Single Doc Seeks Efficient Practice

Office automation is spawning a growing number of solo practitioners, and those pioneers are helping to break the trail for newcomers.

By Eileen Lockwood | Feature Articles | July/August 2008


The old days:  You walked with your mother to a pleasant clapboard house where, in a sunny side room, your friendly family doctor would make you say “ah,” diagnose a respiratory infection and send you on your way with a timely prescription. Or worse, wave a frightening needle in your face and then stick it in your arm.

The NEW days, as described by a growing number of 21st-century physicians:  Patients make same-day appointments on the internet, type in health information online, and drive to a small office building where they know that friendly Dr. Jones will see them immediately. During the exam, which includes a couple of clicks on the physician’s laptop and to bring up the patient’s electronic medical record (EMR, or EHR for electronic health record), Dr. Jones may spend a good half hour with the patient, perhaps typing a prescription order on the computer, zipping it off to the patient’s pharmacy. After the visit he enters new information—online—into the health record, prepares his bill, and zips that off to the appropriate medical insurer.

Exhibit A: Scott Clemensen, MD, who can’t resist a little preening. “By the end of the day, I’ve completed all documentation, my billing has been sent electronically to the clearing house, all of my correspondence is done, and all my patients have been followed up with on the daily work,” he says. In today’s technological terms, “The inbox is empty at the end of the day.” more »



Right-Those Wrong First Impressions

When you've gotten off on the wrong foot - whether with a supervisor, a co-worker, or a patient, it's both important and possible to get the relationship back on track. Simple steps to patching things up and moving forward.

By Marilyn Haddrill | Feature Articles | July/August 2008


Early in his medical career, pathologist Ronnie Garner, MD, was working at a medical facility where he observed blood bank procedures that he was convinced needed to be changed immediately.



Practicing in the Public Eye

It's not the glamour job you may think, and you probably won't get rich, but physicians who work in the media agree that if you have the passion, it's a great career.

By Jon Van Zile | Feature Articles


Pamela Peeke, the chief medical correspondent for nutrition and fitness for the Discovery Health cable network, made an unusual career choice a few years ago: She moved into a full-time media position.

When she did this, Peeke, MD, MPH joined a small group of high-profile physicians who serve as trusted advisers, teachers, and frequently authors, and who live in a rarified world of high public exposure.

“We are a self-selected group,” Peeke says. “People who get jobs in media are inquisitive, are always learning, and are willing to be very flexible with a crazy schedule.”

Peeke and other “media docs” have been—and in many cases, still are—practicing clinical physicians and scientists. But somewhere their career paths took a turn and they ended up in front of a camera or behind a word processor. In fact, media exposure and even working for a news outlet may be good for a doctor’s career. It can raise your profile and give you additional streams of income. In some rare cases, a media job can be lucrative enough that you can transition completely out of clinical medicine if that’s what you want. more »



Banishing the Aura

Separating your professional and private life can be as easy as a stock response to requests. Making your friends and family heed that, however, presents a whole new wrinkle.

By Julie Sturgeon | Feature Articles


He knows the drill well: He’s dining in a restaurant with his family, catching up on the day when suddenly someone appears at his elbow. “Why, hello, doctor! Imagine running into you here,” the person greets him.

Maurice Ramirez, DO could put money on what the rest of the conversation will center around. The visitor swears she called the office/meant to call the office/should call the office but—could he call in a refill prescription for her? It will just take a minute and she’s down to her last one.

It’s a scenario he inherited the minute he started picking up board certifications in emergency medicine, family practice, and sports medicine to name a few of the specialties he covers in his boutique practice in Kissimmee, Florida. No matter where he goes, Ramirez—along with the other 700,000-plus physicians in this country—are sitting ducks. Blame it on the media, folklore, or gossip, but the American society isn’t set up to allow physicians to be regular people. The pressure, says John-Henry Pfifferling, PhD, the director of the Center for Professional Well-Being in Durham, North Carolina, is always to be on, always knowledgeable, clear and present, never tired or irritable, and an exceptional human being.

“A lot of people look to doctors as surrogate fathers who know everything from stock tips to housing advice, to how to deal with a cold,” says Thomas Demaria, PhD, the assistant vice president of behavioral health sciences at the South Nassau Communities Hospital in Oceanside, New York. “The assumption is that they are all powerful.”

