Five years as a yoga instructor gave Priel Schmalbach an intuitive sense of others’ well-being and a desire to heal the medical ailments that lay beyond yoga’s reach. So the Miami native enrolled in UC Irvine’s School of Medicine as an MD/PhD student, pursuing a career as a family practitioner.
Then the warnings started, from industry veterans frustrated with the realities of the job — the endless paperwork, the need to maintain a heavy patient load to defray overhead costs, the falling insurance reimbursements for care.
“When I tell people I’m going into family medicine, they look at me like they can’t believe it,” said Schmalbach, 24, who is completing his first year of medical school. “That can deter a lot of people from doing it.”
Schmalbach’s experience isn’t unique. The national debate on health care reform has highlighted long-brewing dissatisfaction among doctors weary of burdensome government regulations and excessive time spent on administrative tasks and away from patients. While many physicians say they are still passionate about their work, others are leaving medicine, discouraged by the business side of a job they say should ideally be focused on care.
As this traditionally Jewish profession lurches toward an uncertain future, the question looms: Is medicine still worth it?
“It’s still great to be helping people, but the bureaucracy has gotten much worse,” said Dr. Joshua Helman, an emergency room physician working in Kissimmee, Fla., for the past 10 years. Mounting frustrations with the high-stress job led him to open a side business in investment coaching.
“As a physician you can spend more time documenting a patient encounter than actually seeing the patient,” Helman said. “Disillusionment” is widespread among primary care doctors, and many, he said, are seeking an escape route from medicine altogether.
Dr. Michael Kotzen, a Van Nuys-based podiatrist, understands his colleagues’ frustration. Rising rent, costly malpractice protection and lower insurance reimbursements are creating a perfect storm that’s pushing some doctors out of the profession, he said.
“Doctors are having a more and more difficult time trying to sustain their practices because our overhead is so high,” Kotzen said. “Not only do we have to see more patients and do more procedures, but we have to try to control our overhead in order to maximize our profit.”
Medicine is no longer the lucrative profession of past generations, defined by luxurious salaries and the promise of summer homes with six-car garages. Training is a hefty time commitment, repaying school loans is difficult, and barriers abound to starting up a new private practice, such as getting on HMO lists and insurance panels. To top it off, the large profits of yore are no longer guaranteed.
A growing number of doctors are turning to concierge medicine, where they can charge ample membership fees for day-and-night access, no waits for appointments and personalized care. The fees allow physicians to greatly limit the number of patients they see — sometimes moving from as many as 2,500 in a practice to just a few hundred — so they can provide more thorough service.
But many others would choose to retire early rather than deal with the continued headaches of practicing, said Dr. Jerome Helman of Santa Monica, Joshua Helman’s father.
“Most primary care doctors are not satisfied with the whole experience,” Jerome Helman said. “The system is very burdensome. Discontent throughout medicine is high.”
A stunning 78 percent of almost 12,000 doctors surveyed in a national poll last year said medicine is either “no longer rewarding” or “less rewarding” than in the past. The survey, released in November 2008 by the Boston grant-making group The Physicians’ Foundation, also found that 45 percent of doctors would retire today if they had the financial means.
Only 17 percent of physicians rated their practices as financially “healthy and profitable.” Ninety-four percent said the time they’ve spent on non-clinical paperwork has increased in the last three years. And tellingly, 60 percent of doctors said they would not recommend medicine as a career to young people.
“A lot of physicians say they wouldn’t even recommend that their own children go to medical school,” Kotzen said. He doesn’t count himself among that group — in fact, he’d be “thrilled” if his 9-month-old daughter would someday take over his practice — but he’d want to make sure his children didn’t graduate saddled with debt.
“If I knew I was able to pay for their schooling and that once they graduated they wouldn’t have student loans, I would definitely encourage medicine,” he said. “But if I was unable to pay for their education and they would come out of school with $200,000 in student loans, that’s a different situation.”
In the 2008-2009 school year, the average cost of medical school tuition and fees in the U.S. was more than $41,000, according to the Association of American Medical Colleges (AAMC). After four years, students are often loaded down with more than $150,000 in debts.
Yet despite dire assessments of the industry, medical school enrollment is climbing. The number of students enrolling in schools across the country swelled from 70,169 in 2003 to 76,070 in 2008, the AAMC found. The number of graduates has been growing almost steadily, from 15,532 in 2003 to 16,167 in 2008.
“Medicine is still a great career and a very satisfying career to go into,” Kotzen said. “I can’t think of too many other careers that provide the stability that medicine does and the compensation for the time that’s involved.”
Although doctors’ salaries have dipped in recent decades, physicians are still compensated well for their time and educational investment in relation to other occupations, Kotzen said.
Besides, the profession continues to carry an air of prestige — especially in the Jewish community — and is still a source of pride, fulfillment and familial nachas.
“I think every Jewish mother or father still wants their son or daughter to be a lawyer, doctor or accountant,” Kotzen said. “We obtain professional status and are respected by society.”
Doctors who are passionate about their work can still maintain a good quality of life, said Dr. Taaly Silberstein, 39, an obstetrician-gynecologist based in Tarzana.
“I still love what I do after eight years,” Silberstein said. “I don’t find myself getting burnt out. I have a lot of job satisfaction and get a lot of reward from practicing my profession.”
One way to keep the profession appealing to young people amid the debate on health care reform would be for the government to subsidize the cost of education, she added. “If the government is going to step in and make decisions about income, then maybe they should step in and subsidize some of our schooling,” Silberstein said.
But the key to maintaining a successful career, many said, is keeping an open mind.
“You have to recognize that things change and you have to have a passion for what you’re doing,” Joshua Helman said. “If you pick a field that you love, you won’t be disappointed.”
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