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.”



The New Generation of Leaders

Value systems, work ethics, and expectations can clash when younger physicians join a practice headed up by "mature" doctors. Learn what makes each group tick, and how physicians - regardless of generation - can work more effectively together.

By Teresa G. Odle | Feature Articles


Mark Slidell, MD, is midway through his general surgery residency at Georgetown University Hospital in Washington, DC. He has taken two years off to acquire a master’s degree in public health and focus on surgical outcomes research, then he’ll return for the final three years fo training. He considers the extra education “another arrow to add to my quiver, an additional strength to offer.”

At 33, Slidell is a Generation Xer; he entered medical school later than most of his fellow residents. When he completes his training, he’ll be an asset to any practice or program. And like most Gen Xers—particularly those in subspecialties—he’ll be heavily recruited.

Several years ago, medical practice and hospital leaders began taking note of the “new breed” of physicians entering the market. They also realized that predictions of a physician glut were proving untrue. Recruiting picked up and competition increased for the new Gen X physician similar to Slidell. But like the latest technological equipment that every physician “has to have,” many practices recruited Gen X physicians without thinking through how best to use them. And unlike laparoscopes, humans don’t come with training manuals on CD-ROM. Many older physicians weren’t sure how to manage these young physicians, so they avoided issues and made assumptions. Often, conflicts arose. The young physician felt misunderstood; many simply moved on.

“One of the biggest hurdles to overcome for the generations is a lack of understanding of each others’ value systems,” says Cam Marston of Charlotte, North Carolina, a workplace generations specialist and the author of the book, Motivating the “What’s in it for Me?” Workforce (Marston Communications, 2005). And neither the older nor the younger group communicates readily about the issues. “It’s unspoken; they just walk away, scratching their heads.”

National practice management consultant Judy Capko of Thousand Oaks, California, confirms this is how physicians handle generational, as well as other conflicts. “I have experienced where the troublesome physicians just stick their heads in the sand to avoid confrontation,” she says.

Distinctions uncovered

Marston offers the “beeper at the hip” as a classic example of generational differences. Doug Lundy, MD, a young Boomer orthopaedic surgeon with Orthopaedic Center of the Rockies in Fort Collins, Colorado, agrees. “It’s well known that younger physicians don’t want to take call as much,” says Lundy. He specializes in trauma, and taking call goes with the territory. (See “The Generation Beat.”)

Brigitta Robinson, MD, a Gen X general surgeon with Associated Surgeons MD, PC in Denver, says younger physicians today often “ask for fewer hours but expect more money.” This is largely due to a core commitment to lifestyle vs. profession. Health-care consultant Rebecca Anwar, PhD, agrees. “Younger physicians want a life outside medicine,” says the co-founder of The Sage Group in Philadelphia. Yet they also have financial obligations. They may be married—even to another physician with debts.

Gen X physicians enter practice with technical savvy typically unmatched by their older colleagues and though loyal to principles, they are less loyal to organizations. This puts even more burden on physician leaders to understand and embrace their differences and values.



Happiness—Are doctors still finding it at work and if not, can they?

The surveys and polls call it "physician satisfaction", but the old-fashioned label is "happiness".

By Wendy J. Meyeroff | Feature Articles | Uncategorized


Matteo LoPreiato, MD, a pediatrician now based in Berlin, Connecticut, admits there are trials and tribulations affiliated with being a doctor nowadays, but he takes the hassles Dr. Matteophilosophically. “Name me one profession that doesn’t have more regulations,” he says. “The job is what you make out of it and the fact is there are a lot of professionals who aren’t as fortunate as we are, getting to do what we want to do day in and day out.”

Where’s that philosophy?

Unfortunately, there are any number of indicators that too many physicians no longer share LoPreiato’s balanced outlook on their profession. The Physician Work Life Study published in 1998 found a significant number of physicians—especially females—unhappy with their work. Among the most critical factors in their dissatisfaction were increased time pressures, more complex patient cases, and lack of control over workplace issues.

A 2004 survey of 50- to 65-year-old physicians by the national search firm Merritt, Hawkins & Associates was equally discouraging. It found that the number of physicians who were finding their jobs “less satisfying” was a disheartening 76 percent, up from 54 percent in the year 2000.

The numbers are not only bad for doctors, they’re bad for this country. The Merritt, Hawkins survey found that a small majority of respondents were somehow going to change their practices, with methods ranging from not taking on new patients to getting out of medicine altogether. With 38 percent of America’s physicians in the 50-plus age group, the surveyors say that could leave the United States with a significant physician shortage in less than 15 years.

While administrative and regulatory changes could undoubtedly help, the fact remains that doctors have to find more personal paths to staying happy in their work. LoPreiato seems to indicate it is still possible. Is he just an exception, or is there hope for other physicians as well?

Acknowledge hurts and hassles

William J. Hall, MD, the director of the Center for Healthy Aging at Highland Hospital in Rochester, New York, admits that, “You ask doctors generically ‘Are you happy?’ and many physicians respond negatively.” But if you dig a little deeper, he says you’ll find a much more complex series of responses.

Even seemingly mild issues can cause physicians to get discouraged, depressed, even angry in one way or another. Michael Krasner, MD, an internist in Rochester, New York, is now part of a larger group practice. “I can’t decorate the office the way I want it. The employees don’t answer to the partners, they’re responsive to the major medical center.” In the grand scheme of things these are minor annoyances—but enough “minor” annoyances and doctors find themselves
stressed, weary, even angry and depressed.