Physicians feed the image, of course: They answer the telephone as “Doctor Smith.” They order family address labels announcing the card sitting in a friend’s mailbox is from Doctor and Mr. Smith. One of Demaria’s friends had the bureau of motor vehicles in his state put the letters MD on his license plate. “I said, ‘Why did you do that?’ and he said quite earnestly, ‘I want to be available in case people need me,'” says Demaria.

Ego is the other unspoken reason. Counselors to physicians readily admit the requirements for entry into this profession weed out the weak personalities and sharpen competitiveness and perfectionism. Doctors commonly fall into the trap of defining themselves as people by their occupation. more »



Healthcare’s Safety Net

Community health centers exist for one reason—to care for patients regardless of ability to pay, resident status, or cultural differences.

By Teresa Odle | Feature Articles


Gary Wiltz, M.D.

A typical spring day in Anchorage, Alaska finds Dr. Thomas Hunt at Anchorage Neighborhood Health Center, caring for a homeless pregnant patient and a Laotian woman—also pregnant—who is mentally challenged and doesn’t speak English. He works nearly 80 hours a week as a family practice physician and the medical director of a community health center that serves both urban and rural patients from a number of cultures with high-risk pregnancies, HIV, diabetes, substance abuse, and other challenging medical needs.

Thousands of miles away, internist Gary Wiltz worries about the state of mental health services in rural Franklin, Louisiana, a town 100 miles southwest of New Orleans. As the CEO of Teche Action Board Inc., he oversees the Franklin Community Health Center (CHC) and three satellite clinics. When Wiltz arrived in 1982 as a National Health Service Corps provider, he had a staff of 10 or 12 and worked out of a crumbling old house in a practice he humbly referred to as “Southern Exposure,” in reference to a 1990s CBS show “Northern Exposure” about a family practitioner and the challenges he faced in the fictitious town of Cicely, Alaska. Today, Wiltz oversees a staff that includes two ob/gyns, a family practitioner, four nurse practitioners, a physician assistant, a pharmacist, and is in desperate need of a pediatrician. The CHC serves 15,000 area residents. “When someone comes into our center, we look at their resources to see not if we’re going to treat them, but how,” says Wiltz.

Therein lies the primary mission of community health centers:  to care for all who enter, regardless of ability to pay or any other barrier, whether it’s financial, cultural, or related to citizenship status. From the U.S. Virgin Islands and Maine to Hawaii and Pohnpei (six hours west of Hawaii), CHCs serve people in 12 time zones. “When I look at the globe, I realize we’re on about a quarter of the planet,” says Dr. Thomas Curtin, the chief medical officer for the National Association of Community Health Centers (NACHC). Curtin also serves on the board of his local health center—the one in East Jordan, Michigan, which he joined in 1978 as a National Service Health Corps scholarship student. more »



The Trailing Family

A new position is exciting, but moving can be stressful for your spouse and even frightening or depressing for your children. Tips to ensure a smooth and happy transition for everyone.

By Karen Childress | Feature Articles


You’ve accepted a new job, one that requires relocating. You were wined, dined, and signed, and before you knew it, you were immersed in a new practice. Meanwhile, your spouse or partner has been tending to the details of moving and is now immersed in unpacking, putting the house in order, getting the family settled, connecting to the new community, and possibly starting a new job of his or her own. It can all be a bit much. Moving is stressful and if isn’t handled with careful thought, attention to detail, and a sense of perspective, it can take a toll on the entire family. Whether you’re relocating across town or across the country, there are issues to consider and steps to take that can make the move easier on everyone.


When you were single—footloose and fancy free, as they say—the decision to relocate and how to go about it was easy. Do you want to go or not? Rent a truck or hire a moving company? Start socializing the moment you unpack, or get settled in first? When you have a family to consider, it’s an entirely different ballgame. Moving is a family decision.

David Miller, M.D.

David Miller, MD, along with his wife, Inge, and their two small daughters moved from Ann Arbor, Michigan, to Santa Monica, California in 2006 for David to complete a urologic oncology fellowship at UCLA.

David Miller, MD, along with his wife, Inge, and their two small daughters moved from Ann Arbor, Michigan, to Santa Monica, California in 2006 for David to complete a urologic oncology fellowship at UCLA. David experienced what he calls ” a twinge of guilt” about extending his training after a six-year residency and moving his young family across the country. Recognizing the challenges associated with being in a new community and away from familiar support systems, David says he’s doing everything he can to make these two years work—for him professionally and for his family. “I’m busy at work and then when I’m home I’m focused on Inge and the kids,” says David. “My wife has been extraordinarily supportive and I’ve redoubled my commitment to the family, which has been great.”

