Published on Sunday, July 9, 2000 in the Boston Globe
The Doctor Is Out
More and more doctors, frustrated with managed care, are trying new professions and finding life less stressful
by Anne Barnard and Kathryn Tong
Ilene Cohen designs software. David Chung founded an Internet start-up. Rod Altman helps pick investments for a venture capital company. Gigi Hirsch is a career consultant, and Stephen Sherwin runs a $33 million biotechnology firm.
Their workdays, incomes, ages, and aspirations may differ, but they have one thing in common: They're all doctors.
Frustration over managed care - coupled with exploding opportunities in Internet ventures, medical technology, biotech, and finance - is spurring more and more physicians to try careers in other fields, doctors and medical organizations say.
Some go looking for autonomy, creativity, status, and financial reward, the hallmarks that once attracted them to the medical profession but now seem to be ebbing away. Others sense the excitement in new high-tech fields and want to be a part of it.
''There were many people walking around in health care who couldn't wait to get out,'' said Altman, 37. He recently left a gritty Chicago-area emergency room for a high-rise office overlooking the Charles River, where he sifts through business proposals from health care start-ups. ''I get up every morning and can't wait to get to work. Can't wait.''
For doctors who slogged their way through costly medical schools, exhausting residencies, and years of clinical practice, such career moves were once practically unheard of. And they are still accompanied by a great deal of soul-searching. Cohen, 44, who left internal medicine last year and now designs software for cardiology tests, likened the switch to ''leaving the priesthood.''
Yet a recent survey of 300 doctors over age 50 found that 10 percent were planning to seek jobs outside clinical practice, according to Merritt, Hawkins & Associates, a national physician headhunting firm. Of physicians who planned to stop working with patients or to retire, 48 percent cited managed care as a significant reason. That trend is making it harder for hospitals to recruit top specialists, said company spokesman Phil Miller.
Meanwhile, a small but growing number of young doctors are postponing, skipping, or curtailing residency training - or leaving just after residency - to start businesses, join Internet start-ups, or work as consultants.
Companies, in turn, are taking a new look at doctors as a pool of intellectual capital: In the last five years, McKinsey & Co. and the Boston Consulting Group have begun recruiting at medical schools nationwide. Hirsch, of Brookline, quit psychiatry to found a company that helps such firms locate and hire physicians.
Perhaps surprisingly, these trends are meeting little resistance or concern from the established medical community, which seems to view them as a sign that doctors and educators are adapting to the changing health care landscape.
Some doctors even believe that the profession's current troubles are weeding out people who went into medicine for status and wealth, and leaving only those who are genuinely interested in helping patients.
Boston-area physicians who changed careers disputed that, saying they acted partly out of disillusionment. They found they had less time for patients, did more grunt work, and got less intellectual stimulation out of following treatment recipes that increasingly are written by insurance companies.
''Society in many ways has devalued medical practice,'' said Mark Goldberg, 40, a former radiologist at Massachusetts General Hospital. He is now vice president of Parexel International Corp., a Waltham firm that applies computer imaging to medical research. Twenty years ago, he said, the ideal role model was a physician; now it's Bill Gates.
Ali Binazir, 28, horrified his parents when, fresh out of medical school and more than $80,000 in debt, he decided to get a job in Cambridge's burgeoning Internet economy. ''The prospect of spending another four years in residency at subhuman wages and being treated like chattel didn't appeal to me,'' he said. ''They say there's a pot of gold at the end - I don't see it.''
Complaints about managed care and the lure of the new economy are being blamed for three straight years of declining medical school applications, according to the Association of American Medical Colleges. Applications declined 6 percent in 1999, to 38,534.
But the 14 doctors interviewed by the Globe about their flight from medical practice also cited more subtle reasons for their moves. Many said they believed they could have a broader impact on health care outside traditional patient care.
''We as physicians never got to make any macro decisions. We never got to decide what was in the basket of goods and services that could be delivered to patients,'' said Altman, who worked 10 years as an emergency room doctor and now evaluates health care business plans for TVM Techno Venture Management.
