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January 7, 2004
Young Doctors and Wish Lists: No Weekend Calls, No Beepers
By MATT RICHTEL
ennifer C. Boldrick lights up when the topic turns to blisters, eczema and skin cancer. She is also a big fan of getting a full night of sleep. And the combination of these interests has led Dr. Boldrick to become part of a marked shift in the medical profession.
Dr. Boldrick, 31, a graduate of Stanford University Medical School, is training to become a dermatologist. Dermatology has become one of the most competitive fields for new doctors, with a 40 percent increase in students pursuing the profession over the last five years, compared with a 40 percent drop in those interested in family practice.
The field may have acquired its newfound chic from television shows like "Nip/Tuck" and the vogue for cosmetic treatments like Botox, but for young doctors it satisfies another longing. Today's medical residents, half of them women, are choosing specialties with what experts call a "controllable lifestyle." Dermatologists typically do not work nights or weekends, have decent control over their time and are often paid out of pocket, rather than dealing with the inconveniences of insurance.
"The surgery lifestyle is so much worse," said Dr. Boldrick, who rejected a career in plastic surgery. "I want to have a family. And when you work 80 or 90 hours a week, you can't even take care of yourself."
Other specialties also enjoying a surge in popularity are radiology, anesthesiology and even emergency-room medicine, which despite their differences all allow doctors to put work behind them when their shifts end, and make medicine less all-encompassing, more like a 9-to-5 job.
What young doctors say they want is that "when they finish their shift, they don't carry a beeper; they're done," said Dr. Gregory W. Rutecki, chairman of medical education at Evanston Northwestern Healthcare, a community hospital affiliated with the Feinberg School of Medicine at Northwestern University.
Lifestyle considerations accounted for 55 percent of a doctor's choice of specialty in 2002, according to a paper in the Journal of the American Medical Association in September by Dr. Rutecki and two co-authors. That factor far outweighs income, which accounted for only 9 percent of the weight prospective residents gave in selecting a specialty.
Many of the brightest students vie for several hundred dermatology residency spots. The National Residency Matching Program, which matches medical school graduates to residency openings, reported that in 2002, 338 medical school seniors were interested in dermatology, up from 244 in 1997 ? though the 2002 figure still represented only 2.3 percent of the potential doctor pool.
In 2002, 944 seniors wanted to pursue anesthesiology, compared with 243 five years earlier ? while the interest in radiology almost doubled, to 903 from 463, according to the matching program's figures.
Numerous medical educators noted that the growth of interest in these fields coincided with a drop in students drawn to more traditional ? and all-consuming ? fields. In 2002, the number of students interested in general surgery dropped to 1,123 from 1,437, for example.
And that has many doctors and educators concerned. "There's a brain drain to dermatology, radiology and anesthesia," Dr. Rutecki said. He said that students who are not selected for residencies in these lifestyle-friendly specialties are choosing internal medicine by default.
"Not only are we getting interest from people lower in the class, but we're getting a number of them because they have nowhere else to go," Dr. Rutecki said.
This notion of a "brain drain" to subspecialties from the bread and butter fields of medicine is not new. But in recent years it has come to be associated with a flight to more lucrative fields. What is new, say medical educators, is an emphasis on way of life. In some cases, it even means doctors are willing to take lower-paying jobs ? say, in emergency room medicine ? or work part time. In other fields, like dermatology and radiology, doctors can enjoy both more control over their time and a relatively hefty paycheck.
According to the American Medical Association, a dermatologist averages $221,000 annually for 45.5 hours of work per week. That's more lucrative ? and less time-consuming ? than internal medicine or pediatrics, where doctors earn around $135,000 and spend more than 50 hours a week at work. A general surgeon averages $238,000 for a 60-hour week, while an orthopedist makes $323,000 for a 58-hour week. The number of dermatology residencies has been steadily growing. The American Academy of Dermatology says there are 343 dermatology residents in their third year, 377 in their second year, and 392 in their first.
