physicians and hedge funds

[Eubulides <paraconsistent@xxxxxxxxxxx>]

U.S. Doctors, Stressed at Work, Escape to Hedge Funds, Business

July 23 (Bloomberg) -- Chip Skowron had visions of happily practicing and
teaching orthopedics after finishing the Yale School of Medicine with M.D.
and Ph.D. degrees in 1998. Then, he met what he calls the ``harsh''
reality of being a doctor.

It was during the long shifts of his hospital residency that Skowron
learned it would mean managing mounting paperwork, worrying about rising
malpractice premiums, being on call 24 hours a day and probably moving his
family frequently as a teaching physician. He left medicine in 2001,
joined hedge fund SAC Partners in New York, and has never looked back.

``There has to be some pretty substantial changes in medicine, and I don't
have any idea how these issues are going to be addressed,'' Skowron said.
``And that's very, very concerning to me.''

Across the U.S., in states such as California, New York, Florida and New
Jersey, physicians are trying to transform themselves into entrepreneurs,
small-business owners and investment managers to escape medicine's long
hours, income constraints and insurance costs.

``There is a sense of betrayal among these doctors --there's a feeling
that the bases have been moved on them,'' said Kurt Mosely, vice president
of business development at Merritt, Hawkins & Associates, a Dallas-based
physician search firm. ``We're seeing a lot of physician departures.''

Defections to other professions or to specialties with lower insurance
premiums, such as family practice and dermatology, are creating shortages
of brain surgeons and obstetricians in some U.S. communities, American
Medical Association President Donald Palmisano said in an interview.

Survey Results

A medical association survey of 4,846 doctors found that 7.3 percent in
specialties where malpractice premiums top $100,000 a year stopped
providing patient care from 2000 to 2002.

Two years ago, David Edelson gave up a six-year-old internal medicine
practice, its long hours and high stress to open a health spa and
weight-loss management business on Long Island.

``I was seeing 40 patients a day, and I was about as miserable as one
could be,'' said Edelson, 46, president of HealthBridge LLC in Manhasset,
New York.

``It's been a lot of work, but I'm much happier,'' Edelson said. ``I've
really reinvented my practice.''

Almost 40 percent of obstetrician-gynecologists working in 12
high-malpractice-premium states -- including Florida, New York,
Pennsylvania and Texas -- don't deliver babies anymore, according to a
Merritt Hawkins survey released this year.

Obstetricians are particularly vulnerable to lawsuits and are among the
specialists who have seen the sharpest rise in malpractice premiums,
insurers say.

Obstetrics Decline

While the number of U.S. internists and pediatricians rose from 1999 to
2001, the number of obstetrician-gynecologists and of anesthesiologists
declined, according to the U.S. Bureau of Labor Statistics. The number of
surgeons, a higher-risk specialty, was little changed.

Apart from surveys, industry groups don't keep statistics on members who
stop practicing or move out of specialties.

In New Jersey, the number of practicing neurosurgeons has dropped to 68
today from 89 in 1994, according to a survey by Peter Carmel, chairman of
New Jersey Medical School's neurological surgery department. Sussex
County, with 144,000 residents, has no neurosurgeons, Carmel said.

Northern Florida has one pediatric neurosurgeon, said Yank Coble, who
preceded Palmisano as president of the American Medical Association.

``That's dangerous,'' said Coble, a practicing endocrinologist in
Jacksonville, Florida. ``When specialists stop doing what they're doing,
it takes a long time to replace them.''

Career Consulting

Stephen Rosen, a career consultant, said inquiries to his office from
doctors seeking a change have doubled to about 20 a week from two years
ago.

``They're saying, `I'm doing what my parents wanted me to and I'm making
$400,000 or $500,000 a year and I can't stand what I'm doing,''' said
Rosen, chairman of New York City-based Celia Paul Associates Inc.

Some of Skowron's Wall Street colleagues never pursued the life of a
practicing physician, deciding soon after obtaining their doctor's degree
to work in finance instead. Among them are Kris Jenner, head of T. Rowe
Price Group Inc.'s Health Sciences Fund; Keith Vendola, a member of Banc
of America Securities LLC's health-care investment banking team; and
Thomas McGahren, vice president of technology research at Merrill Lynch &
Co.

Administrative Burdens

Skowron said that during his residency, senior doctors complained about
administrative burdens, declining pay and the strain of paying insurance
premiums.

``My current job allows me to look at the newest developments in oncology
and to translate that into investment opportunities,'' said Skowron, who
now manages health-care investments at Greenwich, Connecticut-based
FrontPoint Partners LLC, another hedge fund.