Asked what advice he might offer other young couples about to make a move, David doesn’t hesitate. “Before you make the decision, think clearly about the implications for both you and your spouse. Explore whether there are substantial reservations on your spouse’s part,” he says. “Choose your next step so you’ll be personally comfortable and where your family will be happy. It’s difficult to achieve professional success if things aren’t happy at home,” says David.

Orthopedic surgeon Chris Hanosh, MD, of Durango, Colorado, has a similar philosophy. He and his wife, DeAnna, and their young daughter moved to Durango from Silver City, New Mexico in 2005. “The stay-at-home person needs to be happy,” he says. “I could do my job anywhere, but DeAnna and Abigail need to be happy in the community.” DeAnna chimes in with the flip side of her husband’s point. “If we loved the community but he hated his job, that wouldn’t work either,” she says.


According to counselors, moving is not something to take lightly. “Relocation is one of the bigger stressors that individuals and families experience,” says marriage and family therapist Greg Miller of Austin, Texas. “You take a new job, you’re moving, changing kids’ schools—it’s a tremendous amount of change all at once.” Miller says it’s not uncommon for adults to experience anxiety or depression during this sort of transition. Symptoms to be on the lookout for include irritability, fighting or arguing with your spouse, self-medicating with alcohol or drugs, engaging in addictive behaviors such as gambling or Internet pornography, changes in sleeping or eating patterns, or neglecting healthy activities like exercise.

Unique to moving is the stress caused by leaving your support system behind. “We tell ourselves we’re getting a new job, more money, a new house, and we expect that everything will be wonderful. It’s not part of our expectation that this move is going to be really difficult. People don’t prepare for it,” says Miller. Make moving less emotionally taxing by setting up a support system in advance. “Connect with a therapist, support group, church, or the local version of whatever group you were connected with back home,” says Miller. “Approach moving with the expectation that it will probably be difficult, and that you should set up a support system as soon as possible.”


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Six Secrets to Finding – and Keeping – Great Employees

Use these strategies to attract and retain top talent for your practice.

By Scott Westcott | Feature Articles | Uncategorized


“Help wanted”

Those two words can strike dread into the heart of a physician running a busy practice. Finding, hiring, and retaining good staff can be a real challenge for physicians already swamped with all the details of operating a successful practice. And the tight health-care job market in many parts of the country makes it even tougher.

“Doctors have to take care of all the aspects of running a business, including hiring, and of course they have to be out there treating patients—it’s not easy,” says Chris Forman, the president and CEO of AIRS, an employee training and consulting firm in Wilder, Vermont. “The reality is, many doctors are not professional managers. One of the things that happens in the health-care environment is you have an individual doctor or a group of people forced into being small business owners.”

Forman knows the challenges firsthand. His wife is a physician and a partner in a family practice. Yet he also believes it is possible to hire and keep great employees. Forman, along with other human resource specialists and successful physicians, says the key is to use fresh tactics that deliver better results than placing traditional help-wanted ads in the newspaper. These six strategies can help you attract—and keep—staffers that will be an asset to your practice.


A rich resource for finding good employees is already in your office—your existing staff. Physicians looking to grow their practice should make employees aware that they can play a key role in finding new talent.

“You should create the mindset that everyone is always recruiting,” says Forman. “Let employees know that you want them always to be looking for good people who might add value to the organization.”

Your employees probably know other people working in the same field and will most likely only recommend friends or acquaintances who will be solid performers. In addition, your current staff will likely share with potential candidates an honest assessment of what it is like working there. That helps weed out the people who might not be a good fit before you put the time and effort into the interviewing process.

The most successful employee referral programs offer cash bonuses to employees for a referring someone who gets hired. Depending on the market and the complexity of the job being filled, referral bonuses typically range between $200 and $1,000.

Charles E. Crutchfield III, MD, a dermatologist and an associate professor of dermatology at the University of Minnesota Medical School, has grown his practice from a handful of employees five years ago to 42 full- and part-time employees today. Crutchfield has made several key hires through employee referrals. He offers his staff a $500 bonus for a referral that results in a hire that lasts at least one year. One hundred dollars is paid at the time of hire, followed by $200 after six months and the remaining $200 at the end of the year.

“It’s been a successful way to motivate our existing staff to recommend someone they know who might be a good fit with our practice,” says Crutchfield, who is the sole physician working at the practice. “No one knows your office as well as your employees, so it takes a lot of the guesswork out of the hire.”