The trend comes as the medical profession is already struggling to balance the demands of patient care with the strain put on doctors from overwork. Since last year, new rules have limited a resident's hours to 80 hours a week.
Some medical careers, like radiology, entail working long hours but not responding to patient emergencies on nights and weekends.
Educators point to a number of factors to explain the newfound emphasis on lifestyle. Dr. Elliott Wolfe, director of professional development for medical students at Stanford, cites the growing proportion of medical students who are women; in the 2002-3 year they made up 49.1 percent of entering students, according to the American Medical Association. Dermatology offers more control and income than, say, pediatrics and family medicine, which have traditionally drawn women.
Lee Ann Michelson, director of premedical and health care advising at Harvard University, said undergraduates considering a future in medicine are extremely concerned about whether they can have a life outside of medicine. She said she talks to numerous children of physicians who are concerned they will be as absent in the lives of their children, as their parents were.
The symbol for "controllable lifestyle" is dermatology. And when residents graduate they can count on plenty of faces and bodies to heal and reconstruct, thanks to an aging, and affluent, population. One-stop dermatology spas seem to open weekly in Manhattan, offering lunchtime visitors quick-fix lip fillers, laser procedures and face peels. It's not fast food, it's fast facial.
"You make your own hours. You can see 15 patients a day, or 10 patients a day. There are very few emergencies. It's not an acute situation, ever," said Dr. Dennis Gross, a Manhattan dermatologist. Plus, he said the procedures dermatologists perform can be lucrative; a 12-minute Botox treatment can cost a patient $400, with the doctor keeping half, for instance.
And the procedures often are elective, meaning that patients pay out of their own pockets. "It's cash, check or credit card," said Dr. Wolfe of Stanford.
The difference in lives is well illustrated by the experience of Z. Paul Lorenc and Marek M. Lorenc, 48-year-old twin brothers who chose careers on different ends of the spectrum.
Marek is a dermatologist in Santa Rosa, Calif., north of San Francisco. He gets into work at 8 a.m., leaves at 6 p.m., and is rarely called to the hospital at night, giving him ample time to spend with his wife and two children. "When I'm done," he said, "I'm a husband and a father. I go to soccer games. I coach soccer games."
His brother is a plastic surgeon in Manhattan. He arrives at work before 7, kissing his two sleeping children before he leaves the house. He performs face lifts, breast augmentations, brow lifts and liposuction, intensive surgical procedures that demand round-the-clock availability at the hospital. He often does not get home until after 9 p.m., and he goes into the office on Saturday. He doesn't see his children nearly as much as he would like, but he said that is what the pursuit of excellence in his specialty requires.
He is bothered by what he sees as a lack of devotion by today's medical students. A faculty member at New York University's medical school, he said the interest in way of life is across the board.
"When residents come looking for jobs, they ask, `How often do I have to take night call,' " he said. "There's less intensity, less determination and less devotion."
But Dr. Boldrick said she is not trying to avoid hard work. While she intends to have two children, she still plans to work full time.
What she wants to avoid is chaos and uncertainty and the lack of control that comes with other specialties. "I see people around me who like to do those things, and I think, `Thank God,' " said Dr. Boldrick, who added that she feels she can make a contribution without taking on the meat and potatoes of say, internal medicine. "If I force myself to do something that didn't make me happy in order to pay a debt to society, that wouldn't do anyone any good," she said.
The reasoning resonates with Dr. Clara Choi, 32, a resident in radiation oncology at Stanford. Dr. Choi finds her field fascinating but pointed out that it also demands few unexpected calls to the hospital.
Married, she plans to have a family. "I'd have to get someone to take care of the baby if I spent every third or fourth night in the hospital," Dr. Choi said.
Dr. Rutecki says he completely understands, having missed out on a lot in the lives of his own two children.
"I missed a lot because I was on call three to five days a week," he said. "Rather than take this data as an opportunity to criticize, I think we recognize that this is the way medicine is moving."