Long hours are a common complaint among physicians.

Almost one-third of all doctors worked at least 60 hours a week in 2000,
according to federal estimates. By comparison, production workers in
December 2000 averaged 34 hours on the job.

The demands of work are heavy in the final years of training, as doctors
complete three to five years as a hospital resident. This month, the group
that accredits residency training programs, the Accreditation Council for
Graduate Medical Education, for the first time set a limit -- 80 hours --
on residents' work week.

A Merritt Hawkins survey this year of 325 medical residents showed that 24
percent wouldn't want to study medicine if they could make the choice
again, up from 5 percent in 2001.

Doctors have been among the most highly paid U.S. workers, even as incomes
for some declines. The average physician salary was $130,000 in 1990, rose
to $141,000 in 1993 and fell back to $132,000 by 2000, according to the
American Medical Association. Government statistics show that
obstetrician-gynecologists' average salary dropped to $133,430 in 2001
from $135,430 in 1999.

Surgeons' average income rose 1 percent to $137,040 in 2001 from $135,600
in 1999, federal estimates show.

Leopoldo Alonzo, a Los Angeles gynecologist, started thinking about
changing careers when health plans cut his fee in the late 1990s for a
complex vaginal repositioning procedure to $600 from as much as $3,000.

Marcus Welby Image

He says putting in 80-hour workweeks and paying $100,000 a year for
malpractice insurance contributed to his dissatisfaction, even while
making $300,000 a year.

``That Marcus Welby image of a doctor is gone,'' Alonzo said, referring to
the 1970s television drama starring Robert Young.

Alonzo, 36 and married with two children, closed his practice in 1998, got
a master's degree in business administration and started a company that
makes patient- scheduling software.

``When clients say that they save money, that makes us feel good,'' he
said. ``That's the kind of role I like doing in medicine.''

Steven Meyer, a former eye surgeon in South Bend, Indiana, is among those
who gave up medicine for a higher-paying job.

``I was finishing up a surgery two years ago and the anesthesiologist told
me what he was able to charge -- a hundred bucks or something like that --
and I just remembered that his fee was less than what a plumber charged me
for putting a new toilet in my house,'' said Meyer, now president of
Payday Advance Plus Inc., a cash-advance service in Los Angeles.

Added Degrees

``People have to derive some satisfaction other than something financial
to go into health care,'' said Howard Forman, a radiology professor and
director of Yale University's joint M.D.-Master of Business Administration
program.

In the last decade, the number of university programs offering joint
M.D.-M.B.A. degrees rose to 38 from six, Forman said.

To the AMA and many doctors, the single most burdensome element of the
physician's job is paying malpractice insurance.

The average premium in 2002 was $12,177 for an internist, $36,354 for a
general surgeon and $56,546 for an obstetrician- gynecologist, according
to Medical Liability Monitor, a Chicago- based newsletter.

The median medical malpractice jury award in 2001 was $1 million, up from
$700,000 in 1999, the institute estimates. In 2001, more than $21 billion
in medical malpractice insurance was purchased, double the amount 10 years
ago, the institute says.

Cutting Costs

According to the AMA survey, 42 percent of specialists in such high-risk
areas as emergency medicine, obstetrics and surgery began referring
complex cases to other doctors to cut their malpractice costs.

Stuart Pomper, a Staten Island, New York, vascular surgeon whose premiums
have risen to $65,000 from $45,000 since 2000, said he wants to start a
vein-treatment center and do less surgery in the next year.

``I don't fix other doctors' complicated problems anymore,'' said Pomper,
who has been sued by patients. ``Whether the lawsuit is meritorious or
not, there's a high level of stress that comes with it.''

Efforts by the AMA and President George W. Bush to hold down medical
malpractice insurance costs by limiting jury awards to injured patients
have failed in Congress. The Senate on July 9 voted 49-48 to block
legislation that would have capped awards for pain and suffering at
$250,000, unless states set their own limits. The bill didn't limit
compensation for economic losses.

Trial Lawyers

Democrats who voted no said the bill didn't ensure that malpractice
premiums will drop; some accused insurers of price gouging. Trial lawyers
opposed the measure.

Harvey Schneier, senior director of internal medicine at drugmaker Forest
Laboratories Inc., who practiced internal medicine at Columbia
Presbyterian Medical Center in New York for 20 years until 1993, said
today's medical students may never be their own boss again.

``The things I loved about practicing medicine became not financially
justifiable under the managed care system,'' Schneier said. ``We lost
prestige, social standing and income, and the profession will never be
what it was before.''




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originality. There aren't any. [Les Paul]