managed-care companies demand. They also spend more time on the phone with insurance companies, justifying their medical opinions and recommendations.

At the same time, they feel the pressure of potential malpractice suits.

``The cost of medicine is soaring and they want us to do things efficiently. And yet, if we miss something, we're liable for malpractice,'' said Fink, who is not happy that his teen-age daughter is thinking about pursuing a medical career.

In the physicians survey, only four out of 10 doctors said they would encourage their children to make medicine their life's work.

The size of their paychecks is a ``not insignificant'' part of physicians' dissatisfaction, Fink said.

``People may ballyhoo the idea of doctors crying poverty,'' he said, but he argues that doctors deserve to be well-compensated.

``We are at patients' beck and call. We are there 24 hours a day, seven days a week. If you were to get that kind of coverage in any other profession, you would pay dearly for it. In our profession, it's taken for granted.''

Salaries vary by speciality, but the overall median income for a physician -- after expenses, but before taxes -- was $164,000 in 1997, down from $166,000 in 1996, according to the American Medical Association. From 1993 to 1998, according to an AMA survey, doctors' median income failed to keep up with the 9.7 percent inflation rate during the period.

But Silvers of Case Western points out that despite the limits on their incomes that managed care has brought, doctors aren't exactly poor.

``They've done extraordinarily well,'' he said. ``These are high incomes.''

But before doctors can earn any income, they must spend a long time in school -- 12 to 15 years beyond high school.

Education was just one barrier that Akron internist-oncologist Dr. Rita Robinson, in her early 50s, had to negotiate to realize her dream of becoming a doctor.

The youngest of nine children born to a housekeeper mother and yardman father, Robinson, of Copley Township, was the only child in her family to go to college. At the time she entered the medical profession, there were few African-American female doctors in the area.

Now, despite her dreams and her sacrifices, she wants nothing more than to get out of a full-time medical practice.

But she can't. And she feels trapped.

As a young doctor, Robinson said, she was fulfilled -- particularly when she could help cancer patients cope with their illness.

``I love medicine,'' she said. ``I enjoy the challenge.''

However, managed care has completely altered the nature of her practice, Robinson said.

``If I had known what medicine would be like when I was 50,'' she said, ``I would have thought about a career in business.''

Until three years ago, about 80 percent of her practice was in oncology and 20 percent in internal medicine. Today that ratio has flipped, she said, because she can't get insurance companies to reimburse her for the longer time she needs to spend with a cancer patient or for administering chemotherapy in her office.

On the side, Robinson has been cultivating a second career that offers her the freedom to interact with clients on her own terms: She sells Mary Kay cosmetics. And when she keeps an appointment with a customer, there's no one checking to make sure she doesn't spend too much time on the transaction before moving on to the next one.

Every day, Robinson said, she thinks about when she can quit her full-time practice.

``I wish I could retire, but I can't,'' said the widowed mother of five.

``I'm stuck out here -- one (child) in college, one to go to college. I've had three in college at one time.''

Robinson, who has one daughter who is a doctor, said she hopes the rest of her children don't go into medicine.

Only one of Akron surgeon Dr. Mike Flynn's eight children is going into medicine -- and she is choosing a career in alternative health care. Two of his sons are in real estate development.

Flynn, sick of coping with the business of medicine, intends to join them and start a new career. Before Flynn, 63, can do that, he has to find a partner to gradually take over his solo practice.

When he was a young surgeon, Flynn said, he assumed he would emulate his mentors, who seemed to enjoy their calling and were ``still working busily into their late 60s and early 70s.''

But that was long before he ran into the financial pressures that are driving him out of medicine: the rising cost of malpractice insurance, coupled with the discounted fees and fee limits that managed-care plans require.

``I will tell you I am being paid fees that are about what I charged and was paid when I started in 1970,'' he said.

Flynn also said he misses the relationships he established with longtime patients -- bonds often severed when managed-care health plans add or drop doctors, or when employers switch plans.

``We (doctors) all thought we were super special,'' he said.

``We didn't think we would lose patients when companies changed (plans), but we did.''

Dr. Tim Newman has given up on the ideal of having direct contact with patients -- a trade-off he accepts to survive the reality of modern medicine.

Newman, 53, an occupational medicine specialist, owned Rapid Response clinics in Cuyahoga Falls and Fairlawn, where he also treated patients. In recent years he sold his clinics to Aetna Inc., which in turn sold them to MedPartners Inc. of Birmingham, Ala.

Soon after the second sale, Newman left the business, citing a difference in philosophy in how the clinics should be run.

Newman, who also had been a part-time medical consultant to Ohio Edison, now works as full-time medical director for the electric utility's parent company, FirstEnergy Corp. He oversees the health care of nearly 10,000 employees -- which means no direct patient care.

``You know the cliches: Life gives you lemons, make lemonade,'' he said, adding that he continues to find professional satisfaction.

``Really, you have to continue to adapt and be flexible in the world of medicine,'' he said. ``If you can't, you can't survive. A lot of doctors are trapped in practices.''

Increasingly, doctors are reworking their careers, said Jeff Forster, editor of Medical Economics, a New Jersey-based trade publication for physicians.

``They may spend part of their career in office practice, but it's not like the old days when someone would hang out a shingle and stay there the rest of their life,'' said Forster, who will publish a career-planning guide for physicians later this year.

Advice for profession With the amount of dissatisfaction evident in the Merritt, Hawkins & Associates survey of doctors' attitudes, Forster's guide should have plenty of potential readers -- who may recommend the guide to their children.

Although doctors such as John Fink and Rita Robinson might be wary about their children going into medicine, others, like Ted Robertson, understand that young people see the potential for fulfillment in a medical career.

Robertson's son, Ted Jr., followed his father's footsteps -- to the University of Akron, to medical school at Ohio State University and to an obstetrics-gynecology residency at Akron City Hospital.

But rather than go into private practice like his father, Ted Jr. is considering a medical career in the Navy.

His father thinks that's a good idea.

``He saw me complaining about managed care,'' the elder Robertson said. ``He also saw the happy times, the challenge, the people who would say `Hi' to me at the store.''

And Robertson the retiree still knows what it is to feel the tug of medicine, the desire to make a contribution by fixing the body's ills. He wants to volunteer in a clinic -- free of the hassles of managed care.

``I just worked too hard to get my license,'' he said. ``I just can't give it up.''

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