Young Doctors and Wish Lists: No Weekend Calls, No Beepers
By MATT RICHTEL
ennifer C. Boldrick lights up when the topic turns to blisters, eczema and skin cancer. She is also a big fan of getting a full night of sleep. And the combination of these interests has led Dr. Boldrick to become part of a marked shift in the medical profession.
Dr. Boldrick, 31, a graduate of Stanford University Medical School, is training to become a dermatologist. Dermatology has become one of the most competitive fields for new doctors, with a 40 percent increase in students pursuing the profession over the last five years, compared with a 40 percent drop in those interested in family practice.
The field may have acquired its newfound chic from television shows like "Nip/Tuck" and the vogue for cosmetic treatments like Botox, but for young doctors it satisfies another longing. Today's medical residents, half of them women, are choosing specialties with what experts call a "controllable lifestyle." Dermatologists typically do not work nights or weekends, have decent control over their time and are often paid out of pocket, rather than dealing with the inconveniences of insurance.
"The surgery lifestyle is so much worse," said Dr. Boldrick, who rejected a career in plastic surgery. "I want to have a family. And when you work 80 or 90 hours a week, you can't even take care of yourself."
Other specialties also enjoying a surge in popularity are radiology, anesthesiology and even emergency-room medicine, which despite their differences all allow doctors to put work behind them when their shifts end, and make medicine less all-encompassing, more like a 9-to-5 job.
What young doctors say they want is that "when they finish their shift, they don't carry a beeper; they're done," said Dr. Gregory W. Rutecki, chairman of medical education at Evanston Northwestern Healthcare, a community hospital affiliated with the Feinberg School of Medicine at Northwestern University.
Lifestyle considerations accounted for 55 percent of a doctor's choice of specialty in 2002, according to a paper in the Journal of the American Medical Association in September by Dr. Rutecki and two co-authors. That factor far outweighs income, which accounted for only 9 percent of the weight prospective residents gave in selecting a specialty.
Many of the brightest students vie for several hundred dermatology residency spots. The National Residency Matching Program, which matches medical school graduates to residency openings, reported that in 2002, 338 medical school seniors were interested in dermatology, up from 244 in 1997 ? though the 2002 figure still represented only 2.3 percent of the potential doctor pool.
In 2002, 944 seniors wanted to pursue anesthesiology, compared with 243 five years earlier ? while the interest in radiology almost doubled, to 903 from 463, according to the matching program's figures.
Numerous medical educators noted that the growth of interest in these fields coincided with a drop in students drawn to more traditional ? and all-consuming ? fields. In 2002, the number of students interested in general surgery dropped to 1,123 from 1,437, for example.
And that has many doctors and educators concerned. "There's a brain drain to dermatology, radiology and anesthesia," Dr. Rutecki said. He said that students who are not selected for residencies in these lifestyle-friendly specialties are choosing internal medicine by default.
"Not only are we getting interest from people lower in the class, but we're getting a number of them because they have nowhere else to go," Dr. Rutecki said.
This notion of a "brain drain" to subspecialties from the bread and butter fields of medicine is not new. But in recent years it has come to be associated with a flight to more lucrative fields. What is new, say medical educators, is an emphasis on way of life. In some cases, it even means doctors are willing to take lower-paying jobs ? say, in emergency room medicine ? or work part time. In other fields, like dermatology and radiology, doctors can enjoy both more control over their time and a relatively hefty paycheck.
According to the American Medical Association, a dermatologist averages $221,000 annually for 45.5 hours of work per week. That's more lucrative ? and less time-consuming ? than internal medicine or pediatrics, where doctors earn around $135,000 and spend more than 50 hours a week at work. A general surgeon averages $238,000 for a 60-hour week, while an orthopedist makes $323,000 for a 58-hour week. The number of dermatology residencies has been steadily growing. The American Academy of Dermatology says there are 343 dermatology residents in their third year, 377 in their second year, and 392 in their first.