LoPreiato feels that the advent of nurse practitioners has in some ways been a detriment to physician satisfaction. It’s not that NPs aren’t great professionals, he emphasizes, but if they do most of the one-on-one work then “you don’t build a relationship with your patients.” In pediatrics, for example, “The parent senses you don’t have a handle on their kid,” or at the very least feels you don’t care enough to treat the child personally.

Part of the problem is finding a way for doctors to balance doing enough themselves so as to keep in touch with the real work of medicine, versus emphasizing a God complex that makes them believe they have to do everything. Nancy Church, MD, an ob/gyn based in Chicago, points out, “You can’t know everything…but that’s the exact opposite of what doctors are taught.”

And there are perhaps the greatest depressants, like one Church highlighted. She remembers finding aggressive ovarian cancer in one of her 37-year-old patients. The only thing Church could do was to provide that patient with emotional support, such as ways to talk to her children about her dying. While Church was doing that, however, she also found herself grappling with de-energizing business hassles, including malpractice insurance that keeps skyrocketing (more than 100 percent in the last two years).

Setting priorities

Yet for every doctor like the ob/gyn Church talks about who left medicine and went into teaching science, there are still many like her who stay, and others still coming into the profession. What keeps them optimistic and even happy?

Church admits she’s a natural optimist, but that alone isn’t always enough. She takes a variety of steps, from paying for a more expensive dry cleaner because it picks up and delivers (thus reducing one stressor in her life) to going out regularly with other female doctors to relax and trade experiences. Friends keep her balanced, too. When she had to cope with that young mother dying of cancer, she says, “I called a friend and said ‘I’m so bummed. You have to come take me out to dinner.'” And that’s what happened.

Sometimes the answer to restoring an upbeat attitude is simple: Take a vacation—a real one. That means not tapping into your e-mail every few hours or calling into the office regularly, both of which doctors say have become major obstacles to re-energizing. W. Lee Wan, MD, an ophthalmologist with Coastal Eye Specialists in Oxnard, California, says that taking family vacations (he’s married 22 years, with two children) helps. Europe was a good spot because, even with all the technology, he says, “with the time differences it was harder to reach me!”

Other times restoring contentment requires more radical approaches. For Wan and his group, it meant no longer accepting managed care patients. He says managed care caused too much of a “disconnect with the patients” which he believes is one of the leading causes of unhappiness among physicians. “Patients came here because they had to see us instead of someone else, or we had to administer a certain treatment whether or not we believed it was best for our patient.”

LoPreiato is also making a pretty major move—literally. At the time we spoke he was getting ready to relocate from his established practice in Pittsford, New York, to Berlin, Connecticut, where he’s starting with no income, no practice. Why? Because it’s nearer to his family, which not only helps him personally, it gives his daughter the extra support of grandparents and cousins. “If in 10 years her life isn’t what I’d hoped it would be, my conscience will be clear,” that at least he did everything he felt he could.

Family matters

Having a stable and happy life outside the office is critical, experts say. For male doctors that may be easier. Church says, “The majority of male doctors have a wife or partner who takes care of their daily needs,” like getting the clothes to the cleaner, sending out the birthday cards, and so on.

Women doctors aren’t so fortunate. A 2000 Case Western University study looked at 1200 physicians in their 30s. More than 60 percent were male physicians, and 22 percent of them were married to a doctor. Of the women, 44 percent were married to physicians and were still primary caregivers for the children. The Physician Work Life Study found female physicians were 50 percent more likely to suffer burnout compared to their male counterparts.

Michael Myers, MD, is a psychiatrist and a clinical professor in that field at the University of British Columbia in Vancouver, Canada. He’s also an expert on physicians’ health. He’s been in practice for 30 years and for 15 of them he has been treating doctors and their families. “When I lecture physicians I tell them I couldn’t do my work if I didn’t have access to their partners or spouses. That way I get the complete picture. Sometimes I only meet with the spouse. They have tons to say about medicine” and what makes it hard for them to maintain a satisfying home environment.

Myers has been married to a nurse for 35 years. They work at the same hospital and he remembers years when one of them worked nights, the other days. You’d think that would have been a strain on their relationship, but they looked at it as a positive. “We didn’t have paid child care and this way one of us was always home.” To put aside personal time for each other, Myers and his wife decided that every two weeks they’d hire a babysitter and go out. These “dates” not only helped reinforce their relationship and kept them happy, it was one of many ways they conveyed to the kids that their relationship as husband and wife was important.

LoPreiato admits that while his family helps him keep his center, it’s not always easy for them, especially with his erratic hours as a pediatrician. There’s no doubt in his mind that “physicians’ spouses and family have to understand the sense of duty doctors have,” but the doctor has to give somewhat, too. “You have to treasure your family.” Here’s one way the LoPreiato family stays together even when he’s seeing patients on a Sunday: “We go out to breakfast together. They come back to the office and wait for me and then we all go out together to do the shopping, see a movie”

Jennifer Virmani, DDS, actually spends an inordinate amount of time with her husband, Mohit—he’s her dental partner in Maryland. You’d think they’d get on each other’s nerves being together day and night, but Mohit Virmani says, “When we’re at work we don’t see each other that much, so we get together at lunch.” Both he and his wife say that playing to each other’s strengths at work and at home enhances both relationships. Mohit says, “I’m better at ordering supplies, for her it’s office design.” Jennifer agrees, saying “He likes researching on the ‘Net and does the accounting on the computer. I actually pay the bills and do more of the creative work.”




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