Yet, Chris Carmon, the CEO of the Carmon Group, a search firm in Cleveland, cautions that employee referrals can sometimes be problematic.

“You have to be careful that an employee doesn’t become too focused on making side money from referrals,” Carmon says. “And if someone makes a referral that is rejected they could cop an attitude. Employee referral programs are great, but it needs to be defined up front that simply making a referral doesn’t necessarily mean the person will be hired.”


Large hospitals and corporations are constantly focused on their “corporate culture.” Physicians running a practice should follow that lead and define what type of atmosphere and culture exists in their office. That makes it easier to look for people who might be a good fit.

“There is nothing a small practice can do on the advertising side to compete with the big hospitals,” Forman says. “The one thing they have to play on is how they practice and the atmosphere they have created in the office that might be attractive to some health-care professionals. There are plenty of RNs who don’t want to work in ICU anymore. They want to do community outreach or work in a family-oriented practice.”

Neil Baum, MD, a urologist working in New Orleans, has worked to create a family-like atmosphere in his office. He gets to know his employees personally, and he publicly recognizes their achievements. He sponsors fun activities outside working hours as well. After Hurricane Katrina hit, many of his loyal employees returned to work for him.

“I treat them like family,” says Baum. “Whenever they have a medical problem, I help them solve it. If they’ve had blood work done, I call and get the results right way. You have to ask yourself this question: ‘Would you want to work in your own practice?’ You should be able to answer ‘yes’ to that.”

An interest in the practice’s focus or mission sorts the field of applicants for some employers. Boris Volshteyn, MD, a plastic surgeon in Reno, Nevada, looks for employees who have a keen interest in cosmetic surgery and are close to the same demographic of many of the patients coming through the door.


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Bucks for Bricks

Whether you remodel or build your practice's facilities, it's not cheap, and unless you're rolling in dough, you'll need to finance at least part of the project. A how-to guide for landing the best deal and avoiding common pitfalls.

By Christine A. Hinz | Feature Articles


When Peter Dayton, MD, and his three partners set out to construct a satellite office in St. Lucie West, Florida, they knew they’d face some lean times.

After all, they didn’t want outside investors, even though each of them had to kick in $75,000 plus the $1.8 million loan.

But no one could have predicted how a force of nature would turn this group’s building plan on its head. When a spate of hurricanes—Frances, Jean, and Wilma—swept over Florida in 2004 and ’05, their ob/gyn practice took a financial hit, though not a physical one. The partners had already signed their construction loan, but the hurricane caused innumerable delays. In the meantime, the clock kept ticking on loan payments, which meant the practice had to carry the debt.

The physicians took smaller paychecks to carry the project during the 18-month delay, which meant actually increasing their investments another $15,000. Moreover, the doctors encountered numerous cost overruns and hurdles, including redrawing the designs to meet new building codes.

But Dayton, who had learned a thing or two about constructing buildings since he’d done it in the past, kept focused on the prize—a functional 15,666 square-foot facility that would meet their space needs now and their investment goals for the future.

“I’m not a super land investor kind of guy,” Dayton says. “But I know it’s better to own your property and lease [to other tenants] than it is to rent from somebody else. That might not be true in other situations, but I think it’s certainly true for us.”


Few decisions pose bigger challenges for a medical practice than financing and constructing an office building. On the plus side, there’s the lure of building equity as your structure appreciates. On the down side, committing millions of dollars to your own bricks, steel, and mortar is an entrepreneurial risk.

With a few make-or-break basics, you can sail smoothly through the process. In general, you want to:

Make sure you’re a high quality borrower.

• Shop around with your proposal to multiple lenders.

• Plan upfront to get accurate project estimates.

• Consider tenants for your building.

• Think twice about outside investors.

• Bring your accountant and attorney to the table to strategize your tax and legal options before you spend one dollar.

“One of the biggest mistakes physicians can make is entering into a financial transaction, especially constructing a medical office building, without talking to a CPA first,” says Joe Scutellaro, a CPA with Jump Scutellaro and Company in Toms River, New Jersey. “There’s always so much more we can do to help structure the deal up front to maximize potential tax benefits. But those benefits can be lost if we’re brought in too late,” he says.

Your advisers, for instance, will no doubt suggest spinning the building into its own Limited Liability Company, or LLC, so it’s separate from the practice. Obviously, state law will govern your options (you may see Limited Liability Partnerships instead), but the idea is that you don’t commingle the two entities for tax and liability reasons.

