http://www.charleston.net/stories/01...5doctors.shtml
Story last updated at 8:23 a.m. Sunday, January 25, 2004
Med students begin to put lifestyle first
BY JONATHAN MAZE
Of The Post and Courier Staff
Dr. Elise Jackson was drawn to dermatology because of its particularly precise approach to surgery and the diversity of patients, from an 8-year-old with a funny mole to a 92-year-old with melanoma.
Her specialty's typical work schedule, considered relaxed in the workaholic field of medicine, didn't hurt, either.
MIC SMITH/STAFF
Elise Jackson, a first-year dermatology resident at MUSC, thinks the hours are great in her specialty, allowing her to gain a sense of some control over her life.
Now that she's a first-year dermatology resident at the Medical University of South Carolina, "I thank my lucky stars that I'm in it," Jackson said. "The schedule is so great."
Jackson, a 26-year-old from a small town in southwest Virginia, says many of the residents and students she knows in dermatology were, in fact, drawn to it because of its less-demanding schedule: few night or weekends shifts or 3 a.m. pages, and plenty of time to raise a family and get some sleep.
This sort of consideration to work schedules is increasingly being made at medical schools across the country, with more students than ever drawn to specialties that get them away from nightmarishly long and erratic hours.
"What hasn't changed is that everybody still works hard," said Dr. Jack Feussner, chairman of the Department of Medicine at MUSC. "The issue is, when you're off, you really are off. You have that time to do other things, to spend with family. It's the uncertainty of being available almost continuously that bothers people."
There are plenty of other reasons why med students go into particular specialties and avoid others. Shortages in certain areas (anesthesiology, for example) help lure students to some specialties, while high malpractice insurance premiums (in obstetrics, among other areas) are keeping some students away.
Lifestyle, however, has become the leading factor in explaining why med students today choose particular specialties.
In 2002, lifestyle played a role in 55 percent of students' choice of specialty, according to a study published in the September issue of the Journal of the American Medical Association. By contrast, income -- historically a leading factor -- was cited in just 9 percent of those decisions.
Dr. Fred Crawford, surgery chairman at MUSC, asks students for the reasons behind their career choices all the time. "Inevitably, in the top three, and usually in the top one, they say lifestyle," he said. "That's a real buzzword."
The medical association study noted that between 1997 and 2002, the number of American medical students interested in dermatology grew by 39 percent. The number interested in anesthesiology nearly quadrupled, and the ranks of those who wanted to go into radiology nearly doubled.
While these three specialties are distinctly different, and the work demands can be strenuous, all are known for schedules that are more easily controlled.
By comparison, the number of students interested in fields known for their all-consuming nature has generally dropped over the same period, according to the study. The number interested in general surgery fell by 22 percent, for instance. Interest in family practice dropped 42 percent, and 7.6 percent fewer students opted for internal medicine.
Dr. Marianne Rosen, a dermatologist in downtown Charleston, said students selecting residencies still tend to pick from a few specialties they like, and then factor in lifestyle concerns. "Nobody wants to go into something they don't like, even if it does offer a good lifestyle."
Length of workweeks seem to have less bearing on students' decisions than when they're made to work. Anesthesiologists, for instance, work an average of 61 hours a week, according to the American Medical Association. Family practitioners, on the other hand, work 52.5 hours a week on average.
While some students are willing to choose lower-paying jobs to gain control of their schedules, they can still make a tidy sum.
Dermatologists work an average of 45.5 hours a week and make $221,000 a year, according to the AMA. The field can be especially lucrative if these doctors concentrate on cosmetic procedures. Anesthesiologists make $225,000; radiologists, $263,000.
The family practitioner, meantime, makes an average of $132,000, though he or she does have one less year of post-graduate training.
Experts offer few reasons for the trend toward more lifestyle-oriented specialties. Crawford, for one, speculated that the movement could be generational.
"It seems that the current generation of medical students have perhaps a different value system than our generation," he said. "I have no sense that it's wrong. It may be right. They're putting more of an emphasis on lifestyle and family relationships."
Many experts note that the emphasis on lifestyle is growing along with the presence of women in medical schools.
According to the Association of American Medical Colleges, women compose nearly half of medical school students, a percentage that has increased steadily over the years.
Women often end up balancing career and family responsibilities and thus have to choose a career with a schedule they can more easily control, said Cindy Rossi, business manager for the dermatology department at MUSC.
"You have to look at lifestyle if you want to be a mother and have children," Rossi said.
Some wonder whether the added emphasis on lifestyle could mean a permanent change in the medical profession.
For instance, Crawford noted that many medical schools, including MUSC, saw a spike this year in applications for surgical residencies, an area that historically saw superhuman work schedules and where interest had waned somewhat.
Crawford worries that students may think the work hours have improved, now that new regulations this year require medical schools to limit residents' work week to 80 hours.
"If people are going into surgery now just because they think the work hours are better, that's not a realistic view of what it's like when you become surgeons," Crawford said.
Another concern is that the movement of students from some specialties to others could create shortages.
Medical schools already rely on more foreign students to fill residency vacancies. Last year, 95 percent of internal medicine residencies were filled, but only 55 percent were by American students. Whether those students remain in this country to practice medicine after graduating is a big concern to the profession.
Over the long haul, some experts say that the drift to less-demanding specialties could create shortages in areas where the work hours are less convenient. Crawford believes there could be a shortage of surgeons in coming years.
Feussner, too, wonders whether there will be enough internists. "It begs the question: Who's going to take care of these people?" Feussner said.
One subspecialty, trauma surgery, already is suffering. Nationally, a shortage of trauma surgeons is hurting hospitals that care for those with the most serious, life-threatening injuries. Those hospitals without enough trauma surgeons could find it more difficult to get such patients into emergency surgery.
South Carolina once had 12 trauma surgeons; it now has eight.
Pay is one reason for the shortage; trauma surgeons aren't paid as well as other surgical specialties. But scheduling has a lot to do with it, too.
MUSC's Dr. Doug Norcross, a veteran trauma surgeon with two children, gets into work at 7 a.m. and, on a good day, leaves by 6 p.m.
"On a bad day, I'm in by 7 and I'm not home until the next afternoon," Norcross said. "It varies from day to day, which is part of the difficulty in it."
Compare that to Rosen's schedule. The 54-year-old James Island resident sees patients from 8 a.m. to 5:30 p.m. She then spends an hour doing paperwork before going home.
Rosen does carry a pager because she allows patients to call when they have a question. It doesn't go off often, and only rarely does the call result in her having to see a patient at night or over the weekend.
For the most part, her time away from her practice is her own.
Rosen said that the need for greater control in her schedule led her to the specialty. The former dental hygienist entered medical school when she was 31. She was married and had three children and needed a specialty that would allow her to raise them and spend time with her husband.
"Doing the rotations you do as a medical student, I was in the hospital a lot and gone a lot," Rosen said. "I had to look at some specialties where I could be home a little more."