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Thinking About Leaving Practice? Read This First

The values you cherish most could be hard to fulfill in other lines of work. Here's how some doctors plan to make medicine fun again.

It's no secret that many physicians -- perhaps even a majority -- become disenchanted with medicine sometime during their careers. The threat of malpractice, growing third-party interference, and escalating paper work even cause some to look around-to consider switching into something else.

"Doctors who want out of stressful situations are hardly losers or incompetents," says Celia Paul, a career consultant who teaches a course called "Career Alternatives for Physicians" at New York University. "The people in our classes are successful by traditional definitions; they have status and high income. But they're unhappy, and they don't feel obligated to subordinate their personal lives to the demands of the profession."

Paul's observations are supported by the flood of physician resumes sent to executive recruiting firms across the country. "We receive almost 300 inquiries every month from doctors eager to leave patient care," says Harry Graham, vice president of Sampson, Neill & Wilkins Inc., of Upper Montclair, N .J., a search firm that specializes in placing physicians in the pharmaceutical and biotechnology industries. "Sixty five percent are from doctors between 35 and 40. Most physicians are nearing their peak in skills and earnings in those years, but some are being forced to look at alternatives."

Older doctors want a change, too. "In the first class I gave," says Celia Paul, "the majority of doctors were residents or new physicians who were under stress and worrying about building a practice. In subsequent classes, more were over 50-successful, but convinced they were in a rut." Paul began her workshops two years ago, to accommodate the increasing number of doctors requesting career counseling services.

The most recent class, held at NYU last spring, was comprised of 20 physicians, evenly divided between residents and established M.D.s. I sat in to hear why doctors are switching careers. Here were the most common complaints:

Premature burnout. After only one year in practice, a young pediatrician at a clinic in New York's poverty-ridden South Bronx had developed a substantial discontent, even though she still enjoys working with patients. "1 know I'm filling a real need," she explains. "But what I find disheartening is the attitude of some clinic staff members. They scare patients away by treating everyone as a number. The bureaucracy is unbelievable. Even so, I'm not sure I'd be better off anywhere else. After the clinic, I just can't see myself taking care of upper-middle-class kids with runny noses and nervous mothers. "

The seven-year (or eight-year) itch. A psychiatrist at a major metropolitan facility for the past eight years says dealing with hospital politics and cost-containment edicts leaves her exhausted. "The hospital is a constant battleground, with daily arguments about where to 'turf' the patient," she says. "That's the name of the game. Push him onto someone else's service, and then get him out as soon as possible. My work is challenging, but I feel agitated most of the time."

Health problems. A 5O-year-old internist who works at an ambulatory-care center claims that midlife crisis brought him to the class. "1 feel as if this is the last chance I have to make a change in my life," he says, "and I want to see what else is available. Then he confesses to a more immediate concern: "I've had some hearing loss, and it's making my job more difficult. "

Wrong original choice. A resident in internal medicine concedes that he became a physician because of family pressure. "My father is a doctor, and it was just expected that I'd be one, too," he says. "It's embarrassing to admit this after all the time, effort, and money involved in my education, but I just don't get the same charge out of patient care as my friends do."

Does a doctor have it made?

The biggest obstacle physicians face in making a career change is psychological, according to consultant Paul. "Once you've become a doctor, you're supposed to have it made," she says. "It takes real courage to break with everyone else's expectations."

At the class I attended, the Bronx pediatrician echoed that analysis. "1 feel shame when I say I'm unhappy being a doctor," she says. "My relatives and friends don't understand. Admitting that you're not satisfied with a career so many people still revere is like conceding you're a failure."

To help doctors shift their focus from what's expected of them to what's right for them, Paul uses a 30-minute values quiz. She asks participants to rank the importance of various goals and values, such as income, intellectual stimulation, working in a congenial atmosphere, status, the feeling that work is socially useful, and autonomy. She then has the class write brief summaries of the jobs they most enjoy and dislike. "The exercises make people look inward and dig deeper to find out what's important to them," she says. "What do you really want out of life? What price do you place on your happiness? Would you give up a high salary, say, to get what you say you want?"

Physicians don't reach lasting conclusions about career objectives as a result of the exercise, of course. For most, the values analysis is the start of a process of clarifying goals. But for some, answers emerge quicker.

New perspectives, fresh outlooks

"I've learned that my current job doesn't match with my skills," says an emergency-room physician. "I'm at my best dealing with critical cases. I feel the most stress and least confidence when I'm dealing with minor aches and problems that so often turn up in the ER. I'm starting to think that I don't need a real career change. This may sound strange, but maybe I need to work for a hospital in a seedier neighborhood where there'll be more trauma work, more action."

The psychiatrist who'd complained that her hospital is a battleground says the NYU class taught her she's not yet ready to abandon it. "1 enjoy taking care of patients there too much," she says. "But to ease some of the burnout I feel, I'll try to cut back to about 20 hours a week and find a part-time job working with the disabled in a non-hospital facility. The job I had most fun at was helping to write a training film for physicians on how to deal with AIDS patients. I'll investigate doing more of that. "

The 50-year-old internist with the "midlife crisis" and hearing loss also decided to stay in his present job. "After listening to everyone else and looking at the alternatives, I found the values I cherish most are being met on my job," he says. "1 need to work more on dealing with my disability. "

The class uncovered some entrepreneurial leanings in one participant, a medical student. "I'll hang in there to get my M.D., but I won't go into patient care," he says. "I'd like to work on the business side of setting up ambulatory health clinics, or home-health-care services for the elderly "

For some doctors, discontent stems from their reluctance to market their practices. Several class members consider marketing little more than "hucksterism." The remedy: Overcome that reluctance.

Paul pointed out that the old referral patterns have broken. "You can be the best doctor in the world, but until you put yourself out there, patients won't know it," she said. "Patient newsletters, speeches to PTAs, charity groups, schools, etc., all help build a practice. Sometimes all it takes to cure burnout is to get the practice growing again."

Where can an unhappy doctor turn?

The class discussed some alternatives to direct patient care, including jobs in biotechnology, pharmaceuticals, medical advertising, and publishing. The range is as broad as you make it. "Some of the doctors I've counseled have merely switched specialties," Paul says, "but others have gone into the restaurant business, real estate, or financial planning."

Harry Graham of the physician recruitment firm told the class that most jobs in the pharmaceutical industry for M.D.s are in the clinical research area, but that there are openings in medical marketing as well. Entry-level salaries for physicians range from $68,000 to $105,000, depending on specialty.

"Right now, cardiologists and infectious disease specialists are in greatest demand," he says. "But the industry is cyclical. A few years ago, gastroenterologists were the hot specialty when the new H2 antagonists and the prostaglandins were coming along."

Although executive search firms can act as a buffer and negotiator between the doctor candidate and the client company, Paul warned the class of some hazards of conducting a job search exclusively with "headhunter" firms. "Since the employer has to pay a fee, you become a more expensive commodity," she says. " And you're not allowed to personally contact the firms the search company is working for, which means you can lose some contacts. So if you use a headhunting firm, tell them not to contact the specific companies you'd planned to interview with on your own. " The recruiters typically ask candidates whether they've submitted applications directly to potential employers so that duplication can be avoided, Graham says.

Paul also recommends using medical skills part time while searching for a new career. For example, the psychiatrist in the class I attended works for the federal government reviewing charts for people applying for disability benefits.

"They pay $50 an hour, and the schedule is very flexible," she says. "I usually put in 10 hours a week in a very relaxed atmosphere. So even if I quit my full-time job, I'd have some income coming in while I was looking for another. ".

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