“If you can get your attorneys involved in the beginning, they can save you a lot of headaches down the road,” says Aasia Mustakeem, an attorney and real estate partner for the law firm of Powell Goldstein in Atlanta. “Sometimes people will say, ‘I’ve negotiated this and I just need you to do X, Y and Z.’ But when you look at what they’ve done, your hands are tied because they did A, B, and C.”

Banks…mortgage brokers…corporate financing groups…institutional investors…even the Small Business Administration. With a plethora of lenders in the market, there’s never been a better time to finance a medical office building. But what’s the best way to do it? And how do you create the kind of leverage that will earn you the most favorable terms?

First, you want to come into the marketplace with capital (usually 20 percent of the total amount needed). While the goal is to spend as little of your own money as possible, in order to compete, you must show that you’re willing and able to invest.



To Landlord or Not to Landlord?

Although it may not have the drama of Shakespeare, whether to rent or own your practice's facility depends - at least in part - on the philosophical question of how you see yourself.

By Mark Terry | Feature Articles


Tori Freeland, DDS, MS, an orthodontist in Lake Orion, Michigan, has a spacious lakefront office in a building designed to look like a lighthouse. Her own office and her patient chairs all face the lake, which is only a few yards from the floor-to-ceiling windows. Freeland, however, doesn’t own her office, but leases it from the owners of the building. “When I bought the practice,” she says, “they weren’t selling the building, which has four owners. I sort of inherited the lease space with the practice.”

Freeland notes that although she’s pleased with the office and the space, “in the long run, if you know the area you’re going to stay in, it’s much better to buy as an investment.”


The biggest problem with leasing for most physicians is the perception that they are throwing money away. Although you’re acquiring a needed service for the money, it’s not an investment. Freeland says, “Rent is not an investment. It is set, but it increases every year.”

Freeland also notes that CAM costs-Common Area Maintenance charges like snow removal, restroom maintenance, and upkeep—typically are lumped into the rent, which can change every six months to a year.

Mike Crosby, CPA, MBA, the president of Provider Resources, a physician practice management company in Nashville, says, “The cons to leasing are that you can end up in a space that requires constant maintenance on a triple net lease. Triple net means essentially that the taxes, insurance, and minor repairs are all passed through to you. You pay the utilities; the taxes are all passed on to you as well as the association fees or general building fees; any general assessments are passed through to you, and then minor repairs are your responsibility as well.”

There are advantages, though. “Leasing gives you a chance to get in and have some options, depending on the length of the lease. You may be entering an area where you’re not sure you’re committed to being in permanently,” Crosby says.

Some of the advantages, of course, depend on timing. John Guiliana, DPM, a podiatrist in Hackettstown, New Jersey and a partner in SOS Healthcare Management Solutions, a practice management group, says, “Most of the people I give advice to I recommend that they lease for at least a year to be sure that this is the right marketplace for them, the right location for them. Then they can certainly restructure their lease so it’s available for repurchase.”

Shelly Klein, MD, a pediatrician in Prescott, Arizona, says, “I don’t have a problem with leasing, but when I found out that the local leasing situation involved paying everything, I figured I might as well own the property and be my own landlord rather than pay all the expenses and have to follow somebody else’s rules and not get any benefit from it.”

Guiliana has owned his own practice facility for almost 20 years. “Unless you’re absolutely averse to having the necessity or responsibility of being a landlord, I would say there’s no real downside to owning. Certainly it’s a capital issue; you do need the capital available for down payment, and that capital that’s tied up in real estate could be used for something else. I can’t really see any other downsides,” Guiliana says.


Although the consensus seems to be that owning your facility is preferable to renting it, it’s not a particularly simple decision. Many physicians acquire or build a building—either to host their practice or for multiple practices or multi-use with the intention of it being a good investment. Paul Angotti, who runs a practice management firm called Management Design in Monument, Colorado, says, “Fundamentally, I would ask, ‘If it wasn’t the building the physicians occupy, would they want to invest in it as a building anyway?’ If it’s not a good deal, but they want to buy it just because they occupy it and want to be able to exhibit some power or want to exhibit some influence over the owners, then they probably shouldn’t do it. If it were a shopping plaza or an office building downtown, would they want to invest in it? If the answer is no, then they shouldn’t do it, because then it’s going to be a bad deal.”


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Doctor Come-Lately

It's not a trend, but physicians who entered medicine after having a previous career aren't a rarity, either. These nontraditional students say the rewards have been worth the sacrifice and the obstacles are not insurmountable.