The trend comes as the medical profession is already struggling to balance the demands of patient care with the strain put on doctors from overwork. Since last year, new rules have limited a resident's hours to 80 hours a week.
Some medical careers, like radiology, entail working long hours but not responding to patient emergencies on nights and weekends.
Educators point to a number of factors to explain the newfound emphasis on lifestyle. Dr. Elliott Wolfe, director of professional development for medical students at Stanford, cites the growing proportion of medical students who are women; in the 2002-3 year they made up 49.1 percent of entering students, according to the American Medical Association. Dermatology offers more control and income than, say, pediatrics and family medicine, which have traditionally drawn women.
Lee Ann Michelson, director of premedical and health care advising at Harvard University, said undergraduates considering a future in medicine are extremely concerned about whether they can have a life outside of medicine. She said she talks to numerous children of physicians who are concerned they will be as absent in the lives of their children, as their parents were.
The symbol for "controllable lifestyle" is dermatology. And when residents graduate they can count on plenty of faces and bodies to heal and reconstruct, thanks to an aging, and affluent, population. One-stop dermatology spas seem to open weekly in Manhattan, offering lunchtime visitors quick-fix lip fillers, laser procedures and face peels. It's not fast food, it's fast facial.
"You make your own hours. You can see 15 patients a day, or 10 patients a day. There are very few emergencies. It's not an acute situation, ever," said Dr. Dennis Gross, a Manhattan dermatologist. Plus, he said the procedures dermatologists perform can be lucrative; a 12-minute Botox treatment can cost a patient $400, with the doctor keeping half, for instance.
And the procedures often are elective, meaning that patients pay out of their own pockets. "It's cash, check or credit card," said Dr. Wolfe of Stanford.
The difference in lives is well illustrated by the experience of Z. Paul Lorenc and Marek M. Lorenc, 48-year-old twin brothers who chose careers on different ends of the spectrum.
Marek is a dermatologist in Santa Rosa, Calif., north of San Francisco. He gets into work at 8 a.m., leaves at 6 p.m., and is rarely called to the hospital at night, giving him ample time to spend with his wife and two children. "When I'm done," he said, "I'm a husband and a father. I go to soccer games. I coach soccer games."
His brother is a plastic surgeon in Manhattan. He arrives at work before 7, kissing his two sleeping children before he leaves the house. He performs face lifts, breast augmentations, brow lifts and liposuction, intensive surgical procedures that demand round-the-clock availability at the hospital. He often does not get home until after 9 p.m., and he goes into the office on Saturday. He doesn't see his children nearly as much as he would like, but he said that is what the pursuit of excellence in his specialty requires.
He is bothered by what he sees as a lack of devotion by today's medical students. A faculty member at New York University's medical school, he said the interest in way of life is across the board.
"When residents come looking for jobs, they ask, `How often do I have to take night call,' " he said. "There's less intensity, less determination and less devotion."
But Dr. Boldrick said she is not trying to avoid hard work. While she intends to have two children, she still plans to work full time.
What she wants to avoid is chaos and uncertainty and the lack of control that comes with other specialties. "I see people around me who like to do those things, and I think, `Thank God,' " said Dr. Boldrick, who added that she feels she can make a contribution without taking on the meat and potatoes of say, internal medicine. "If I force myself to do something that didn't make me happy in order to pay a debt to society, that wouldn't do anyone any good," she said.
The reasoning resonates with Dr. Clara Choi, 32, a resident in radiation oncology at Stanford. Dr. Choi finds her field fascinating but pointed out that it also demands few unexpected calls to the hospital.
Married, she plans to have a family. "I'd have to get someone to take care of the baby if I spent every third or fourth night in the hospital," Dr. Choi said.
Dr. Rutecki says he completely understands, having missed out on a lot in the lives of his own two children.
"I missed a lot because I was on call three to five days a week," he said. "Rather than take this data as an opportunity to criticize, I think we recognize that this is the way medicine is moving."