He added that he took a small pay cut to make the switch, and noted that while venture capital could be more lucrative in the long run than medicine, it is also riskier.
Younger doctors in particular see no contradiction in weaving business into their careers and do not view themselves as abandoning medicine. Traditional nonclinical paths, such as working for drug companies, no longer have the stigma they once had, said John Lacey, a spokesman for Harvard Medical School.
Twenty-eight of the country's 125 medical schools offered joint MD-MBA programs in 1998, with 143 students enrolled - up from 16 programs with 78 students the year before. MBA programs for established physicians have multiplied in the last decade from one or two to around a dozen.
As for the new, high-tech medical fields, the Stanford University School of Medicine actively encourages students to explore them and to become entrepreneurs. This fall it will begin giving credit for rotations at private firms, such as biotechnology and medical instrument companies.
Of Stanford's 89 MD graduates this year, two joined consulting firms, three headed to business school, and one to a medical device firm. Those numbers are expected to increase next year, said senior associate dean Phyllis Gardner, who herself took time out from medicine to work at a start-up.
Chris Shen, 27, has taken time off from his Stanford medical schooling to get an engineering degree and help design a device for treating strokes. He plans to get an MBA as well and become ''a bridge between physicians and engineers.'' Working in medicine full time, he said, he wouldn't have time envision new devices; yet his medical education will be indispensable to understanding what devices are needed.
In Boston, David Chung, 29, founded Beansprout.net, a Web site for pediatricians and parents, during his pediatrics residency at Children's Hospital. He now plans to practice in Brockton three days a week and work two days a week at Beansprout. He said that at any given time in his residency program, a half-dozen young doctors were working on side business ventures, even as they covered overnight shifts in the hospital.
Hospitals, meanwhile, are not alarmed at the trend, said Debra Weinstein, who oversees residency programs at MGH and Brigham and Women's Hospital. She defined residency's mission as ''training people to be leaders in a variety of medical fields.'' As an example, she pointed to Richard Peters, a former MGH resident who cofounded MedNav.com to make Internet networks for hospitals.
People were not always so understanding. Stephen Sherwin, CEO of Cell Genesys, a California biotech company that researches cancer vaccines, graduated from Harvard Medical School in 1974. His interest in research led him first to the National Cancer Institute, then to a private firm where he felt he could take a more active role in directing drug research. Few of his colleagues identified with his choice. In 1984, a 10th reunion booklet listed him as an ''industrial physician,'' a moniker that conjured up ''an unfortunate soul doing worker's comp physicals,'' Sherwin said.
In fact, he was able to do research without begging for grants, as well as profit from getting into biotech on the ground floor. His first company went from 150 employees to 1,500. Later Sherwin helped create Cell Genesys, which recently raised $250 million by selling shares in a spinoff called Abgenix. That is a staggering amount of capital for researching new cancer cures, he said: ''In some ways it's just another way of being a doctor.''
Richard Solit, 33, might not have put it quite that strongly when he joined the consulting giant McKinsey & Co. shortly after completing a residency at Thomas Jefferson University in Philadelphia. But he did dream that a financial job would allow him to help the medical industry negotiate the difficulties of managed care.
Reality so far has been more complicated: After consulting for several drug companies and one managed-care organization, he said, ''I've done nothing that would directly impact the physician dilemma.'' One problem, he said, is doctors' adversarial attitude toward managed care.
His wife, Cheryl Tessler, 29, also an MD, went to McKinsey for a different reason: She did not want to enter a 90-hour-per-week residency while caring for an infant daughter.
Ilene Cohen, too, was thinking of her personal life when she gave up a beloved internal medicine practice at Mount Auburn Hospital in Cambridge to design software for Bard Electrophysiology in Lowell. She traded a maple-furnished office for a cubicle at half the pay. But every day, she takes her lunch to a picnic table - something she almost never had time for in 12 years of practice. The other day, she even played table tennis with colleagues. ''I could not believe this was happening to me,'' she said. ''I have entered another universe.''
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