By Debbie Feldman | Archives 2007 | Feature Articles | Physician life


As the first child in any generation of her family to attend college, Deborah Clements, M.D., dreamed of becoming a physician, but she didn’t choose a career in medicine as an undergraduate because “during that time [the late ’70s] women rarely entered medicine unless they were from families of physicians, which I was not. I was further discouraged by my undergraduate adviser who told me I wasn’t smart enough to become a physician,” she says.

Clements, 46, an associate professor and the associate program director in the department of family medicine at the University of Kansas Medical Center, entered medical school at the age of 33 after working in a variety of jobs, including 13 years at Methodist Health System in Omaha, Nebraska, first as a human resources systems manager and later, as director of compensation.

Clements is typical of a breed of doctors who enter medicine after working in other careers. “It’s not a trend, but it applies to a fraction of the applicants we see,” says Harold Helderman, the assistant dean of admissions at Vanderbilt University School of Medicine in Nashville. According to Andrew Frantz, M.D., the associate dean for admissions at Columbia University College of Physicians and Surgeons, a handful of the 150 people admitted to Columbia’s medical school each year are career changers. They come from fields as diverse as law, engineering, teaching, finance, and management.


Some of the “eventual” physicians intended to go into medicine from the start, but got sidetracked or delayed pursuing medical school. Others initially chose one career and later decided to switch to medicine.

Clements started her pre-med education as a biology major in college, but didn’t complete her undergraduate degree for another 13 years. She left college after three years, got married, became pregnant, and worked full-time to support her family. “Unfortunately, my education and my dream of medical school became less and less of a priority,” she says.

At the age of 30, she was widowed and “decided I’d put off my dream of becoming a physician long enough. I eventually went back to medicine because of the advice of another adviser. After my husband’s death, I decided I would not spend the rest of my days in front of a computer analyzing pay data. We were in the midst of a nursing shortage at that time and the hospital also had a college of nursing. One of the employee benefits at my job was paid nursing school tuition for full-time employees, so I decided that if I couldn’t be a physician, I’d return to school and get a nursing degree,” Clements says. “After my first semester, my nursing advisor suggested that she and the rest of the faculty thought I should apply to medical school because, ‘we really don’t see you taking orders from anyone.’ That was the gentle nudge I needed. I finished my premedical requirements that year, applied to one medical school and was accepted.”

David Krol, M.D., is the vice president of medical affairs for The Children’s Health Fund, a New York City health advocacy organization. He was a professional baseball player in the Minnesota Twins minor league system for almost three years. “I didn’t go into medicine in the beginning because I had always had a dream of being a professional baseball player. When I was presented with the opportunity to fulfill my dream, I took it. I knew that I could always go back to school, but I couldn’t always be a professional baseball player.” He was released from the minor leagues after three years without playing in the majors.

When he left baseball, he had eyes for only one thing:  a career in medicine. “I wasn’t interested in anything else. I didn’t want to go into business or law or engineering and I was very interested in health policy and trying to change our health-care system.” After his release, Krol did a stint as an assistant greens keeper on a golf course, loaded trucks at a Coca-Cola warehouse, and worked as a chemist at a wastewater-treatment facility. “Those weren’t careers—just jobs to make money for medical school during the time between baseball and the start of the academic year,” he says.

According to the Association of American Medical Colleges (AAMC), of the roughly 17,000 people who enter medical school each year, about five percent are older than 30, and less than one percent are older than 38 upon entrance. The average age of medical students entering their first year of medical school has hovered around 24 for the past two decades.

According to Frantz, the age upon medical school entrance doesn’t make a lot of difference unless someone starts school in their 40s vs. their 20s. He says that although older students often have more maturity, better focus, and more social experience, Columbia is reluctant to accept someone 40 or 50 years old into medical school because “it’s harder for older people to assimilate information. There is also the added consideration of how long will they be in service in medicine?” he says.

Maturity a plus

While “older” medical students can feel set apart from their just-out-of-college fellow students, Susan Skaff Hagen, 31, an M.D./PhD candidate at the University of South Carolina School of Medicine, who entered medical school at the age of 28, says that being the oldest female in her class isn’t a problem. “I haven’t really allowed age to interfere with my relationships with my classmates. Some are still one step from college and enjoy frequenting bars more than I do. The beauty of medical school is that there are a variety of people to meet with similar schedules and there are plenty of people who enjoy similar things to me.”

