Stephanie Patrick, Staff Writer – Dallas Business Journal
GREATER METROPLEX — For Okemefuna Okpara, arriving at the decision to pursue a career in emergency medicine was largely a process of elimination. His family practice rotations were too slow-paced for his liking, and life as a general surgeon was too time consuming. “I had heard so many rumors about how they had no personal lives and the long hours,” said Okpara, a soon-to-graduate medical student at The University of Texas Southwestern Medical School at Dallas. “Who wants that?” Apparently, fewer and fewer of Texas’ medical students and newer doctors. To avoid the long workdays and frequent after-hours care of patients that long have been considered the norm for physicians, many are making career decisions they hope will allow them to spend more time with their families and give them fewer business hassles. Other factors in their decisions are a long-term interest in a specialty, patient relationships and intellectual content, according to information provided by the Texas Medical Association.
For some, a clinical or academic setting will win out over a traditional practice. Others are eschewing the many primary care-related fields in favor of specialties allowing set hours. Primary care, including family practice, pediatrics and internal medicine, were the choices of 56% of all Texas medical students and residents in 1996, but dropped to 39% last year, according to a report by the TMA. And, although state and national figures from the Association of American Medical Colleges are preliminary, results for this year’s crop of medical students entering residency programs in the summer showed declining interest in most primary care areas and surgery.
Instead, growing numbers are opting for anesthesiology, physical medicine and rehabilitation and diagnostic radiology, according to a March 21 report by the TMA in Austin. While primary care remains important, locally there’s growing interest in emergency medicine, which, although known to be demanding, offers steady shift work, said Dr. Barbara Waller, the longtime director of student affairs at UT Southwestern. Mirroring state and national trends, radiology, which in the past few years has experienced severe shortages, is also popular. So is dermatology. General surgery and Neurosurgery are not. “I’ve noticed the change in just the last few years,” Waller said. “The word lifestyle comes up in conversations more and more.” Lifestyle was a prime consideration for Dr. Adriana Karpati. While she liked surgery, she did not want to be “attached to the pager all the time.” Karpati chose podiatry and, since completing her residency at JPS Health Network in 1998, attends mainly to diabetic patients who need constant foot care but are usually seen in scheduled appointments. She sees 15 to 20 patients during a typical eight- to nine-hour day unless a hospitalized patient requires more time. “You can still have a one-on-one relationship with patients and then go home to a family,” said Karpati, now working in a Grapevine practice and expecting her first child.
Even those training for primary care careers are making adjustments. A “reasonable call schedule” has led Dr. Niraj Mehta, a 2001 graduate of Texas College of Osteopathic Medicine in Fort Worth, to undertake his internal medicine residency at nearby Plaza Medical Center instead of other hospitals. He’s home most nights by 7 p.m., while others in his field are working 15-hour days, Mehta said. He expects to make between $120,000 and $150,000 after his residency and hopes to practice in either the Dallas-Fort Worth area or Austin. Veteran doctors have told him to consider joining large practice groups, where the workload is shared. However, Mehta is considering becoming a hospitalist, typically an internist or generalist who spends all or most of his time taking care of hospitalized patients. A relatively new and growing field, a hospitalist’s primary duty is to coordinate patient care from admission to discharge.
However slight, changes in doctors’ workloads resulting from the move toward less time-intensive specialties, are sure to affect patient care, said Marcia Collins of TMA. Texas has more than 30,000 practicing physicians and more than 90% are involved in direct patient care. As the state’s population continues to grow and baby boomers continue to age and need more care, projections indicate nearly 36,000 doctors will be needed by 2005, according to TMA. Primary care physicians accounted for 45% of the physician work force in Texas in 2000, the latest statistics available. It’s not just the younger physicians looking to ease the workload. An American Medical Association survey found that the average Texas physician’s workload dropped to 56.2 hours in 1999, compared with 61.3 in 1990. The average number of office visits per week dropped from 122.2 in 1990 to 106.9 in 1999. And, citing the skyrocketing premiums for medical liability insurance, many TMA members reported contemplating early retirement, according to a survey released last month. “That includes 56% of those ages 46 to 55 and an astounding 53% of those under 35,” said former TMA president Dr. Tom B. Hancher. About 40% of the 615 Texas doctors surveyed said they are imposing new or tighter limits on patients they will accept, and nearly a third said they are reducing the services they provide. Discouraged by the demanding workload and other hassles of “corporate medicine” in group-practice environments, Dr. Jennifer Aldrich has opted to practice medicine as a temporary for several months. Most of the family practitioner’s time is spent working at various practices in the Metroplex, and she recently spent a month on an Indian reservation in South Dakota. “There really aren’t that many hours in the day to practice medicine and handle the business side,” said Aldrich, who completed her residency at JPS Health Network in 1999. Aldrich should have no difficulty returning to full-time practice. Al Baume, a physician recruiter with Odell & Associates in Dallas, said 40% of his searches are for primary care physicians. Positions that used to be relatively easy to fill now “take four to five months.” Dallas, and Texas in general, appeals to many out-of-state doctors, Baume said. However, many newer physicians are opting for “garden spots” such as San Francisco, New York and Boston and shunning the medically underserved rural areas. But some, like UT Southwestern medical student and aspiring family practitioner Valerie Wreed of Irving, are opting for the smaller towns. Wreed said an upcoming move to Scott Air Force Base in Bellville, Ill., should allow her more time with her husband and 3-year-old son. “In a smaller town you can still pop out for a while and go see your son play soccer, and then go back to work and see a variety of patients,” she said.