Yet, her life experience does sometimes set her apart from her classmates. “Some of my classmates had never lived on their own and did not understand the demands of life—grocery shopping, laundry, cooking,” says Hagen. “They were asserting their independence while trying to learn a massive amount of information. Some say learning in medical school is like drinking a sip of water from a fire hydrant. I had a good balance on my personal life prior to entering medical school which made me feel much more grounded,” she says.

While Krol wasn’t the oldest in his class, “I did feel like I had seen and experienced more than many of them by not going straight through from college.” Clements, who entered medical school at 33, says that in her class, the average was 25 and there was one student older than her and about five students between 29 and 33. “I can’t say that I was more or less prepared. I was just differently prepared. I knew more about time management, for example, than my younger classmates.”

Leslie Brott didn’t plan to become a doctor. Brott, 41, who practices family medicine at Physicians’ Medical Center in McMinnville, Oregon, graduated from college with a BA in history and taught high school ESL (English as a Second Language) in Texas for nine years before attending the University of Texas Health Science Center in San Antonio.

While she loved teaching and came from a family of educators, she realized she needed more. “Teaching ESL was a joy, but the content itself was not challenging. There are always challenges with the students and administration, but those weren’t intellectually challenging. I felt that I would thrive with a career that caused me to be continually learning and updating my knowledge base. Medicine is always changing and to be effective one has to be as up-to-date as possible on the newest and best theories and practices.”

Once she realized she needed a career that demanded more intellectually, Brott explored other options. “Medicine seemed like such a natural choice that I wonder why I didn’t choose it originally. The human body and mind have always fascinated me,” she says. “A career helping others was clearly a goal and medicine just seemed to fit.”

For Brott and others, however, the issue of the science requirement looms large. How do medical schools’ admissions boards see career changers? “If their undergraduate education was strong, we treat their application the same [as those with pre-med backgrounds],” says Joanne McGrath, the assistant dean of admissions and financial aid at New York University School of Medicine. “If not, then we suggest they do post-baccalaureate work in science or a master’s in science and then apply to medical school.”

At Columbia, catching up involves one year each of biology and physics and two years of chemistry. “Our humanities majors do just as well as others from science backgrounds,” when it comes to fulfilling the science requirement, says Frantz. At Columbia, students can go to the Columbia School of General Studies to fulfill the science requirement.

Because Brott majored in history in college, “I took only the bare minimum in science to graduate from college and I had many pre-med classes to take. I didn’t think I could “do” science. I quit calculus in high school and never took math again in college. I took basic, basic science classes the first time in college as I had no confidence in my ability to succeed in science. Knowing that if I wanted a career in medicine, I had to take those classes, I jumped in.” For her pre-med classes, she started with biology. “I loved it. A lack of a science background is not a barrier to entering medicine. You just have to do it.”

Brott moved to her home state of Oregon and took pre-med classes to make up for her lack of a science background. “I really couldn’t afford to just attend college, so I started working again in the public schools. I taught ESL and Spanish at a small high school for five years while I took my pre-med classes at a university in Portland.” But, attending classes at night and during summer term made Brott feel “completely out of the loop with regard to pre-med advising, so I had to do my own navigating of the medical school entrance procedures. I found it rather difficult to be a part-time pre-med student, unable to interact frequently with other pre-med students and completely unable to meet with an adviser.” Since she had the summers off, she was able to complete many credits during summer terms. During the school year, “Time management was my friend and having some flexibility at work helped as well, as I could leave at 3:30 to get to my evening classes,” Brott says.

Hagen, who majored in Spanish in college and taught Spanish for three years says, “I felt disadvantaged because I was not as prepared to enter medical school with a seven- to eight-year gap between when I finished my undergraduate work and medical school. I felt removed from the rigors of learning basic science.”

Krol majored in biology in college, but had to brush up on science nonetheless. “I was on a pre-med track so I was prepared to enter med school. Though, because I didn’t take my MCAT until after my playing days were over (five years after freshman biology and chemistry), I had to re-learn all of that stuff. It was a busy summer of studying after I was released from the team”

Money doesn’t have to matter

While finances may be a disadvantage of starting medical school as a career changer, it doesn’t have to be a deal-breaker. “I will be a member of the camp of diminishing returns, especially after my decision to enter a general surgery residency for five to seven additional years after graduation,” says Hagen. “But, I also must acknowledge that since my husband is a physician, the financial aspect of three to five additional years at low pay will not be as important for us.”

Brott entered medical school at 31 years old, right after marrying. She worked during medical school as a lab assistant and tutor, received a large scholarship in her fourth year of medical school, and her husband worked while she attended medical school. She finished residency at age 38. “Now, in my third year of practice, I’m paying off an $80,000 student loan debt. Hopefully, I’ll pay it off by the time I retire!”

Clements also graduated with considerable debt. “By the time I finished medical school, I was about $100,000 in debt and behind another $150,000 in lost earnings,” she says. “Certainly, I thought about this before I made the decision to make the commitment to medicine, but if the choice to work in medicine is about money for anyone, it’s the wrong choice.”

Krol also has loans, but “I didn’t really worry too much about paying them back, because I knew that eventually I would. It didn’t factor at all into my decision to enter med school.”

He used his baseball signing bonus to cover part of his first year of medical school. “I didn’t think I’d be at Yale, so I thought it would cover my whole first year. It didn’t. Minor league baseball isn’t much of a money-maker, so I really didn’t save much for my education. It was lots of loans for me.”

The emotional and financial support of family members goes a long way in helping career changers ease the way into their new career. “My choice has not been without cost. I remarried just before medical school and divorced a few years after I finished residency,” Clements says. “This passion is difficult for many to understand. On the surface, my husband was very supportive, although I don’t think he ever understood the commitment he was making.”

Brott says spousal support was crucial to her success. “My husband was completely supportive of my decision to enter medicine,” she says. “We met while I was teaching high school. He knew from the beginning that my goal was to become a doctor and he helped every step of the way. He quizzed me in some subjects, kept the household going, participated in the medical school social life, and essentially allowed me to pursue my studies.”

Something “extra”

While career changers may have to “catch up” with the science and share many of the financial hurdles of traditional students, they also bring special abilities and transferable skills. “The most transferable skill I brought to medicine,” says Krol, “was the ability to work as part of a team. In baseball, the team is most successful when each member is performing their individual tasks with a shared goal of winning as a team.”

Hagen majored in Spanish acknowledging that language barrier is an important aspect of medicine and says her clinical performance reflects this experience. “I excel on the wards at the hospital with the ability to communicate with a variety of patients,” she says.

Clements agrees and says the experience from her “first life” helps her as a physician. She says her human resource background helps her know how to approach patients and her business experience “has helped me to recognize the parts of medicine that need to be treated like a business in order to remain successful and to make effective career decisions.”

Brott says transferable skills were a boon to her career change. “There are many skills I developed during my first career as a teacher which help me now. The interpersonal skills involved in a teacher-student relationship carry over into medicine. As doctors, we’re constantly teaching and we need varying skills to address the learning needs of our patients. Understanding how a school runs (the hierarchy, the paperwork) definitely helps in navigating medical school, residency, and in running a practice,” she says.

What qualities do career changers need to make it through medical training? “People who change careers must have diligence, determination, and focus,” says Hagen.

Clements says anyone going into medicine as a second career must be resilient and keep their eye on the prize. Brott agrees that changing careers takes a big commitment. “The maturity we’ve developed helps ensure that the commitment is appropriate. Flexibility is a must, as things don’t always go as planned. You certainly can’t expect things to be the same as they were—life is always changing along with career changes,” Brott says.

A strong work ethic and ability to focus are also qualities that career changers share. “I treated medical school like a job—I went to class every day and studied before I played,” says Brott.

Krol agrees. “Through baseball and other athletic experiences, I developed a work ethic that has helped me in my medical, advocacy, and policy efforts. Having played pro ball also gives me a great way to connect with many different types of people and help them feel at ease because I can talk about something other than medicine. I think my work ethic took me further than my talent would have taken me alone. I promised myself that I would never look back and say, ‘If only I would have worked harder.’ And I never have.”

Are these docs happier than before they went into medicine? “I’m not sure I can say I am happier, because playing baseball was and is so much fun. It’s hard to beat being on a ball field,” says Krol. “I’d have to say I am equally happy because I am passionate about what I do. One passion—children and child advocacy—has replaced another—baseball.” His advice for career changers? “Be passionate about what you do.”

Clements puts the rigors of medical school education and the challenges of practicing into perspective. “I recognize that this thing I do every day is not hard work,” she says. “Hard work is having three jobs, all of which you hate, to pay the rent and buy the groceries. I am blessed to be able to do what I love every single day.”

Brott agrees. “I’m very satisfied with my career change. It’s taken a lot of work, time and money, but if I hadn’t done it, I would probably be bored and restless, as well as older anyway!”

For Clements, the choice was about passion. “I’ll probably die with a stethoscope in my hand and student loans yet to be paid, but I will have had the career of my dreams. Not many people ever really get to do that, at any cost.”




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